Osteoarthritis in the basal joint at the wrist and base of the thumb can require a surgical procedure called arthroplasty. After an arthroplasty, your doctor can suggest physical therapy exercises to help regain strength and mobility in your thumb. The July 2003 issue of the “Journal of Orthopaedic and Sports Therapy” recommends that patients complete passive and active range-of-motion exercises following a basal joint arthroplasty. Complete exercises only under the supervision of your doctor or physical therapist.
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Osteoarthritis and Arthroplasty
Osteoarthritis results when cartilage that cushions the bones wears away -- allowing the bones to rub together. This joint-related arthritis can cause pain, stiffness, swelling and a lack of mobility in your thumb and wrist. For severe cases of osteoarthritis, a doctor can recommend an arthroplasty procedure to help reduce pain and improve mobility in the basal joint.
Arthroplasty replaces or reconstructs part of the basal joint, using tendons from you or a donor. After an arthoplasty, physical therapy can help you regain strength and mobility in her hand. Exercises that improve basal joint mobility include thumb abductions involving the abductor muscles, flexions using the flexor muscles and extensions utilizing the extensor muscles in your hand.
During the first weeks following a basal joint arthroplasty, physical therapy includes active range-of-motion exercises on the fingers not immobilized by a cast. One such exercise, an active finger flexion, entails slowly straightening and bending each unaffected finger.
Weeks four through seven -- after cast removal -- might include activities involving all the joints of your wrist and hand. However, your doctor might recommend performing only passive abduction and extension exercises on the carpometacarpal joint. A therapist completes a passive thumb abduction by placing her thumb and index finger between your thumb and index finger, and stretching your fingers apart.
In addition, you might execute an active wrist flexion by interlocking the fingers on both hands -- with your affected thumb on top -- and carefully bending the wrist forward and backward with your unaffected hand. Your doctor will determine the exercise durations and frequencies.
Physical therapy exercises for postoperative basal joint arthroplasty from eight to 11 weeks generally include active thumb abductions, oppositions, extensions and circumductions. Active thumb abductions involve moving the affected thumb down -- away from the palm -- and then back to touch the index finger. A physical therapist might also increase movement in your carpometacarpal joint by having you complete a thumb extension, which involves placing your palm facedown on a table and lifting you thumb up for 10 seconds before lowering it.
A thumb opposition exercise entails moving the affected thumb to touch the tip of the little finger. You might also complete circular exercises to increase range-of-motion in your thumb joint. One such activity involves placing your fingers in a forward position and making circles with your thumb. The physical therapist might suggest completing 10 repetitions of this exercise.
Physical therapy activities for weeks 12 through 24 include the continuation of abductions that strengthen the muscles at the base of your thumb and lateral pinches. You might actively carry out thumb abductions by placing your unaffected thumb and index finger between the same digits on your affected hand and stretching them apart.
Lateral pinch exercises, also called key pinches, involve grasping an object, such as a flat key, with the affected thumb pressed against the middle bone of the index finger. You gradually progresses from moderate functional activities to optimal functioning by week 24. However, final exercise recommendations may vary according to your progress.