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Wednesday, July 18, 2012

Wednesday Q&A: Arthritis of the Thumbs

Q: I have arthritis of the thumbs. I'm told that it's fairly common in women "of a certain age." I wear thumb braces if I'm lifting or gripping for an extended time. It seldom affects my practice. But I have noticed that I don't have much hand strength. Do you have any suggestions for hand exercises?

Dear Thumbs,

Thanks for writing in about this. In my years as a Family MD and a medical acupuncturist, I have had the occasional patient with complaints of thumb pain at the joint where the wrist bones meets the thumb palm bone, known as the carpo-metacarpal joint. Sometimes there is swelling at the joint, and even redness to the skin and heat to touch. All these symptoms, as well as limited range of motion, decreased strength and pain with movement point to the probability of arthritis of the thumb. In fact, the thumb is the most common joint affected by arthritis in the hand. This is due in part because the thumb has greater mobility than the other fingers, and tends to be used a lot in daily activities, especially when grasping is involved.

There are multiple factors that can lead to the possible development of arthritis in the thumbs, including a history of injury or trauma, as well as arthritis in other major joints of the body. Additional risk factors for developing arthritis in your thumbs include being female (as you correctly noted), being over 40, having certain hereditary conditions (such as joint laxity or malformed joints), stressful activities for the hands or having rheumatoid arthritis.

As with other kinds of osteoarthritis, the normal covering at the ends of the bones, known as cartilage, ends up wearing down and exposing bone on bone movement, which results in swelling in the joint, and sometimes leads to overgrowth of new abnormal bone, called bone spurs.

As you have discovered, treatment can include special splints that limit range of motion and provide added stability for the joint. This often reduces pain quite a bit. In addition, western docs also prescribe anti-inflammatory medications, occasionally inject corticosteroid medication into the joint, and if the pain is severe enough, may recommend surgery.

According to the Mayo Clinic website, your doc or hand therapist can prescribe range of motion exercises that move your thumb through its full range of motion. This improves the joint’s mobility and may preserve the strength you have, but may not improve your hand strength. Unfortunately, since using the thumb more can cause the joint to become more inflamed, trying to strengthen the thumb can be a Catch-22. Other ways to quiet the pain down in the thumbs include using modified hand tools that limit thumb participation, using ice or heat as indicated by your symptoms, and avoid clenching your hands when you have to carry things. 

Kaiser Permanente had this link to exercises for thumb arthritis. In looking them over, it seems to me that these might also increase your strength, so you might want to get some personalized instructions from a physical therapist before starting such a program. And although I don’t know about how they might apply, there is a program called Finger Fitness developed by a musician in Cincinnati, Ohio (a town I once called home) named Gregg Irwin that I read about recently in the book Fooling Houdini by Alex Stone. I was interested in checking into it to increase my finger strength for playing all of my musical instruments, but it might be worth investigation on your part as well.

As far as yoga related practices, the yoga tradition has a practice involving the hands called “mudras,” which are used as meditation devices and could have some use in this setting. But you’d want to check around and talk to a teacher in your area who practices mudras in their practice and is comfortable teaching them to you. All the best in your search for improved hand strength!

—Baxter
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