Effect of Thumb Joint Mobilization on Pressure Pain Threshold in Elderly Patients with Thumb Carpometacarpal Osteoarthritis

The Effectiveness of a Manual Therapy and Exercise Protocol in Patients With Thumb Carpometacarpal Osteoarthritis: A Randomized Controlled Trial

“…A larger sample size might have detected significant changes in PPT between groups. Previous studies examining the effects of either joint mobilization [49][50][51] or nerve mobilization 49,51 in this same population have found a difference between groups for PPT measurements. However, in these studies, the differences in PPT did not exceed the SEM and thus were within measurement error and likely not clinically meaningful.…”

“…Typical physical therapy management strategies for this population include manual therapy and exercise. Manual therapy interventions for this population include both joint [49][50][51] and neurodynamic mobilization techniques. 48,52 Recently published randomized controlled clinical trials 49,51 have demonstrated that 4 to 6 sessions of joint mobilizations over a 2-week period resulted in significantly greater improvements in pressure pain thresholds (PPTs) measured over the first CMC joint and scaphoid bone than a sham intervention (nontherapeutic ultrasound).…”

Hand Osteoarthritis: An Update on Therapy

“…10 In a double-blind RCT, Maitland's passive accessory mobilization of the thumb led to increased pain pressure threshold in the trapeziometacarpal (TM) joint, but did not improve tip, tripod pinch, or grip strength. 12 A combination of joint mobilization, neural mobilization, and exercise was shown to improve pain levels after two months of treatment in patients with hand OA, but it had limited effect on improving pressure pain thresholds, as well as pinch and grip strengths. 13 A number of guidelines recommend splinting for base-of-thumb OA, yet no evidence of efficacy exists.…”

“…20 Within balneotherapy, the use of sulphurous spa water alone was shown to be more effective than that of warm tap water exclusively in the reduction of pain in patients with hand OA. 21 Another Radial nerve mobilization 10,11 Arnica gel 30 Metacarpal osteotomy 45 Maitland's passive accessory mobilization 12 Topical analgesic + paraffin bath therapy 31 Carpometacarpal arthrodesis 45 Joint mobilization + neural mobilization + exercise 13 Intraarticular corticosteroid injections [32][33][34][35] Joint replacement 45 Custom-made splinting 17,18 Intraarticular hyaluronic acid injections 36 single-blind RCT showed that paraffin bath therapy in patients with bilateral hand OA was successful in reducing stiffness and pain at rest and during activities of daily living. As well, range of motion was enhanced in one hand, and muscle strength was better maintained as compared to the control group.…”

Botulinum toxin type A combined with neurodynamic mobilization for upper limb spasticity after stroke: a case report

“…19,20 However, other types of sliding mobilizations that were successful in other pathologies may not have the same results. 28,29 About the effects of NM on pain and spasticity, some neurophysiological mechanisms can be used to explain them. For instance, it is suggested that NM stimulates the periaqueductal gray matter in a key area in the descending and ascending control of nociception.…”