Exercise for the patient with upper quadrant osteoarthritis

Effect of home-based hand exercises in women with hand osteoarthritis: a randomised controlled trial

“…Furthermore, excessive exercises to reach full flexion and opposition of the thumb, as well as improving pinch or key grip strength, may result in increased subluxation and pain in unstable joints 4 5 28 29…”

Development of an evidence-based exercise programme for people with hand osteoarthritis

“…According to the literature, exercises in HOA are aimed at maximizing a stable and pain-free functional ROM of the finger joints, increasing functional strength, maintaining joint stability, and preventing or delaying the development of fixed deformities (29)(30)(31)(32)(33)(34).…”

“…As it is well known that hand injuries or diseases may lead to muscle atrophy and restriction of movement in the elbow and shoulder (37), exercises for the shoulder girdle and upper arm may also be an important part of an exercise programme for HOA. It is suggested that the deforming force of the CMC1 joint is the strong pull from the adductor pollicis muscle combined with an increasing weakness of the opposing thenar intrinsic musculature (30)(31)(32)(33)(34). Hence, in order to maintain the first web space, avoid adduction deformity, and improve thumb stability, it is recommended to strengthen the thumb extensors and abductors as well as the wrist extensor muscles.…”

“…Hence, in order to maintain the first web space, avoid adduction deformity, and improve thumb stability, it is recommended to strengthen the thumb extensors and abductors as well as the wrist extensor muscles. Many authors further claim that excessive exercises to improve pinch or key grip strength should be avoided, as these, especially in later phases of CMC1 OA, may result in increased subluxation and pain in instable joints (31)(32)(33)(34). Concern is also expressed regarding exercises aimed at reaching full flexion and opposition of the thumb, since the motion gained by this exercise may be of no functional benefit to the patient if the increased ROM results in a painful motion (34).…”

“…It is often stated that exercises for people with HOA should be of low intensity, be performed in periods with little pain and inflammation, and not cause pain that persists for more than two hours after the activity (30,31,34). Nonetheless, it has been argued that for people with OA, a pain score of 5 on a scale from 0 to 10 (0 = no pain) is acceptable immediately after training and that the pain should be back to a basic level after 24 hours (38).…”