Original Article
Hypoalgesic and Motor Effects of Kaltenborn Mobilization on Elderly Patients with Secondary Thumb Carpometacarpal Osteoarthritis: A Randomized Controlled Trial

https://doi.org/10.1016/j.jmpt.2011.08.005Get rights and content

Abstract

Objective

This study evaluated the effects of Kaltenborn manual therapy on sensory and motor function in elderly patients with secondary carpometacarpal osteoarthritis (CMC OA).

Method

Twenty-nine female patients with secondary CMC OA (70-90 years old) were randomized into Kaltenborn manual therapy and sham groups. This study was designed as a double-blind, randomized controlled trial (RCT). Therapy consisted of Kaltenborn mobilization of posterior-anterior gliding with distraction in grade 3 of the carpometacarpal (CMC) joint of the dominant hand during 6 sessions over 2 weeks. Pain was measured by algometry, as the pressure pain threshold (PPT) at the CMC joint and tubercle of the scaphoid bone. The tip and tripod pinch strength was also measured. Grip strength was measured by a grip dynamometer. Measurements were taken before treatment and after 1 week (first follow-up [FU]) and 2 weeks (second FU).

Results

All values in the sham group remained unchanged during the treatment period. In the treated group, the PPT in the CMC joint was 2.98 ± 0.30 kg/cm2, which increased after treatment to 4.07 ± 0.53, and was maintained at the same level during the first FU (3.46 ± 0.31) and second FU (3.84 ± 0.36). Similarly, the PPT in the scaphoid bone was 3.61 ± 0.29 kg/cm2, which increased after treatment to 4.87 ± 0.37, and was maintained at the same level during the first FU (4.44 ± 0.43) and second FU (4.22 ± 0.32). In contrast, we found no differences in the tip, tripod pinch, and grip strength measurements between the treatment and sham groups.

Conclusions

This study showed that Kaltenborn manual therapy decreased pain in the CMC joint and scaphoid bone areas of elderly female patients; however, it did not confer an increase in motor function in patients with CMC OA.

Section snippets

Subjects

Twenty-nine subjects aged 70 to 90 years with secondary CMC OA in the dominant hand with clinical pathologic history of more than 10 years were recruited from the Department of Physical Therapy, “Residenze Sanitarie Assistenziali” (RR.SS.AA), which depends on Azienda Sanitaria Locale 3 (A.S.L 3), Collegno (Italy). Patients were randomly assigned into either a treated or a sham group. The baseline demographic characteristics of the population are listed in Table 1. Because the patients were

Results

Twenty-nine patients with CMC OA, aged 70 to 90 years (mean, 80.83 ± 7.44 years), were included in this study and assigned to 1 of 2 groups who received either Kaltenborn mobilization technique (n = 14) or sham (n = 15). All treated patients were females. Table 2 shows the flow diagram of subject progress through the study and the followed criteria. All subjects were right-hand dominant. No significant differences between the groups (P > .05) were found in key demographic variables and baseline

Discussion

Our findings show that the posterior-anterior gliding with distraction of the CMC joint technique significantly produced immediate hypoalgesic effects and increased strength that lasted for first week after treatment. This is the first report of the use of this mobilization technique for the treatment of CMC OA.

Conclusions

In conclusion, this study provided new evidence that accessory mobilization with distraction of the human osteoarthritic CMC joint has both an immediate local and a widespread hypoalgesic effects. Therefore, joint mobilization may be an effective means of reducing osteoarthritic pain and may potentially improve motor function.

Funding Sources and Potential Conflicts of Interest

This work was supported by personal funds of JHV and in part by a grant from the J. Robert Cade Foundation to GBS. No conflicts of interest were reported for this study.

Practical Applications

  • We found that Kaltenborn manual therapy decreases pain in the CMC joint and scaphoid bone with secondary CMC OA of the dominant hand.

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