Original Research
Bilateral Sensory Effects of Unilateral Passive Accessory Mobilization in Patients With Thumb Carpometacarpal Osteoarthritis

https://doi.org/10.1016/j.jmpt.2013.05.008Get rights and content

Abstract

Objective

The purpose of this study was to investigate changes in pressure sensitivity and pinch grip force in the nonsymptomatic side in patients with thumb carpometacarpal (CMC) osteoarthritis (OA) after the application of a unilateral passive accessory mobilization to the symptomatic hand.

Methods

Secondary analysis of data from a randomized trial with concealed allocation, blinded assessor, and intention-to-treat analysis was performed. Twenty-eight patients (72% females), with unilateral CMC OA and mean age ± SD of 82 ± 6 years, met all the inclusion criteria and agreed to participate. The experimental group received passive accessory mobilization to the CMC OA, and the control group received a nontherapeutic dose of intermittent ultrasound on the affected side for 4 sessions over 2 weeks. Outcome measures including pressure pain thresholds (PPTs) at the lateral epicondyle, thumb CMC joint, tubercle of the scaphoid bone, and the unciform apophysis of the hamate bone and tip and tripod pinch and grip strength of the contralateral/unaffected hand were assessed at baseline as well as 1 and 2 weeks after treatment by an assessor blinded to the group allocation. A repeated measures analysis of variance was used to determine changes in PPT and pinch and grip strength.

Results

No important baseline differences were observed between groups. At the end of the follow-up period, the experimental group exhibited a significant increase in PPT at the CMC joint as compared with the control group 0.6 kg/cm2 (95% confidence interval, 0.3-1.0; F3.0 = 4.89; P = .009). Although PPT changes in the experimental group were higher than the control group at the remaining sites, differences did not reach statistically significance. Similarly, tip, tripod pinch, and grip strength remained unchanged after the intervention.

Conclusion

This secondary analysis found that the application of a unilateral passive accessory mobilization targeted to the symptomatic CMC joint induced an increase of PPT levels 2 weeks after treatment; however, differences were small and likely of limited clinical value. No contralateral motor effects were observed. Future studies including larger sample sizes are needed to examine the effects of joint mobilization on motor and sensory effects.

Section snippets

Subjects

We performed a secondary analysis of data from a randomized controlled clinical trial.2 The methods and description of the trial have been previously described.2 The most relevant parts of the design are summarized below.

Subjects with dominant hand thumb CMC OA were recruited. The diagnosis was based on the patient's medical history and radiographic evidence of stage III and IV thumb CMC OA according to the Eaton-Littler-Burton Classification.18, 19 Inclusion criteria for this study were age

Flow of Participants Through the Study

Twenty-eight patients (72% females), with unilateral CMC OA and mean age ± SD of 82 ± 6 years, met all the inclusion criteria and agreed to participate (Fig 1). No significant differences in any outcome were found at baseline between groups. Baseline data of the participants are summarized in Table 1.

Changes in Mechanical Pain Sensitivity

The intraexaminer repeatability of PPTs over the contralateral lateral epicondyle, thumb CMC joint, scaphoid, and hamate bones was 0.93, 0.95, 0.78, and 0.89, respectively. The SEM was 0.44, 0.29,

Discussion

This secondary analysis found that the application of a unilateral passive accessory mobilization intervention targeted to the symptomatic thumb CMC joint in individuals with thumb CMC OA resulted in limited hypoalgesic effects over the contralateral CMC only at the 4-week follow-up period. No differences were noted for PPT level over the contralateral lateral epicondyle, the tubercle of the scaphoid bone, and the unciform apophysis of the hamate. Therefore, it is likely that joint mobilization

Conclusions

The findings of this secondary analysis showed that the application of a unilateral passive accessory mobilization intervention targeting the symptomatic thumb CMC joint in patients with thumb CMC OA resulted in limited hypoalgesic effects over the contralateral CMC joint at 2 weeks after the intervention. No changes were observed for PPT levels over the lateral epicondyle, the tubercle of the scaphoid bone, and the unciform apophysis of the hamate. No motor effects were associated with the

Funding Sources and Potential Conflicts of Interest

No funding sources or conflicts of interest were reported for this study.

References (29)

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