Positive results at one year with exercise and splinting persisted for longer than five years.

Thumb carpometacarpal osteoarthritis is a common, frequently work-related, disability that is often managed in the short term with some combination of splinting, corticosteroid injection and exercise. In this Dutch study, researchers assessed the value of splinting and exercise as a longer-term approach by identifying 217 adults (mean age, 59 years) who had diagnoses of thumb carpometacarpal osteoarthritis from a hand surgeon and who were referred for hand therapy.

Participants received weekly instruction for six weeks on thumb strengthening, stretching and positioning for optimal function (the authors provide a helpful Appendix illustrating these exercises). They also were fitted with standard thumb orthoses.

Participants were assessed at baseline, three months, 12 months and more than five years with validated hand-function questionnaires. Forty-seven patients (22%) converted to surgical treatment during a median follow up of seven years, 70% within the first year. For the 170 patients who maintained nonsurgical therapy, various measures of pain, function, activities of daily living and satisfaction increased significantly from baseline to three and 12 months; these scores were maintained through at least five years. 

Comment: These results should encourage clinicians to advise patients to consider structured nonsurgical approaches for thumb carpometacarpal osteoarthritis as a long-term strategy. The functional results appear to hold for a prolonged time, and the voluntary conversion rate to surgery is fairly low.

Thomas L. Schwenk, MD, Professor Emeritus, Family and Community Medicine, University of Nevada School of Medicine, Reno, USA.

Esteban Lopez LMJ, et al. Long-term outcomes of nonsurgical treatment of thumb carpometacarpal osteoarthritis: a cohort study. J Bone Joint Surg Am 2023; 105: 1837-1845.

This summary is taken from the following Journal Watch titles: General Medicine, Ambulatory Medicine.