31 janeiro, 2012

Mobilization technique decreases pain in patients with thumb carpometacarpal osteoarthritis

MedWire News: Results of a randomized controlled trial suggest that a mobilization technique applied to the thumb could be used to reduce pain in elderly patients with thumb carpometacarpal osteoarthritis (TCOA).

Jorge Villafañe (Rey Juan Carlos University, Madrid, Spain) and colleagues explain that osteoarthritis frequently develops at the trapeziometacarpal joint (TMJ), often as a result of athletic injury or cumulative trauma associated with an arduous occupation or hobby.

In this study, they evaluated the effects of Maitland's passive accessory mobilization on local hypoalgesia and strength in elderly patients with TCOA.

Twenty-eight patients, aged 70-90 years, with TCOA in the dominant hand were recruited and randomly assigned to receive a mobilization or sham intervention. The treatment was delivered in four sessions distributed over 2 weeks.

The mobilization technique was performed for 3 minutes and then repeated three times, with a 1-minute rest between repetitions. Approximately 60 oscillations per minute were performed.

Because the TMJ is the most affected joint during TCOA, Villafañe and team measured pressure pain threshold (PPT) at the TMJ and in the bones linked to it - the tubercle of the scaphoid bone and the unciform apophysis of the hamate bone - before and after treatment, as well as 1 and 2 weeks post-treatment. The tip and tripod pinch and grip strengths were also measured at these time points.

As reported in the Journal of Manipulative and Physiological Therapies, all values remained unchanged during the treatment period in the sham group.

In the mobilization group, the PPT in the TMJ increased from 3.85 kg/cm2 before treatment to 3.99 kg/cm2 directly after treatment. This significant increase was maintained at both the 1- (3.94 kg/m2 ) and 2-week (4.74 kg/cm2 ) follow ups.

There were no significant increases in PPT after treatment for any of the other structures assessed. Furthermore, tip, tripod pinch, and grip strength showed no significant change after treatment.

"Although we found significant effects in our study, at the moment, we lack the information necessary to explain the mechanism involved," write Villafañe et al.

They add: "Because PPT was statistically significant at the TMJ but not at the scaphoid bone and the hamate bone, it is essential that future studies investigate whether the passive accessory mobilization technique has more influence when used to treat a particular anatomical area."

By Nikki Withers

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