Comprehensive Guide for Occupational Therapists, Physical Therapists and Hand Therapists: Treating CMC Arthritis in the Clinic

Baytide Health
Jun 22
3 min read

Comprehensive Guide for Occupational Therapists, Physical Therapists and Hand Therapists: Treating CMC Arthritis in the Clinic

CMC arthritis can be a frustrating and limiting condition for patients, but as occupational and hand therapists, we have the tools to help them maintain function, reduce pain, and improve quality of life. This guide covers everything from muscle strengthening to splint fabrication so you can provide the best care for your patients.

Understanding the Key Muscles

When treating CMC arthritis, targeting the right muscle groups is essential:

Abductor Pollicis Longus (APL) & Abductor Pollicis Brevis (APB): Strengthening these muscles helps improve thumb stability and reduce stress on the CMC joint.
First Dorsal Interosseous (FDI): Releasing tension in this muscle can improve thumb positioning and function. You will notice on many of these patients their thumb is adducted and they have limited ability to open their thumb wide for grip, placing excessive load on CMC. Working on their FDI can be a game changer and a significant form of pain relief.
Flexor Pollicis Longus (FPL) & Extensor Pollicis Longus (EPL): Strengthening extrinsic flexors and extensors helps balance forces around the joint. You can also start to incorporate wrist muscles, specifically the extensors to help improve stability and functional grip (any time we lift or grip our wrist will naturally move into slight extension- tenodesis!)

Strengthening Exercises for CMC Arthritis

Focus on exercises that activate key stabilizers while minimizing stress on the joint:

Thumb Abduction with Resistance Band or Rubber Band: Strengthens APL and APB.
Isometric Pinch Holds: Improves endurance without excessive joint compression. Make sure to be critical of thumb position. We want a slight arch in the thumb with no CMC collapse.
Thumb Opposition Exercises: Enhances coordination between intrinsic and extrinsic muscles.
Wrist Extension and Radial Deviation Strengthening: Helps support the thumb and wrist and improve functional gripping
Eccentric Thumb Strengthening: Slowly control movements to improve joint stability.

Releasing the First Dorsal Interosseous

The FDI often compensates for weakened thumb stabilizers, leading to excessive tightness. Techniques to address this include:

Soft Tissue Mobilization: Using gentle massage to release tension.
Trigger Point Release: Applying sustained pressure to sensitive areas.
Stretching Techniques: Passive stretching to improve thumb mobility.
Dry Needling: If certified in dry needling this can be a great tool to help release this muscle and provide significant pain relief.

Adaptive Tools for Functional Independence

Providing patients with ergonomic solutions helps reduce strain on the CMC joint:

Built-up handles: Reduces gripping force needed for writing and utensil use.
Jar openers and button hooks: Minimize strain during daily tasks.
Ergonomic scissors and kitchen tools: Promote proper grip mechanics.

Splint Fabrication for CMC Arthritis

Custom splinting is one of the most effective ways to manage symptoms. Key splint types include:

Short Opponens (Thumb Spica) Splint: Provides CMC stabilization while allowing function.
Long Opponens Splint: Offers additional wrist support when needed.
Soft Compression Wraps: Helps reduce swelling and provide mild support.

Home Exercise Program

Ensuring patients continue their progress at home is essential. Recommended exercises include:

Thumb web space stretching to maintain mobility.
Isometric thumb stabilization exercises for daily strengthening.
Grip and pinch retraining using putty or soft resistance tools.
Wrist strengthening- such as flexion, extension, radial/ulnar deviation, supination and pronations. As they progress they can start to hold a small 1lb weight while they do them.

CMC arthritis doesn’t have to mean the end of function for your patients. By incorporating strengthening, soft tissue release, adaptive tools, splinting, and a solid home program, you can help them manage their condition effectively. Strongly educate your patients on the importance of positioning and working smarter, not harder with adaptive tools. Their arthritis is not going to change but their mechanics can drastically decrease their pain and improve their function! Education is one of the most valuable things you can offer them for long term success.

At Baytide Health, we’re here to support both therapists and patients in achieving optimal outcomes. If you have questions or want to collaborate, reach out—we love nerding out about hand therapy!