Functional task kinematics of the thumb carpometacarpal joint

Abstract

Background: Abnormal biomechanical loading has been identified as an associated risk factor of osteoarthritis in the wrist and hand. Empirical data to date are insufficient to describe the role of altered biomechanics in thumb carpometacarpal (CMC) arthritis.

Questions/purposes: This is a pilot study to evaluate motion analysis of the upper extremity while performing functional tasks. We wished to describe the in vivo kinematics of the thumb and hand in relation to the larger joints of the upper extremity in subjects without arthritis in functional positions at rest and while loading the CMC joint. If reproducible, we then planned to compare kinematics between these subjects and a subject with advanced thumb CMC arthritis.

Methods: In vivo kinematics of the hand and upper extremity during the functional tasks of grasp, jar opening, and pinch with and without loading of the CMC joint were evaluated using cameras and a motion-capture system in four asymptomatic female subjects and one female subject with advanced radiographic (Eaton Stage IV) osteoarthritis.

Results: Kinematics of the hand and upper extremity can be reliably quantified. Loading of the CMC joint did not alter the hand and forearm kinematics in control subjects. In the subject with osteoarthritis, the adduction-extension deformity at the CMC joint resulted in kinematic alterations as compared with the four control subjects.

Conclusions: This study represents preliminary steps in defining thumb CMC position, motion, and loading associated with activities of daily living. These findings enhance our understanding of motion at the CMC joint and how it differs in arthritic patients.

Level of evidence: Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

Fig. 1

This is a schematic of finger markers for motion analysis.

Fig. 2

These are the tasks performed by each subject using positioning jigs with embedded load cells.

Fig. 3

This is the motion analysis of a control subject’s thumb interphalangeal flexion during jar opening with force. This is an example of how control subjects demonstrated consistency throughout trials.

Fig. 4

This is a comparison of the adduction/abduction motion of the thumb of an arthritic versus control subject during jar opening. Our subject without arthritis had the ability to adduct the thumb during loading. As compared with control subjects, our subject with arthritis demonstrated the need for overall increased abduction of the thumb phalanges resulting from her CMC adduction deformity. She also demonstrated minimal motion as compared with the subject without arthritis once reaching final position and required increased time to completion of the task and returning to the resting position.