Hypoalgesic and motor effects of Kaltenborn mobilization on elderly patients with secondary thumb carpometacarpal osteoarthritis

INTERVENTION: Kaltenborn?s mobilization technique: In brief, Kaltenborn described these mechanics in terms of the convex‐concave rule. The direction of decreased joint gliding in a hypomobile joint and thus the appropriate treatment can be deduced by this rule. With movement of a concave joint partner, the glide occurs in the same direction. The form of the joint surface has been considered to induce its gliding/sliding movement; a female (concave) joint surface glides in the same direction as the bone movement while a male (convex) surface glides in the opposite direction of the bone movement. Traction is the technique that distracts one articular surface perpendicular to the other, and the glide technique describes the translational gliding of one articular surface parallel to the other. 1. We used the specific Kaltenborn mobilization of posterior‐anterior gliding with distraction of the carpometacarpal (CMC) joint 2. The Convex/Concave Rule was applied in each case 3. The subject is seated with his arm in the anatomic position, the elbow at 90° flexion, and the forearm and hand with the cubital face downwards and the dorsal face against the body of the physiotherapist 4. The physiotherapist takes the right thumb metacarpal bone of the subject with his right thumb and index finger and makes a specific Kaltenborn?s mobilization of posterior‐anterior gliding of a short amplitude with distraction of the CMC joint for 3 minutes with a 1 minute pause. The action is repeated three times. 5. The physiotherapist distracts the joint retracting from the thumb and glides the first metacarpal bone in a posterior‐anterior orientation 6. In the posterior‐anterior gliding movement of the first metacarpal bone, the head and body must slide in the same way because the articular surface of the trapezium is convex and the surface of the first metacarpal bone is concave 7. The gliding movement respects the rule of convexity‐concavity of the joint Placebo technique: 1. Participants in the plac CONDITION: Carpometacarpal osteoarthritis ; Musculoskeletal Diseases ; Arthrosis of first carpometacarpal joint SECONDARY OUTCOME: No secondary outcome measures INCLUSION CRITERIA: Patients who used the dominant hand systematically such as ex‐factory workers and home workers, and were diagnosed with secondary carpometacarpal osteoarthritis in the dominant hand by X‐ray detection of stage III and IV according to the Eaton‐Littler‐Burton Classification PRIMARY OUTCOME: 1. Pain measurement ; 1.1. Pressure pain threshold (PPT) was measured by using a mechanical pressure algometer (Wagner Instruments, Greenwich, Connecticut, USA) with a 1cm2 rubber tipped plunger mounted on a force transducer; 1.2. The PPT is defined as the minimum amount of pressure that results in the sense of pressure changing to pain; 1.3. The mean of three measurements (intra‐examiner reliability) was calculated and used for the main analysis; 1.4. The range of values of the pressure algometer was 0 to 10 kg, with a minimal sensibility of 0.1 kg; 1.5. For these specific cases, the algometry has higher reliability (Intra‐class correlation coefficient [ICC]=0.91, Interval confidence [IC] del 95%: 0.82‐0.97) for PPT measurement in older patients; 1.6. In addition, previous studies have reported an intra‐examiner reliability for this procedure ranging from 0.6 to 0.97, and the inter‐examiner reliability ranged from 0.4 to 0.98; 1.7. PPT measurements were collected at both thecarpometacarpal (CMC) joint at the bottom of the anatomical snuffbox and tubercle of the scaphoid bone; 2. Strength measurements:; 2.1. Pinch strength:; 2.1.1. The pinch strength was measured by a mechanical pinch gauge (Baseline, NY, USA) while the patient was in the sitting position with the shoulder adducted and neutrally rotated and the elbow flexed at 90°; 2.1.2. Two different measurements were taken: first, the tip pinch between the index finger and thumb and, then, the tripod pinch between the index and medial fingers and the thumb 2.1.3. The reliability of this procedure to measure the pinch strength has been found to be on the order of 0.93; 2.2. Grip strength measurements:; 2.2.1. Grip strength measurements were taken with a grip dynamometer (Baseline, NY, USA) while the patient was also in the sitting position, which has a precision and reliability of ± 3% for grip strength measurements; 2.2.2. The reliability of the measurements was expressed by ICC between 0.82 and 0.97 for grip strength measurements