Hand kinematics in osteoarthritis patients while performing functional activities.

PURPOSE

To identify the impact of kinematic limitations on hand osteoarthritis patients' ability to perform daily living activities.

METHODS

An experiment was performed on 33 patients and 32 healthy subjects. Active ranges of motion (AROM) of 16 hand joint angles were measured, together with scores of different hand tests of dexterity (Box and Block, Nine Hole Peg, Kapandji) and function (Sollerman Hand Function Test, SHFT). Functional ranges of motion (FROM) were recorded during SHFT tasks. Results by task are also reported.

RESULTS

Patients' AROM is limited in flexion of thumb carpometacarpal and interphalangeal, and finger metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints, and in palmar arch. Patients scored worse in gross dexterity and opposition, but only Kapandji score was correlated with AROM limitations. Pain is mostly reported in patients with limited extension of finger MCP and PIP joints. Patients used significantly different FROM in almost all the joints, and needed more time to accomplish the SHFT tasks.

CONCLUSIONS

AROM measurements can be used as indicators for early diagnosis. Patients use specific strategies to accomplish each task, arising from AROM limitations; some tasks with very extreme postures. The tasks where precision or force are required for thumb are the most affected ones.Implications for rehabilitationActive range of motion is an indicator for early hand osteoarthritis diagnosis.Patients' functional ranges are reduced, and thumb opposition and gross dexterity are hindered.Rehabilitation should focus especially on tasks requiring precision and thumb strength.Rehabilitation should favor the improvement of task completion times.