Thumbs up

Apr 28, 2006

Working with local orthopedists, a Kettering researcher helped test a treatment for the joint most likely to develop osteoarthritis, the uniquely opposable thumb.

The body part that sets us apart as human is also the most likely to develop osteoarthritis, according to Dr. Patrick Atkinson, associate professor of Mechanical Engineering at Kettering University.

"As the only opposable digit, it does about four times the amount of work as your fingers," he said. "We use it a lot, and because of that it wears out - it is that wearing out process we call osteoarthritis." Thumb arthritis affects women more often than men and surfaces around the age of 60, with about 92 percent of people over 70 affected, he added.

Thumb arthritis makes it difficult to do simple every-day tasks such as turn a doorknob or turn the ignition key in a car.

For patients who don't want surgery as their first option for treatment, there are cumbersome braces or methods for introducing steroids into the joint to reduce inflammation and reduce pain. The steroid treatments include injecting the steroid directly into the joint or using an ultrasonic vibration or electrical current to pass steroid cream through the skin into the joint.

Atkinson worked with Dr. A. George Dass M.D., an orthopedic surgeon specializing in hand surgery at Family Orthopedics in Flint, and Dr. Elizabeth Jain Ph.D., a bio-statistics expert at Wayne State University, to test the effectiveness of the non-surgical steroid treatments.

"We conducted a two-year, double-blind test of both non-surgical steroid cream techniques with 80 patients suffering from osteoarthritis of the thumb, including two control groups receiving placebo treatments," said Atkinson. As frequently happens with research, the results didn't identify the treatments as miracle cures.

"Symptoms were documented before and after treatment and we found no statistically significant difference between the test patients and the control patients," Atkinson said. What this means for thumb arthritis sufferers is that their doctor is probably not going to recommend a course of treatment that doesn't work, he explained. The treatments, used worldwide, had never been tested in relationship to thumb arthritis but had mixed results when used to treat tennis elbow, Atkinson said.

But just because steroid creams don't work doesn't mean patients can't find relief. Injecting steroids into the joint can provide temporary relief, and using a rigid brace has proven effective, but requires constant use. This constant use raises hygiene problems and limits motion, according to Atkinson. Oral anti-inflammatory medication can provide some relief, but upsets many older patients' stomachs and digestive tracts.

So what REALLY works? Surgery. "There has been excellent success with a relatively minor surgical procedure," said Atkinson. "It solves the problem completely in nearly all the patients that undergo the procedure," he added.

Atkinson and Jain designed the research project to study patients in the Flint area and interpreted the data following the physical testing.

Written by Dawn Hibbard