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Practical exercises for thumb proprioception

Journal of Hand Therapy xxx (2020) 1e4
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Journal of Hand Therapy
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Practical exercises for thumb proprioception
Raquel Cantero-Téllez PhD, PT, OT *, Ivan Medina Porqueres PT, MSc
Faculty of Health Sciences, Physiotherapy Department, University of Malaga, 29010, Málaga, Spain
a r t i c l e i n f o
Article history:
Received 14 January 2020
Accepted 2 March 2020
Available online xxx
Thumb stability
Thumb proprioception
We need a sense of where our thumb is and how it is moving to
interact efficiently with our environment. Thumb movement is a
fundamental and essential component of human life. All the afferent
neural inputs originating from mechanoreceptors about the thumb
joints constitute thumb proprioception. This proprioceptive input
can be appreciated consciously as joint position sense and kinesthesia (joint movement sense) and force/application to the joints.1
Numerous studies have advocated that proprioception is crucial in
hand function and plays a critical role for accurate movement and
for preserving joint stability in shoulder, hip, knee, ankle, and wrist
joints.2-5 Although the role of thumb proprioception has yet not
been fully developed, the importance of neuromuscular control and
mechanoreceptors present in ligaments and tendons for muscle
action and thumb stability has been highlighted.6,7 Thumb mechanoreceptors detect abnormal mechanical stress and provide afferent
information on joint position and velocity.8,9 Proprioceptive exercise regimes have been widely used for treating different conditions
and are recognized as key components in the restoration of joint
control and joint function.10,11
Previous research has stressed the relevance of proprioception in
manual tasks when performing a variety of activities, such as
buttoning a shirt, picking up small items, writing, and lifting objects
with different weights.12 It has been established that the distribution
of mechanoreceptors corresponds to specific proprioceptive functions and the innervation of ligaments could differ among patients
with different pathologies.8 This fact could have repercussion on the
type of exercises and may be the objective for future research.
Based on previously described proprioception assessment
techniques,13-15 a thumb proprioceptive exercise protocol will be
determined to address impairments, dysfunction, and any imbalance to be corrected.
Thumb exercises based on proprioception assessment
Proprioception can be assessed using different methodologies.
There are three main testing techniques for assessing proprioception: Threshold to Detection of Passive Motion (TTDPM),15 Reproduction of Passive and Active Joint Position (RPJP and RAJP), also
known as joint position matching,13 and Active Movement Extent
Discrimination Assessment (AMEDA).14
Thumb exercises for Detection of Passive Motion (DPM)
* Corresponding author. Faculty of Health Sciences, Physiotherapy Department,
University of Malaga, 29010, Málaga, Spain. Tel./fax: þ34 952226453.
E-mail address: [email protected] (Raquel Cantero-Téllez).
Movement type: Passive (Fig. 1A and B).
Movement velocity: Very slow.
Proprioceptive information: Largely movement information.
Vision: Blocked.
0894-1130/$ e see front matter Ó 2020 Hanley & Belfus, an imprint of Elsevier Inc. All rights reserved.
R. Cantero-Téllez, I. Medina Porqueres / Journal of Hand Therapy xxx (2020) 1e4
Fig. 1. (A and B) Therapy passively reproduces flexion or extension movements in the desirable range of motion. The patient with eyes closed should tell whether the finger has
been moved into flexion (in this case represented with the number 1) or extension (number 2).
Fig. 2. The patient is asked to reproduce letters or numbers both in open and closed
kinetic chain patterns.
Fig. 4. (A and B) A tennis ball is used to ensure correct thumb position. An elastic band
will guide the movement and mark two different positions. Patient is asked to slide
his/her thumb along the line, stopping at position 1 and position 2. After 3 to 5 repetitions, the patient may repeat the exercise with eyes closed.
Objective: Patients should report the perceived direction of
movement of their thumb.
Fig. 3. The patient is asked to perform pinch force until the dynamometer reaches a
certain number. After 3 to 5 repetitions, the patient is asked to close their eyes and try
to reproduce the movement by doing the same pressure. This exercise can also be
performed with different types of clamp depending on the objective.
Thumb exercises for Reproduction of Passive and Active Joint
Position (RPJP and RAJP)
Movement type: Passive/active (Figs. 2, 3, 4A, and 4B, 5A-5C).
Movement velocity: Slow to normal.
Proprioceptive information: Depends on whether a physical
stop is used during target joint position establishment.
Vision: Blocked.
Objective: Patients should reproduce thumb movements. The
thumb is returned to the initial start position, either passively
by hand therapist or actively. Patients are then required to
reproduce the target thumb position previously experienced,
that is, he/she needs to remember the target position and
reproduce it.
R. Cantero-Téllez, I. Medina Porqueres / Journal of Hand Therapy xxx (2020) 1e4
Fig. 5. (A, B, and C) A stick marked with different numbered lines is used. The patient is asked to alternatively tip these marked points. Different wrist and elbow positions can be
used. Reproducing these maneuvers with eyes closed will increase the difficulty. (D) With a finger dynamometer attached to the thumb, the patient is asked to perform a specific
movement. Generated tension is then recorded. Subsequently, the patient is asked to reproduce the same tension in the same plane but with eyes closed. This action can be
accomplished at any thumb movement.
Objective: To allow proprioception assessment using “real-life”
Clinical implications
Fig. 6. (A and B) Several daily-life activities are used using different thickness,
strength, texture, or weight of objects. Patient should recognize the object: its shape,
its weight, or its texture>.
Thumb exercises for Active Movement Extent Discrimination
Assessment (AMEDA)
Movement type: Active (Fig. 6).
Movement velocity: Normal.
Proprioceptive information: Both movement and position
Vision: Available.
Clinically, reduced thumb proprioception can be found after
stroke, thumb carpometacarpal joint osteoarthritis, ligament injuries, or any condition affecting thumb mobility. Proprioception is
important for motor control and can be used in combination or in
the absence of other sensory systems. An optimal rehabilitation
must acknowledge the tasks the patient will assume in the future.
Proprioceptor exercises could help therapists improve motor
planning and patients' performance during task execution. With
intent of providing a common foundation for thumb proprioception
reeducation, a preliminary exercise regimen proposal is hereby
provided to the reader. Clinical studies are needed to investigate
the impact of proprioception loss on thumb and hand function, and
the effect of proprioception reeducation in patients and subjects
with a high demand on the thumb column in both preventing and
rehabilitating thumb conditions.
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