From the Guidelines
For synovitis of the 1st MCP joint and sprain of the ulnar collateral ligament (UCL) of the 1st MCP joint, I recommend a progressive exercise program focusing on gentle range of motion, strengthening, and stability, as supported by the 2019 EULAR recommendations for the management of hand osteoarthritis 1.
Exercise Program
The program should begin with pain-free passive range of motion exercises 3-4 times daily, gently flexing and extending the thumb without resistance. After the acute phase (typically 1-2 weeks), add active range of motion exercises, moving the thumb in all directions without assistance.
- Progress to light resistance exercises using therapy putty or a small rubber band for thumb opposition, abduction, and adduction, performing 10-15 repetitions, 2-3 sets daily.
- Include specific UCL strengthening by placing a rubber band around the thumb and index finger and moving them apart against resistance.
- Incorporate functional pinch and grip exercises with gradually increasing resistance as pain allows.
Flexibility Exercises
As recommended in the 2018 EULAR guidelines for physical activity in people with inflammatory arthritis and osteoarthritis 1, flexibility exercises should be performed:
- At a frequency of ≥2–3 days/week, with daily exercise providing the greatest gains in joint range of motion.
- With an intensity that stretches to the point of feeling tightness or slight discomfort.
- Holding a static stretch for 10–30 seconds, with older persons potentially benefiting from 30–60 seconds.
- Using a series of flexibility exercises for each of the major muscle–tendon units, including static flexibility, dynamic flexibility, ballistic flexibility, and PNF stretching.
Additional Considerations
Throughout rehabilitation, maintain proper joint alignment and avoid positions that stress the UCL, particularly forceful abduction of the thumb. Apply ice for 10-15 minutes after exercises to manage inflammation. This program helps reduce synovial inflammation, promotes healing of the ligament, and restores strength and stability to the joint while preventing stiffness that can occur with immobilization.
From the Research
Synovitis of 1st MCP Joint and Sprain of Ulnar Collateral Ligament of 1st MCP Joint
- Synovitis of the 1st MCP joint and sprain of the ulnar collateral ligament of the 1st MCP joint are conditions that require accurate diagnosis and prompt treatment to prevent loss of function 2.
- The ulnar collateral ligament of the first MCP joint is a common site for injury, often referred to as a gamekeeper's injury or skier's thumb 3, 4.
Exercises for Ulnar Collateral Ligament Injuries
- For low- to medium-grade partial UCL tears, a period of rest and a graduated throwing program may be recommended 5.
- Nonoperative management of a low-grade partial UCL tear can allow athletes to return to competitive throwing in 3 to 4 months 5.
- For acute partial UCL injuries, nonoperative treatment can be successful, while acute complete or displaced UCL injuries may require operative repair 3.
- In cases of chronic UCL injury, treatment options include static and dynamic reconstructions, and salvage may be performed with MCPJ fusion if painful arthrosis is present 3.
Importance of Accurate Diagnosis
- Accurate diagnosis of UCL injuries is crucial to determine the appropriate treatment plan 2, 3, 4.
- Valgus stress testing can diagnose a complete UCL rupture, and operative treatment has been shown to produce excellent results in cases with complete UCL tears 4.
- Imaging studies, such as magnetic resonance imaging and magnetic resonance arthrography, can be useful in evaluating the severity of the injury and aiding in treatment planning 2.