The most prevalent area of arthritis of any joint in the body is the 1st CMC joint which occurs at the base of the thumb.

This joint is unique in that it is a saddle joint. One side is a dome and the other side is shaped like a U that fits on the dome. This allows the thumb to bend forward and backward as well as slide side to side. The term apposable thumb is derived from this motion. However because of this wide range of movement and how often we use our thumbs it leads to more wear and tear on the joint than any other joint in the human body leading physical therapists to study hand therapy techniques.

The primary use of the thumb is to squeeze in and across the palm of the hands and fingers for gripping and pinching. The muscle needed for that is located in the meaty base of the thumb called the thenar eminence or the web space between the thumb and first finger. The thumb joint is also looser as you move towards your palm to allow for more dexterity. Years of use will wear down the joint and these muscles become shorter and stronger we will get pain in the base of the thumb as well as weakness with pinching activities.

Hand Therapy

Hand therapy plays a role if the CMC joint is not too worn down. You can stretch the muscles back out. And with help of a physical therapist, you can learn stabilization exercises that can correct the muscles and delay the wearing down of this joint as well as increase the function.

Trigger Point Dry Needling

Trigger point dry needling is the act of inserting a small needle into the tender trigger point of a muscle until it twitches and or releases. This gives us a more pliable and less painful muscle attached to the joint. This can rapidly speed up the recovery process. Trying to stretch small shortened and painful muscles can take some time but trigger point dry needling can greatly quicken this process by breaking up the trigger points in these muscles. I have found this to be effecting in decreasing the time of treatment by up to half the normal time and cut down severe pain in some case within a day or two.


Following the stretching and loosening up the tight muscle of the thumb, it is important to train the weaker muscles around the thumb to stabilize this joint. A thumb stabilization program is recommended which consist of 5 simple exercises that can be performed 4-5 times of day along with the thumb stretches. Sometimes the joint is to worn down to be fully stabilized by these other small muscles and a brace will need to be incorporated. There are many soft braces with extra thumb support that do well in giving the extra needed stabilization to this joint during early stages of arthritis. For later stages that need more support a custom made thumb spica splint may be needed.

If your hands are causing you pain, schedule your free Rapid Recovery Injury Assessment with Doug Rich, PT, CHT, at our Red Mountain clinic. He is a Certified Hand Therapist that can determine the best action to help relieve your hand pains.

Dehydration doesn’t just affect you when you are outside sweating, or when hiking through the hot desert. Dehydration can affect you just as easily when going through your normal daily activities. This article has information on dehydration signs, the toll it takes on your body, and hydration tips.

Symptoms of Dehydration to Watch out For: 

  1. Dry mouth
  2. Headaches
  3. Increased thirst
  4. A low volume of urine with a darker yellow color than normal
  5. Tired or sleepy
  6. Dry skin
  7. Dizziness
  8. Muscle cramping

How Much Water Should I Drink to Stay Hydrated?

Dehydration by definition means a loss of body fluid greater than what your body needs to take in for proper function. So what is the proper amount of water we need to take in? That is a question we are asked to answer on a weekly basis at Foothills Sports Medicine. The answer to this can and will vary with almost every individual. Activity, size, environment, age, medications, and type of fluids can all affect the answer to how much fluid you need to take in a day. Most physicians, when pushed, say you need 8–10 glasses of water a day.

Of course, that leads to the next question. How big of a glass? Well, most juice glasses are about eight ounces. So, eight, eight-ounce glasses of water equates to 64 ounces a day. That’s about two big gulps of water from your local convenience store.

Other questions you could be asking are; “How does my shape and size affect what I need?” “What if I sweat a lot?” “What if I take diuretics?” “What if I work out a lot?” One rule of thumb you can use is: drink half your weight in ounces of water a day. If you weigh 100 pounds then, most likely, 50 ounces of water a day is enough. If you weigh 160 pounds then 80 ounces is probably enough.  Even then, no answer will be perfect for everyone.

Our body has a built-in thirst regulator called the hypothalamus that kicks in when it feels the body’s water levels are becoming too low. It will tell us we are thirsty and need to drink something. You might think, ‘great, I will simply drink when I’m thirsty and I will be ok.’ But, that isn’t exactly the case. If you are taking in around 60 ounces of water, and you’re not very active, you are probably okay. However, if you are drinking caffeinated beverages, you will not be getting the hydration necessary to function.

Caffeine is a diuretic, which means you will basically rid whatever you drink. Even then, it isn’t that simple.  Our hypothalamus tends to quit working as well in our later years. As your hypothalamus becomes less responsive, you will begin to not feel thirsty as often. In these cases, people tend to hydrate when they feel dry mouth, also known as cotton mouth. Unfortunately, a small sip of water can rid one of this symptom while not being enough to replace what your body is actively losing.

Patients often say they drink water consistently all through the day. But, if they are only taking sips of water all day they are hardly getting any fluid. A hydration tip I give these patients is to try drinking out of something measurable, such as a 32-ounce water bottle, and see if they can drink two of these in a day. Many patients find out that they have been drinking way less than they thought.

The Toll of Dehydration on the Body

A cardiologist friend of mine calls dehydration the “80-year-old dropout.”  Patients are admitted to his ER complaining of dizziness, slurred speech, rapid heart rate, elevated blood pressure, and sometimes have passed out. The patient would immediately have been put on a saline drip after being transported to the hospital and about three hours later would be ready to go home feeling normal and healthy.

Due to the commonality of this event, the doctor began looking at echocardiograms he ran on many of these patients when they were first emitted. The results: the heart and major arteries had shrunk down. However, echocardiograms ran later in the day, after the patient had been on IV saline solution, showed normal heart and artery size. His explanation was that the shrinking of the heart and arteries, as well as the thickening of the blood, were all due to lack of water. Which, in response, the arteries would then squeeze down as the heart begins to pump faster attempting to increase the pressure in order to move the thicker blood. This can become so severe that a person could not get enough blood to their head, leading them to pass out. So, to avoid this and the IV of saline solution, stay hydrated as best you can!

How to Physically Check If You Are Dehydrated

By pinching the skin on the top or backside of your hand you can easily check whether you should be drinking more water. If your skin bounces back to a quick, smooth position then you are less likely dehydrated. If your skin slowly goes back flat to your hand and leaves a crease for a few seconds, then it’s probably time to find some water!

We hope this information on dehydration and the accompanying hydration tips help you stay active and healthy this summer! If you’re experiencing a pain that is keeping you from being active, we can help. Schedule an appointment with us to get started.

Foothills Sports Medicine Physical Therapy, a Scottsdale physical therapy provider, is dedicated to providing hands-on, quality care to patients who suffer from every kind of injury or complaint. Our staff is highly trained, and will work with you to develop an individualized plan for your rehabilitation. To make a free appointment with one of our PTs, go online today! If you want to learn more about physical therapy, follow our blog.

Doug Rich is an orthopedic certified specialist and a certified hand therapist. He has been a practicing physical therapist for over 20 years, and was voted one of the best orthopedic physical therapists in the state of Arizona. Doug currently runs our Civic Center Scottsdale physical therapy clinic. He is here today to explain how your posture can actually effect carpal tunnel syndrome, and how physical therapy can help you can change it.

Carpal tunnel syndrome is the compression of the median nerve (which travels through the arm), caused by swelling as it passes through the carpal tunnel, a tight area in the wrist. This leads to symptoms such as numbness, pain, or tingling in the thumb, first finger, middle finger, and half of the ring finger. It also causes slower and altered signals to the hand from the brain, which can lead to weakness of the hand. Often, someone with carpal tunnel syndrome will complain of having difficulty hanging on to objects such as coffee cups. Another hallmark sign of the syndrome is increased pain or tingling while trying to sleep.

The cause of carpal tunnel syndrome is generally considered to be the product of excessive pinching with the thumb and fingers, combined with a repetitive bending of the wrist. This causes a thickening of the tissue around the carpal tunnel as the body strengthens to deal with these stresses. The smaller carpal tunnel then compresses the median nerve more. However, a recent model explaining the syndrome, called double crush syndrome, sheds new light on the condition. In this model, the medial nerve is already a little swollen before it even reaches the carpal tunnel. This means it is already being squeezed in another area, so a very small amount of pressure at the wrist would be enough to inflame the nerve. It turns out, these other crushing areas are the result of our 21st century posture, caused by sitting for long durations. Nine times out of ten, someone with carpal tunnel syndrome has the posture of a forward head and shoulders and a bent upper back.

A forward head leads to compression of the nerves that exit the neck and pass through the muscles that are tightened from trying to hold the head in this position. The forward shoulders also cause a tightening of the chest muscles, and again compress the same nerves as they continue through the body. A hunched-back posture (kyphosis) is the result of the body trying to give our head, which weighs as much as a bowling ball, some support by moving the lower spine back under the head. Therefore, to properly address double crush symptom, we find it necessary to also address posture problems. Here are a few of the simple techniques that may help.

Just telling someone to sit up straight is a great idea in theory, but the muscles and ligaments won’t physically be able to straighten because they have already tightened up and adapted to a poor posture. Therefore, we must first stretch out these tissues before we can straighten our posture. To achieve a forward head, therapists implement a chin tuck. Patients lie on their backs and tuck their chin down, making a double chin, while keeping their head in contact with the bed or floor. To remedy the forward shoulder and hunched back, patients start with a pectoral (chest) stretch. They stand in a corner, place their forearms against the wall, and lean their chest forward until they feel a stretch. Therapists also utilize foam rollers, and patients can lay on them to slowly straighten their upper backs.

There are many different techniques to achieve better posture, but knowing why we are doing certain exercises can be a motivation in itself. As the neck and shoulder areas loosen up, we can tell patients to “straighten up,” just like mom used to. Except this time, it will have an effect on the entire body and even decrease some problems down in the arms.