Radiographic prevalence of scaphotrapeziotrapezoid osteoarthrosis

Sex differences in photon-counting detector computed tomography-derived scaphotrapeziotrapezoid joint morphometrics

OBJECTIVE

The scaphotrapeziotrapezoid (STT) joint transmits load between the wrist and thumb. Despite its clinical importance, it has received less diagnostic attention than adjacent wrist and thumb joints. CT-derived three-dimensional models offer the ability to improve measurement of articular space by evaluating subchondral articular surfaces, which can be quantified using articular morphometrics. The objectives of this study were to investigate whether articular surface areas, interosseous proximities, and carpal bone positions differ between sexes.

MATERIALS AND METHODS

Thirty participants (50% female, median age 27.0 years) were prospectively recruited to a cohort study of normative wrist imaging and biomechanics. Carpal bones were meshed from CT-based segmentations using a marching cubes algorithm. Rigid body kinematic parameters of individual bones were calculated. Carpal bone postures were defined using projection angles between bone centroids. Articular surface areas and interosseous proximity distributions between adjacent bones were calculated. Morphometrics were compared between sexes using Wilcoxon rank sum or two-tailed Kolmogorov-Smirnov tests as appropriate.

RESULTS

Median articular surface area was significantly smaller in females than in males at the trapeziotrapezoid but not scaphotrapezium or scaphotrapezoid joints. Interosseous proximity distributions were closer in females at all joints (scaphotrapezium, 1.19 versus 1.42 mm; scaphotrapezoid, 1.15 versus 1.43 mm; trapeziotrapezoid, 0.45 versus 0.65 mm). Distal bones were more dorsally translated in females.

CONCLUSION

This study quantifies sex-stratified morphological variations at the STT joint. Interosseous proximity distributions may guide interpretation of imaging-derived STT joint space and can serve as reference ranges for studies of STT arthrokinematics.

Functional outcome of trapeziometacarpal prostheses in pan-trapezial osteoarthritis

Trapeziometacarpal osteoarthritis is frequently associated with scaphotrapeziotrapezoid osteoarthritis. Long-term outcomes have not been reported for trapeziometacarpal protheses in patients with radiological pan-trapezial osteoarthritis that is symptomatic only in the trapeziometacarpal compartment. The primary objective of this retrospective multicenter multi-operator study was to evaluate the effectiveness of trapeziometacarpal arthroplasty for pain relief in patients with radiographic pan-trapezial osteoarthritis without symptomatic scaphotrapeziotrapezoid involvement. A total of 70 thumbs in 67 patients were evaluated by a single independent operator at a mean follow-up of 58 months. Scaphotrapeziotrapezoid osteoarthritis severity on Crosby score was stage II in 84% of patients and stage III in 16%. Mean pain score on visual analog scale decreased from 7.7 preoperatively to 1.3 at last follow-up. There were no reoperations at last follow up. These results suggest that, in patients with radiological pan-trapezial osteoarthritis without symptomatic involvement of the scaphotrapeziotrapezoid joint, a trapeziometacarpal prothesis yields good medium-term clinical outcomes. LEVEL OF EVIDENCE: III.

Prevalence and Associated Factors for Primary Osteoarthritis of the Scaphotrapeziotrapezoid, Radiocarpal, and Distal Radioulnar Joints in the Japanese General Elderly Population

PURPOSE

The incidence and etiology of primary osteoarthritis (OA) of the scaphotrapeziotrapezoid joint (STTJ), radiocarpal joint (RCJ), and distal radioulnar joint (DRUJ) remains unknown. The purpose of this study was to evaluate the prevalence and factors associated with primary wrist OA in a cross-sectional study of a basic resident registry.

METHODS

A total of 1,297 residents between the ages of 50 and 89 years were randomly sampled from the registry of a Japanese town. A questionnaire was administered to all subjects, and each of them underwent radiographs of the bilateral hands, wrists, and elbows. STTJ, RCJ, and DRUJ radiographic osteoarthritis (ROA) were evaluated according to a previously described method. Associated factors for STTJ and DRUJ ROA were recorded. Associations between the incidence of ROA of the DRUJ, ulnar variance, and severity of elbow ROA were investigated.

RESULTS

A total of 676 wrists (162 men and 176 women; mean age of 69.0 years) were investigated. The prevalence of STTJ, RCJ, and DRUJ ROA was 5.3%, 1.5%, and 21.2%, respectively. Factors associated with STTJ ROA were thumb carpometacarpal joint ROA, female sex, and increasing age. Factors associated with DRUJ ROA were elbow ROA, use of vibrating tools, increasing age, and positive ulnar variance. Prevalence of DRUJ ROA was 54.4% in wrists with severe-grade elbow ROA. Ulnar variance of the wrist in severe-grade elbow ROA was significantly larger than that in mild-grade or nonelbow ROA.

CONCLUSIONS

The prevalence of ROA was highest in the DRUJ, followed by the STTJ, and lowest in the RCJ. The occurrence of ROA of the STTJ and DRUJ was affected by the presence of ROA of the adjacent joint.

CLINICAL RELEVANCE

Primary DRUJ ROA occurs at a moderate frequency, similar to primary ROA of other extremity joints; however, primary STTJ and RCJ ROA is rare.

Prevalence and associated factors for primary osteoarthritis of the thumb carpometacarpal joint in the general elderly population: A cohort survey randomly sampled from a basic resident registry of a small rural town in Japan

BACKGROUND

Osteoarthritis of the thumb carpometacarpal joint often presents pain and affects activity of daily life. There is no consensus regarding prevalence of primary radiographic osteoarthritis and symptomatic osteoarthritis of the thumb carpometacarpal joint, and their associated factors are not well investigated. The purpose of this study is to evaluate the prevalence and associated factors of primary radiographic and symptomatic osteoarthritis of the thumb carpometacarpal joint in a resident cohort.

METHODS

A total of 1297 residents aged 50 to 89 were randomly sampled from a small rural town in Japan, and their demographic data and questionnaire regarding lifestyle and job were obtained. All participants underwent posteroanterior radiographs of the bilateral hands. Participants with thumb carpometacarpal joint radiographic osteoarthritis were diagnosed if one of their thumb carpometacarpal joints was Kellgren-Lawrence grade 2, 3, or 4. Symptomatic osteoarthritis was diagnosed by tenderness or positive motion pain at the thumb base. Associated factors for the thumb carpometacarpal joint radiographic osteoarthritis were statistically analyzed.

RESULTS

A total of 646 thumbs with 323 participants (153 male and 170 female) were investigated. The mean age was 69.1 (range 50-89) years, The prevalence of thumb carpometacarpal joint radiographic osteoarthritis was 17.3 % (13.7 % males and 20.6 % females) and that of thumb carpometacarpal joint symptomatic osteoarthritis was 3.1 %. Associated factors for thumb carpometacarpal joint radiographic osteoarthritis were presence of finger joint radiographic osteoarthritis in the ipsilateral hand, increasing age, and female in order of degree of relevance. Dominant hand, body mass index, smoking history, heavy manual or agriculture work, use of vibrating tools, racket or bat sports, or scaphotapeziotrapezoidal joint radiographic osteoarthritis were not associated factors for thumb carpometacarpal joint radiographic osteoarthritis.

CONCLUSIONS

The prevalence of thumb carpometacarpal joint primary radiographic osteoarthritis in general Japanese elderly aged 50-89 years was 17.3 %, most of carpometacarpal joint radiographic osteoarthritis was asymptomatic.

Retrospective analysis of scaphoid trapezium pyrocarbon implant intervention in STT arthritis: a 3-year follow-up study

AIM

The purpose of this study was to evaluate clinical, patient rated and radiological outcome of the scaphoid trapezium pyrocarbon implant (STPI) at a minimum of three years follow-up.

METHODS

Consecutive patients operated with the STPI due to scaphotrapeziotrapezoidal (STT) arthritis between 2012 and 2019 were included. Patients were evaluated preoperatively and annually after surgery for range of motion, grip strength, key pinch, quick-DASH, pain, and satisfaction. Radiographs were evaluated for implant position, signs of dorsal intercalated segment instability (DISI), capitolunate (CL) angle, scapholunate (SL) distance, and presence of osteophytes.

RESULTS

Twenty-six patients (29 implants) were included. Seven implants were revised during the follow up, mainly due to pain: three implants were removed, four patients received a new STPI of a different size, leaving 22 implants in 20 patients available for follow up, 9 males and 11 females. Median age was 61.7 years (51-78 years). Median follow-up time was 68 months (37-105 months). Comparing preoperative status to the last follow-up, wrist extension and deviation, thumb abduction, and grip strength did not change. Key Pinch, quick DASH, pain, and patient satisfaction improved significantly at last follow-up. Radiographic signs of DISI were seen in six cases preoperatively and in 12 cases at last follow-up.

CONLUSION

At a minimum of three years follow-up, the STPI used for STT-arthritis improve pain, quick-DASH result, and patient satisfaction significantly. ROM and grip strength did not change compared to preoperative values. Radiographic signs of carpal instability were common at the follow-up and the revision rate was high.

Joint capsule innervation does not explain the difference in symptoms between scaphotrapezial and trapeziometacarpal osteoarthritis

OBJECTIVES

Peritrapezial osteoarthritis (OA) includes scaphotrapezial and trapeziometacarpal OA. In clinical practice, scaphotrapezial OA seems better tolerated than trapeziometacarpal OA, with fewer complaints and better tolerance. The difference in pain could be linked to a difference in joint capsule innervation, perhaps with fewer nerve fibers in the scaphotrapezial than the trapeziometacarpal joint.

MATERIALS AND METHODS

We performed a histologic evaluation of these two joints to compare their respective innervation in 17 cadaveric specimens with peritrapezial OA. Radiographic scoring confirmed the presence of peritrapezial OA. Mean Kellgren-Lawrence score was 2.2 ± 1.1 in the trapeziometacarpal joint and 1.5 ± 0.7 in the scaphotrapezial joint (p = 0.08).

RESULTS

There was no difference between scaphotrapezial and trapeziometacarpal joints in number of neurofilaments: 5.2 ± 3.9 and 4.4 ± 4.5, respectively (p = 0.20). A significant difference was found in S100 staining (myelinated structures), with a higher rate in the scaphotrapezial joint: 11.8 ± 7.5 vs 6.6 ± 5.2 (p = 0.005).

CONCLUSION

The present study suggests that lower tolerance of trapeziometacarpal OA is not due to a difference in joint capsule innervation. On the contrary, we found a higher rate of myelinated tissues in the scaphotrapezial joint. These results suggested other pain pathways to explain clinical observations.

Management of Scaphotrapeziotrapezoid Osteoarthritis: A Critical Analysis Review

» The scaphotrapeziotrapezoid (STT) joint is a common location of degenerative osteoarthritis (OA) in the wrist.» STT OA may occur in isolation or with concomitant thumb carpometacarpal joint (CMCJ) OA or scapholunate advanced collapse (SLAC) and other wrist OA patterns.» Nonoperative management strategies include activity modification, bracing, anti-inflammatory medications, occupational therapy, and injections.» Surgical treatment may be determined by whether the STT OA occurs in isolation or with concomitant thumb CMCJ or SLAC OA and includes STT arthrodesis, distal scaphoid excision with or without interposition or implant arthroplasty, trapeziectomy with proximal trapezoid excision, four-corner fusion in combination with scaphoid/radial column excision, and proximal row carpectomy.

Scaphotrapeziotrapezoid joint loading during key pinch grip before and after trapeziometacarpal arthroplasty: a cadaver study

In a previous cadaver study, we directly measured the load acting on the trapeziometacarpal joint for increasingly greater key pinch forces. We noted that the joint load ranges from 2 kg to 4 kg during progressively greater key pinch from 0.5 kg to 1.5 kg. Using the same experimental approach, the aim of the current study was to measure and compare the load acting on the scaphotrapeziotrapezoid joint for the same levels of isometric key pinch force, and how it changes after trapeziometacarpal arthroplasty. We performed a cadaver study using 7 fresh-frozen, unembalmed adult forearms and hands (2 right and 5 left). Thumb pinch was simulated by loading the main actuator tendons involved in the key pinch grip (i.e., adductor pollicis, flexor pollicis longus, extensor pollicis longus, extensor pollicis brevis and abductor pollicis longus tendons). Measurements were made inside the joint using a force-sensing resistor sensor (Tekscan® FlexiForce™ force sensor). Before the trapeziometacarpal joint surgery, median load values recorded in the scaphotrapeziotrapezoid joint were 1.2 kg (IQR, 1.0-1.4), 1.6 kg (IQR, 1.6-2.5) and 2.4 kg (IQR, 2.3-3.4) during 0.5 kg, 1 kg and 1.5 kg key pinch, respectively. After the trapeziometacarpal arthroplasty, median joint contact forces did not change significantly relative to the original configuration. Our findings indicate that the loads measured in the scaphotrapeziotrapezoid joint during a simple key pinch are in fact lower than those measured inside the trapeziometacarpal joint. After trapeziometacarpal arthroplasty, the values are similar with no increase in load, suggesting that clinically asymptomatic scaphotrapeziotrapezoid radiographic involvement may not be a contraindication to arthroplasty.

The INCA® implant to treat isolated scaphotrapeziotrapezoid osteoarthritis: Preliminary results at a minimum 2 years' follow-up

We report results with the INCA® distal scaphoid pole resurfacing implant anchored within the scaphoid for isolated scaphotrapeziotrapezoid osteoarthritis. Thirty-five implants in 27 patients (mean age, 69 years) were retrospectively included with a minimum follow-up of 2 years. Outcome criteria were pain (VAS), PROMs (QuickDASH, PRWE and MMWS), wrist motion, pinch and grip strength, and radiographic assessment. The average follow-up was 4.6 years. There was a significant improvement in pain, PROMs, grip and pinch strength. Radial deviation and wrist extension showed slight but significant postoperative decrease (-4° for both). Dorsal intercalated segment instability (DISI) was significantly improved postoperatively (7 cases versus 21 preoperatively). There were 2 cases of implant loosening (6%) within the first 10 months: 1 keel malpositioning and 1 insufficient postoperative immobilization. These findings suggest that the INCA® implant is an effective and reliable medium-term solution for isolated scaphotrapeziotrapezoid osteoarthritis. By restoring scaphoid length and gliding on the trapeziotrapezoid surface, the implant contributes to restoring normal bone alignment of the wrist.

Techniques for Injection of the Scaphotrapezium-Trapezoid Joint Without Image Guidance

Purpose

Scaphotrapezium-trapezoid (STT) joint arthritis is one of the most common forms of wrist arthritis. Conservative management often involves corticosteroid injection. Despite this, there is a scarcity of literature on palpation-guided injection techniques for the STT joint. We aimed to determine a standardized palpation-guided injection method that is easily reproducible and poses minimal risk to local anatomic structures.

Methods

Six fresh-frozen cadaveric upper extremity specimens were tested. Access to the STT joint was attempted with dorsal, volar, and radial approaches. Fluoroscopy was used to confirm accurate placement within the joint. Needle placement was documented in relation to the surrounding soft tissue and bony landmarks were measured with a ruler, and the angle of the needle entry was recorded using a goniometer. The cadavers were carefully dissected to identify the surrounding neurovascular structures at risk of injury.

Results

To access the STT joint with the dorsal approach, the needle was angled at 90º and inserted one-third of the distance from the prominence of the base of the second metacarpal to Lister tubercle. No neurovascular structures were found in the immediate vicinity of the needle. For the volar approach, the needle was angled at 65º and inserted at the distal wrist crease, 1 cm ulnar to the radial border of the wrist, in line with the second metacarpal. The volar branch of the radial artery was at risk with this approach. For the radial approach, the needle was angled at 60º and inserted immediately dorsal to the extensor pollicis brevis tendon, midway between the radial styloid and the prominence of the thumb metacarpal base. The dorsal branch of the radial artery was at risk with this approach.

Conclusions

In a clinical setting where fluoroscopy or ultrasound is not readily available, the dorsal approach may allow for safe and accurate placement of the injectate into the STT joint.

Type of study/level of evidence

Therapeutic IV.

Anatomy and biomechanics of healthy and arthritic trapeziometacarpal joints

Understanding the biomechanics of the trapeziometacarpal (TMC) or first carpometacarpal (CMC1) joint, the pathophysiology of basal thumb arthritis, the design and performance of surgical procedures require a solid anatomical basis. This review of literature summarizes the most recent data on the descriptive, functional, and comparative anatomy of healthy and arthritic TMC joints.

Scaphotrapeziotrapezoid osteoarthritis: From the joint to the patient

Scaphotrapeziotrapezoid osteoarthritis (STT OA) is common and often associated with thumb basal joint arthritis. Pain at the base of the thumb on the volar aspect and during resisted extension is characteristic of symptomatic STT OA. If conservative treatment fails, surgical treatment may be offered. In case of STT OA, treatment may range from arthrodesis to trapeziectomy (isolated or associated with ligament reconstruction and/or interposition). Any preoperative intracarpal instability (DISI) can be exacerbated by resecting more than 3 or 4 mm of the distal pole of scaphoid. For peritrapezial osteoarthritis, trapeziectomy is the logical solution, but it exposes the patient to known complications: loss of strength, long recovery, trapeziometacarpal impingement. Initial treatment of thumb basal joint arthritis by arthroplasty is also an option. Treatment of both sites is also possible by interposition of pyrocarbon implants. In all cases (isolated or associated STT OA) and no matter the technique chosen, maintaining the scaphoid height (arthrodesis, resection < 3 mm and/or associated interposition) and performing oblique trapezoidal osteotomy (to prevent scaphoid-metacarpal impingement) are the two crucial elements of surgical treatment.

Introducing the “SOAC Wrist”: Scaphotrapeziotrapezoid Osteoarthritis Advanced Collapse

Despite being the second most common osteoarthritis of the wrist, little is known about scaphotrapeziotrapezoid osteoarthritis. Not all patients with this type of osteoarthritis have symptoms, and, even in those symptomatic patients, the intensity of the complaint is not proportional to the severity of the degeneration. In symptomatic patients, when the conservative treatment fails, grading classifications to help define the surgical treatment are solely based on the joint characteristics, and fail to assess the rest of the carpus.

In general, most carpal degenerative processes show the same evolution pattern, which varies according to the initial injury, along with the type of deformity and the inherent instabilities. Thus, we hypothesize that the degenerative evolution due to primary osteoarthritis of the scaphotrapeziotrapezoid joint also follows a logical evolutionary sequence, similar to the one that occurs in cases of scapholunate advanced collapse (SLAC), scaphoid nonunion advanced collapse (SNAC), scaphoid malunion advanced collapse (SMAC), and scaphoid chondrocalcinosis advanced collapse (SCAC), thus resulting in scaphotrapeziotrapezoid osteoarthritis advanced collapse (SOAC). We have divided the SOAC into three groups, and considered that their treatment shall be guided by the evolutionary stage of the disease, and not by the surgeon's preferred technique.

Current Trends in Operative Treatment of Scaphotrapeziotrapezoid Osteoarthritis: A Survey among European Hand Surgeons

Objective  Based on the available evidence, the optimal surgical treatment for isolated scaphotrapeziotrapezoid oarthritis (STT OA) remains unclear. The purpose of this study is to explore the prevailing surgical practice for isolated STT OA among European hand surgeons. We hypothesized that a considerable variance exists in the current surgical practice among hand surgeons in Europe. Methods  An online survey was distributed to 20 participating member states of the Federation of European Societies for Surgery of the Hand (FESSH). Respondents were questioned on their country of practice, surgical experience, preferred surgical procedure, frequency of performing this procedure, factors in decision-making, and other performed surgical procedures. Results  Four hundred and sixty-five responses were received with an estimated response rate of 19%. Trapeziectomy with partial trapezoidal excision was the surgical treatment of choice among the participating hand surgeons in Europe (38%), followed by STT joint fusion (30%), and distal scaphoid excision (14%). Conclusion  This survey provides an insight into the surgical management of isolated STT OA among hand surgeons in Europe. A wide variety of preferred treatment techniques were found. Evidence concerning the optimal surgical treatment has not been established. Future prospective randomized studies comparing different techniques are warranted.

Surgical Management of Scaphotrapeziotrapezoid Arthritis

Scaphotrapeziotrapezoid (STT) arthritis occurs commonly with basal joint arthritis, but can also occur in isolation or in conjunction with other patterns of wrist arthritis, such as scapholunate advanced collapse. Surgical options depend on the specific clinical scenario encountered. Isolated STT arthritis was classically managed with arthrodesis, but is now often addressed with distal scaphoid resection (open or arthroscopic), trapeziectomy (partial or complete) and partial trapezoid resection, or implant arthroplasty. Development of postoperative dorsal intercalary segment instability is a notable concern with any of these techniques. STT arthritis in conjunction with basal joint arthritis can be managed effectively with trapeziectomy and either partial trapezoid excision or distal scaphoid excision. STT arthritis with scapholunate advanced collapse is uncommon, but can be managed with proximal row carpectomy or scaphoidectomy and four-corner fusion. If basal joint arthritis is also present, trapeziectomy can additionally be performed, but grip strength is likely to be substantially diminished.

Dynamic MRI of the wrist in less than 20 seconds: normal midcarpal motion and reader reliability

OBJECTIVE

To describe the normal motion pattern at the midcarpal compartment during active radial-ulnar deviation of the wrist using dynamic MRI, and to determine the observer performance for measurements obtained in asymptomatic volunteers.

METHODS

Dynamic MRI of 35 wrists in 19 asymptomatic volunteers (age mean 30.4 years, SD 8.6) was performed during active radial-ulnar deviation using a fast gradient-echo pulse sequence with 315 ms temporal resolution (acquisition time, 19 s). Two independent readers measured the transverse translation of the trapezium at the scaphotrapezium joint (STJ) and the capitate-to-triquetrum distance (CTD). Relationships between these measurements and laterality, sex, lunate type, and wrist kinematic pattern were evaluated.

RESULTS

At the STJ, the trapezium moved most in radial deviation, with an overall translation of 2.3 mm between ulnar and radial deviation. Mean CTD measurements were the greatest in ulnar deviation and varied 2.4 mm between ulnar and radial deviation. Mean CTD was greater in men than women in the neutral position (p = 0.019), and in wrists with type II lunate morphology during radial and ulnar deviation (p = 0.001, p = 0.014). There were no significant differences in trapezium translation or CTD with wrist laterality and kinematic pattern. Intraobserver and interobserver correlation coefficients were 0.97 and 0.87 for trapezium translation and 0.84 and 0.67 for CTD.

CONCLUSION

This study is the first to demonstrate the performance of dynamic MRI to quantify STJ motion and CTD. Dynamic MRI with a short acquisition time may be used as a tool to supplement static MRI in evaluation of the midcarpal compartment.

A new radiographic view of the scaphotrapeziotrapezoid joint-a cadaveric study

BACKGROUND

The scaphotrapeziotrapezoid joint (STTJ) has a complex osseous and ligamentous anatomy. Precise radiographic assessment is paramount when assessing osteoarthritic, post-traumatic, or post-operative patients. There has been no described technique to image the STTJ without any wrist movement, unobscured by the rest of the carpus. The aim of this study was to define an optimal radiographic method to assess the STTJ while maintaining the wrist in neutral position.

METHODS

Computer tomography 3-D reconstructions of three uninjured wrists were initially used to determine an approximate beam angle. Serial radiographs of 12 cadaveric wrists were taken. The forearms were positioned in varying degrees of pronation and supination. The beam angle was concurrently adjusted to varying degrees of caudal tilt. From the images obtained, we assessed if the adjacent carpus obscured the view of the STTJ.

RESULTS

Optimal STTJ imaging was in the semi-pronated wrist position with the X-ray beam tilted caudal. We found that the STTJ was best visualized at 48° supination from a fully pronated wrist and a caudal beam angle of 22°.

CONCLUSIONS

The described wrist and beam orientation can aid in achieving an unobstructed view of the STTJ with little technical effort. This can aid in imaging ambulatory patients where symptoms prevent using other imaging techniques as well as patients in the operating room where imaging timing can be critical.

Evaluation and Management of Scaphoid-Trapezium-Trapezoid Joint Arthritis

Degenerative arthritis at the articulation of the scaphoid, trapezium, and trapezoid (STT or triscaphe joint) is a common degenerative disease of the wrist. Pain and weakness with grip strength reduction and functional limitations when performing routine daily tasks are common complaints of patients with STT arthritis. Initial conservative treatments for STT arthritis include splinting, bracing, activity modification, anti-inflammatory medication, and steroid injections for pain relief. Failure of conservative treatment is the main indication for surgery, which may include distal scaphoid excision, with or without filling of the void after excision, trapeziectomy, STT arthrodesis, or STT implant arthroplasty.

Comparison of Radiographic and Intraoperative Visual Assessment of Scaphotrapezoid Joint Arthritis in Patients With End-Stage Carpometacarpal Arthritis of the Thumb Base

Background: The purpose of this investigation is to compare the radiographic and intraoperative assessment of scaphotrapezoid (ST) joint arthritis in patients with end-stage carpometacarpal (CMC) arthritis of the thumb base. We aim to define the incidence of ST arthritis in this population and determine whether radiographic features such as lunate morphology, dorsal intercalated segment instability (DISI), and scapholunate (SL) diastasis are associated with the incidence of ST arthritis. Methods: We retrospectively reviewed consecutive patients with end-stage CMC arthritis of the thumb treated operatively with trapeziectomy. Preoperative wrist radiographs were reviewed, and the presence of ST arthritis was determined using the Sodha classification. Lunate morphology, DISI, and SL diastasis were noted. Intraoperative grading of ST arthritis was assessed using a modified Brown classification. The specificity and sensitivity of radiographic assessment was compared with the gold standard of intraoperative direct visualization. Results: In total, 302 thumbs met inclusion criteria. End-stage ST joint arthritis determined by intraoperative visual inspection was noted in 31% of cases. No radiographic or demographic variables were found to be risk factors for ST arthritis. Plain radiographs were 47% sensitive and 94% specific in their ability to detect end-stage ST joint arthritis. Conclusions: We report a 31% incidence of end-stage ST joint arthritis in surgically treated patients with CMC arthritis based on visual inspection which is lower than previous literature. Wrist radiographs demonstrate a 47% sensitivity and 94% specificity in predicting end-stage ST joint arthritis. It is imperative to directly visualize the ST joint after trapeziectomy, as radiographs demonstrate poor sensitivity.

Obtaining a Reliable Scaphotrapeziotrapezoid Radiograph: Pronation, Ulnar Deviation, and Thumb Abduction

A simple, reproducible technique for assessing the scaphotrapeziotrapezoid joint radiographically is described. In addition to its diagnostic value, the technique is simple to perform with a minifluoroscopy unit, allowing for image-guided injections of the scaphotrapeziotrapezoid joint.

Arthroscopic Management of Scaphoid-Trapezium-Trapezoid Joint Arthritis

Scaphoid-trapezium-trapezoid (STT) joint arthritis is a common condition consisting of pain on the radial side of the wrist and base of the thumb, swelling, and tenderness over the STT joint. Common symptoms are loss of grip strength and thumb function. There are several treatments, from symptomatic conservative treatment to surgical solutions, such as arthrodesis, arthroplasties, and prosthesis implant. The role of arthroscopy has grown and is probably the best treatment of this condition. Advantages of arthroscopic management of STT arthritis are faster recovery, better view of the joint during surgery, and possibility of creating less damage to the capsular and ligamentous structures.

The effect of smartphone addiction on hand joints in psoriatic patients: an ultrasound-based study

BACKGROUND

Distal interphalangeal (DIP) arthritis is a frequent form of psoriatic arthritis being often linked to nail psoriasis. Modern society is characterized by overuse of smartphones. Indeed, literature has recently focalized on research into smartphone addiction and health-related problems.

OBJECTIVES

As smartphone addiction is able to determine overuse and repeated movements of DIP joints and nails, the aim of this study was to evaluate the impact of smartphone use on hand joints of young psoriatic patients.

METHODS

An observational study involving four different groups such as non-smartphone-addicted (SA) psoriatic patients, SA psoriatic patients, non-SA controls and SA controls was performed. Each subject underwent an ultrasound examination of both hands by three independent and blinded to group assignment radiologists. A specific score was used to evaluate the inflammatory state of the analysed joints.

RESULTS

The total ultrasound score was statistically significantly higher in SA controls respect to non-SA controls (3.4 vs. 1.4; P < 0.05) as well as in SA psoriasis patients compared to non-SA psoriatic subjects (15.2 vs. 6.7; P < 0.01). Higher mean of ultrasound score was found for left hand in controls (both SA or not) and for right hand in psoriatic subjects (both SA or not), however without reaching statistical significance.

CONCLUSIONS

Smartphone overuse was found to be linked with higher signs of inflammation of musculoskeletal structures of hands joints in both psoriasis and controls through ultrasound examination. Therefore, smartphone overuse may be a factor which facilitate or speed up the possible development of psoriatic arthritis.

Radiographic Patterns of Radiocarpal and Midcarpal Arthritis

Introduction:

The purpose of this study was to determine the specific locations of radiocarpal and/or midcarpal joint osteoarthritis (RC/MC OA).

Methods:

A total of 1,007 wrist radiographs were screened for the presence of RC/MC OA. The locations of the degenerative changes were identified. In addition, the observers then determined whether the observed patterns fell under the scapholunate advanced collapse (SLAC) pattern.

Results:

The SLAC pattern did not represent the majority of observed degenerative changes. Almost one-third of the patients had degenerative changes present at the radiolunate or scaphocapitate articulations in the absence of radioscaphoid changes. Women have a lower risk of arthritis compared with men (odds ratio, 0.306; P < 0.05). Increasing age correlated with the presence of arthritis (odds ratio, 1.05; P < 0.05).

Conclusion:

Contrary to the previous reports in the literature, our cohort demonstrated that <50% of wrist OA fell into the category of SLAC arthritis.

Interobserver Agreement of the Eaton-Glickel Classification for Trapeziometacarpal and Scaphotrapezial Arthrosis

PURPOSE

To determine whether simplification of the Eaton-Glickel (E-G) classification of trapeziometacarpal (TMC) joint arthrosis (eliminating evaluation of the scaphotrapezial [ST] joint) and information about the patient's symptoms and examination influence interobserver reliability. We also tested the null hypotheses that no patient and/or surgeon factors affect radiographic rating of TMC joint arthrosis and that no surgeon factors affect the radiographic rating of ST joint arthrosis.

METHODS

In an on-line survey, 92 hand surgeons rated TMC joint arthrosis and ST joint arthrosis separately on 30 radiographs (Robert, true lateral, and oblique views) according to the (modified) E-G classification. We randomly assigned 42 observers to review radiographs alone and also informed 50 of the patient's symptoms and examination. Information about symptoms and examination was randomized. Interobserver reliability was determined with the s* statistic. Because of the hierarchical data structure, cross-classified ordinal multilevel regression analyses were performed to identify factors associated with the severity of arthrosis.

RESULTS

Shortening the E-G classification to the first 3 stages significantly improved the interobserver reliability, which approached substantial agreement. Providing clinical information to observers marginally improved interobserver reliability. Factors associated with a lower E-G stage for TMC joint arthrosis, among observers who rated the severity of TMC joint arthrosis based on radiographs and clinical information, included female surgeon, practice setting, supervising surgical trainees in the operating room, self-reported number of patients with TMC joint arthrosis typically treated annually, male patient, higher patient age, pain limiting daily activities, and shoulder sign. A self-reported larger number of patients with TMC joint arthrosis treated annually was the only variable associated with a higher modified E-G classification to rate ST joint arthrosis.

CONCLUSIONS

Our findings suggest that simpler classifications that focus on a single anatomical area are reliable and that surgeon and patient factors can bias interpretation of objective pathophysiology such as radiographic findings.

TYPE OF STUDY/LEVEL OF EVIDENCE

Diagnostic III.

Midcarpal and Scaphotrapeziotrapezoid Arthritis in Patients with Carpometacarpal Arthritis

BACKGROUND

Carpometacarpal arthroplasty provides well-documented pain relief with preservation of thenar function in basal joint arthritis treatment. Nevertheless, some patients continue to have pain following surgery. The authors hypothesize that unrecognized midcarpal (capitolunate) arthritis is a contributor to persistent pain after carpometacarpal arthroplasty. The prevalence of midcarpal arthritis in patients with basal joint arthritis is unknown. This article establishes the radiographic prevalence of midcarpal arthritis in patients with carpometacarpal arthritis.

METHODS

Patients with basal joint arthritis were identified from a search using International Classification of Diseases, Ninth Revision code 716.94. Hand radiographs were reviewed and graded using the Eaton classification and Sodha classification for carpometacarpal arthritis. Scaphotrapeziotrapezoid arthritis and midcarpal arthritis were graded using the Sodha classification for arthritis as follows: grade 1, no or nearly no arthrosis; grade 2, definite arthrosis but not severe; and grade 3, severe arthrosis.

RESULTS

Eight hundred ninety-six radiographs were reviewed. The prevalence of scaphotrapeziotrapezoid arthritis in this population was 64 percent. The prevalence of midcarpal arthritis in this population was 23.5 percent. The prevalence of midcarpal arthritis in patients with radiologic evidence of carpometacarpal arthritis was 25.4 percent. The prevalence of severe midcarpal arthritis was 7 percent.

CONCLUSIONS

The prevalence of midcarpal arthritis in patients with basal joint arthritis is 24 percent. The presence of two locations of arthritis may explain persistent hand and wrist pain in this population despite carpometacarpal arthroplasty. Clinically, these data will allow hand surgeons to better educate patients with basal joint arthritis regarding the possibility of incomplete pain relief following carpometacarpal arthroplasty.