Effect of carpometacarpal joint osteoarthritis, sex, and handedness on thumb in vivo kinematics

The Female Thumb Carpometacarpal Joint: Motion and Force Changes Due to Arthritis and Surgical Intervention

Thumb carpometacarpal (CMC) osteoarthritis (OA) has been one of the most common locations of hand OA. CMC OA disproportionately occurs in females over males. In severe cases, surgical intervention may be needed. However, to determine the effects of surgical treatment, normative, pre-, and postsurgery function must be understood. The goals of this work were to compare the thumb motion and force abilities of older healthy (OH) females without CMC OA to those of females with CMC OA and who received ligament reconstruction with tendon interposition (LRTI) surgery at time points presurgery, 3- and 6-months postsurgery. On average, CMC OA participants 3- and 6-months postsurgery showed 35.6% and 32.9% less overall metacarpal motion compared to presurgery, 31.9% and 29.1% less than OH, and exhibited altered motion. Metacarpal flexion/extension and abduction/adduction ranges were 51.9 deg and 43.4 deg for OH, 52.9 deg and 40.3 deg presurgery, 39.9 deg and 33.5 deg at 3-months, and 42.6 deg and 32.7 deg at 6-months postsurgery. On average, participants had increased force generation at 6-months postsurgery compared to presurgery, and 20% of participants returned to the level of OH females. These data sets highlight changes in thumb metacarpal movement and thumb force generation due to disease and surgical intervention. This work has the ability to support both surgeons and patients through improved outcome assessments as well as additional data to inform the decision process on intervention.

Three-dimensional motion analysis of pre- and postoperative thumb movement in trapeziometacarpal joint osteoarthritis-Comparison of arthrodesis and trapeziectomy with suspensionplasty

Trapeziometacarpal osteoarthritis (TMC-OA) reduces the range of motion (ROM) of the thumb. However, the kinematic change achieved through surgical treatment remains unclear. Therefore, to quantify the kinematic change following TMC-OA surgery, we performed a three-dimensional motion analysis of the thumb using an optical motion capture system preoperatively and 1 year postoperatively in 23 patients with TMC-OA scheduled for arthrodesis (AD) or trapeziectomy with suspensionplasty (TS). Eighteen hands of nine healthy volunteers were also included as controls. Both procedures improved postoperative pain and Disability of the Arm, Shoulder and Hand scores, and AD increased pinch strength. The ROM of the base of the thumb was preserved in AD, which was thought to be due to the appearance of compensatory movements of adjacent joints even if the ROM of the TMC joint was lost. TS did not improve ROM. Quantifying thumb kinematic changes following TMC-OA surgery can improve our understanding of TMC-OA treatment and help select surgical procedures and postoperative assessment.

Current Concepts in Upper-Extremity Motion Analysis: Room To Grow?

Kinematic motion analysis (KMA) is well established in the assessment of gait and lower-extremity kinematics; however, its application to upper-extremity (UE) pathology has been limited. This review provides a concise overview of information related to the KMA technology that is pertinent to the clinician. Advantages of KMA for UE assessment are discussed, along with barriers to implementation. An example of KMA used for perioperative assessment of a patient undergoing a distal humerus osteotomy for the correction of arthrogrypotic internal rotation deformity is provided to illustrate its clinical feasibility. Kinematic motion analysis has exciting potential to advance the evaluation and management of UE disorders; however, broad application will require validation and standardization of UE-specific KMA protocols in addition to decreased logistical and cost burdens.

The effect of rheumatoid arthritis on upper extremity functions: A kinematic perspective

AIM

To examine the global upper extremity kinematics in 3D while performing "jar opening motion" in Rheumatoid Arthritis (RA) and to compare these with healthy individuals.

METHOD

Twenty-four women (12 healthy, 12 RA) were included. Evaluations were made with a JAMAR dynamometer, Health Assessment Questionnaire, and 3D kinematic analysis of global upper extremity during "jar opening motion." The time taken during "jar opening motion" was analyzed in 2 parts (Part 1, Part 2), with total time: part 1 + part 2. In addition, shoulder-to-table distance; elbow flexion angle; wrist extension angle; the area scanned and angular rotation by arm, forearm and hand were used in the analysis.

RESULTS

Between groups, there was a statistical difference in: bilateral hand grip strength; part 1, part 2, total time; shoulder-to-table distance; elbow flexion angle; the area scanned by hand; angular rotation of arm and hand in favor of the healthy group (P < .05). In stepwise multiple regression analysis, the most predictive variable for disability was elbow flexion, explaining 53.9% of disability.

CONCLUSION

Compared to healthy individuals, individuals with RA have slower motion, more elbow flexion, less hand grip strength, circular pattern in hand, rotation in arm and hand. Increased disability may result in greater load on elbow flexion.

Comparison of finger kinematics between patients with hand osteoarthritis and healthy participants with and without joint protection programs

STUDY DESIGN

This is a cross-sectional, clinical observational study.

BACKGROUND

Finger range of motion (ROM) and functional performance are critical in many daily activities. Hand osteoarthritis (H-OA) is a prevalent disease that impairs both variables. Little quantitative research has been performed on finger kinematics during activities of daily living (ADLs) across health status and method of performance (with or without joint protection programs).

PURPOSE

The purpose of this research is to examine the effects of H-OA and method of performance on ROM in the thumb, index, and middle digits (flexion/extension and abduction/adduction) during ADLs.

METHODS

This study was conducted using 10 healthy participants (mean age: 28 years) and nine participants with H-OA (mean age: 72 years). All participants performed baseline ROM movements followed by 9 activities of daily living. These activities involved prehension type grasps and were performed with and without the recommended joint protection procedures specific to each task. Thumb IP and MCP, index distal interphalengeal (DIP) and proximal interphalengeal (PIP), and middle DIP and PIP joints were continuously recorded using an electromagnetic tracking system for ROM analysis.

RESULTS

Participants with H-OA had a statistically significant decrease in ROM when comparing values measured in the healthy cohort during active ROM (25° decrease) and ADL ROM (25° decrease) in the flex/ext direction. Similarly, following joint protection instruction, a statistically significant decrease in ROM was found during tasks in the flex/ext direction (healthy participant decrease in ROM: 17°, H-OA decrease in ROM:10°) CONCLUSIONS: This study demonstrated that people with hand arthritis move through a smaller arc of motion when performing some functional tasks as compared with the controls, and that with instruction on joint protection techniques, participants made significant changes in the amount of movement used to perform tasks, which supports a proof of principle of joint protection.

Three-dimensional analysis of thumb motion recovery after carpal tunnel release

This study quantified recovery of thumb motion in patients with carpal tunnel syndrome after carpal tunnel release using three-dimensional motion analysis with a retroreflective surface-based marker method. Eighteen hands from 14 patients who underwent carpal tunnel release for idiopathic carpal tunnel syndrome were included. The angular movements of the three joints of the thumb, the path length of the thumb tip and the area enclosed by the perimeter path of the thumb tip were measured during circumduction. The range of joint movement, including abduction/adduction of the trapeziometacarpal joint, and flexion/extension of the interphalangeal and metacarpophalangeal joints and the path length of the thumb tips, improved significantly 1 year after surgery. The quantification of thumb kinematics helps to better understand motor dysfunction in carpal tunnel syndrome, assess the severity of the condition and decide on treatment.Level of evidence: 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.

Trapeziometacarpal Joint Arthritis: Is Duration of Symptoms a Predictor of Surgical Outcomes?

PURPOSE

Great effort has been placed on determining the optimal surgical treatment for trapeziometacarpal joint arthritis (TMA). However, a paucity of literature exists concerning the optimal timing of surgical intervention. We hypothesized that an increased duration of TMA symptoms before operative intervention would negatively affect surgical outcomes.

METHODS

We performed a retrospective review on 109 adult patients with 121 joints with symptomatic TMA treated with trapeziectomy and ligament reconstruction with tendon interposition (LRTI) from 2006 to 2017. Outcome measures included Quick-Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, complication rates, and surgical revision rates.

RESULTS

Among 109 patients, average QuickDASH score at initial presentation was 41.1 ± 17.9. Patients had symptoms of TMA for an average of 3.2 years (median, 2.1 years) before undergoing operative intervention. Patients were divided into 2 groups: those with symptoms less than 2 years and those with symptoms greater than 2 years. Patients who underwent LRTI after less than 2 years of symptoms achieved a significantly greater degree of improvement in the QuickDASH score compared with patients with symptoms greater than 2 years (26.2 vs 5.3).

CONCLUSIONS

Patients with less than 2 years of symptomatic TMA before LRTI can expect the greatest improvement in patient-reported disability impairment compared with those with more than 2 years of symptoms. This can be used to counsel patients regarding the optimal timing of surgery if nonsurgical treatment has failed to provide durable symptomatic relief.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic IV.

The immediate effect of thumb orthoses on upper extremity's movement: A kinematic analysis of five unique devices

BACKGROUND

Thumb orthoses are a standard treatment modality, with substantial evidence to support its usage for multiple conditions affecting the upper extremity. Despite commonly prescribed, little is known about the immediate impact of such devices on the upper extremity, including potential modifications on motor patterns.

RESEARCH QUESTION

We aimed to determine the changes in the upper limb kinematics during the usage of thumb orthotics, comparing differences in orthotic design, length, and fabrication materials.

METHODS

In this cross-sectional study, subjects performed a standardized reaching task and the placing subtest of the Minnesota Manual Dexterity Test (MMDT) while wearing five unique thumb orthoses. Besides the active range of motion of the shoulder, elbow, wrist and hand joints, movement smoothness (Number of Movement Units-NMU), speed, and motion control strategies were analyzed through eight Qualisys Oqus 300 cameras (Qualisys AB, Göteborg, Sweden).

FINDINGS

Ten non-disabled, university students participated in this study. Despite differences in fabrication materials, all orthotics reduced thumb's abduction (13.3° to 4.3°), and metacarpophalangeal flexion (11.5° to 4.2°). Although orthotics impacted movement smoothness and hand function during its usage, forearm-based devices further increased the NMUs and the time required for the MMDT performance (Control: NMU = 4.8, MMDT = 58.1; Long Orthotics: NMU = 6.6, MMDT = 78.2), while short, flexible orthoses provided thumb stabilization without significant impact on upper extremity movement strategies.

SIGNIFICANCE

Although joint stabilization was similar among orthotics fabricated with rigid and flexible materials, the improved hand dexterity observed during the use of flexible devices suggests an advantage of flexible orthotics for enhanced stability and hand function. These results can assist healthcare professionals during the selection and prescription of thumb orthotics, providing information not only on the range of motion but other sensorimotor aspects involved in upper extremity movement patterns that may be affected by orthotics usage.

Complex thumb motions and their potential clinical value in identifying early changes in function

BACKGROUND

Early diagnosis and treatment of osteoarthritis of the thumb allows for early interventions that may mitigate osteoarthritis progression and decrease severity later in life. Early identification of motion changes is limited by the clinical reliance on single planar measurements using goniometry. Multi-planar measurements using motion capture can provide insights into joint function and pathophysiology that cannot be obtained from single-plane goniometry measurements. Thus, the goals of this research were 1) to determine differences in thumb motions across three groups of participants (young healthy (n = 23), older healthy (n = 11), and those with carpometacarpal osteoarthritis (n = 24)) and 2) to determine if multi-planar motions provided additional movement information in comparison to standard planar measures.

METHODS

In this study, a motion capture system was used to collect standard clinical ranges of motion and complex multi-planar tasks. Differences in motion patterns due to aging and osteoarthritis were identified. Motions tested included palmar adduction-abduction, radial adduction-abduction, metacarpophalangeal flexion-extension, interphalangeal flexion-extension, functional adduction-abduction, opposition, and circumduction.

FINDINGS

Results indicated that motion capture was capable of detecting changes in carpometacarpal mobility that were not detected using standard approaches. Our results suggested that use of multi-planar measurements have the potential to identify changes that are indicators of early stages of osteoarthritis.

INTERPRETATION

Early indicators are clinically useful as they will enhance patient treatment by permitting the application of treatment approaches sooner, potentially leading to reduced overall functional deficits.

Impact of Osteoarthritis and Total Joint Arthroplasty on the Kinematics of the Trapeziometacarpal Joint: A Pilot Study

PURPOSE

To quantify the effect of osteoarthritis (OA) and total trapeziometacarpal (TMC) joint replacement on thumb kinematics during the primary physiological motions of the thumb.

METHODS

We included 4 female patients with stage III TMC OA. A computed tomography-based markerless method was used to quantify the 3-dimensional thumb kinematics in patients before and after TMC joint replacement surgery with the Arpe implant.

RESULTS

Trapeziometacarpal OA led to a marked decrease of internal rotation and abduction of the first metacarpal (MC1) during thumb flexion and a decrease of MC1 adduction during thumb adduction. As a compensatory phenomenon, the trapezium displayed increased abduction. The absence of MC1 translation in the ball-and-socket implant seems to induce a decrease of MC1 adduction as well as a decrease of trapezium adduction during thumb adduction, compared with OA and healthy joints. Implant replacement displayed an unchanged MC1 flexion during thumb flexion and seemed to slightly increase MC1 axial rotation during thumb flexion and adduction. Abduction and adduction of the MC1 are limited and compensated by this somewhat increased axial rotation, allowing more efficient thumb opposition.

CONCLUSIONS

The study highlights that advanced TMC OA mainly restricts the MC1 mobility. We also showed that, whereas total joint arthroplasty is able to restore thumb function, it cannot fully replicate the kinematics of the healthy TMC joint.

CLINICAL RELEVANCE

The quantification of TMC joint kinematics in OA and implanted patients is essential to improve our understanding of TMC OA as well as to enhance the functionality of implant designs.

Radiographic Analysis of Simulated First Dorsal Interosseous and Opponens Pollicis Loading Upon Thumb CMC Joint Subluxation: A Cadaver Study

BACKGROUND

Therapy programs to treat thumb carpometacarpal (CMC) arthritis may engage selective activation and reeducation of thenar muscles, particularly the first dorsal interosseous (FDI) and opponens pollicis (OP) to reduce subluxation of the joint. We describe the effect of simulated selective activation of the FDI and OP muscles upon radiographic subluxation of the thumb CMC joint.

METHODS

In a cadaver model of CMC subluxation, loads were applied to the FDI, the OP, and then concomitantly at 0%, 25%, 50%, 75%, and 100% maximal loads and radial subluxation of the joint and reduction in subluxation was measured.

RESULTS

Selective activation of the OP, alone, improved the subluxation ratio (SR) in a dose-dependent manner. Selective activation of FDI, alone, demonstrated minimal effects on SR. Concomitant activation of OP and FDI improved the SR across all loading states, and activation of 75% and greater, when compared with FDI activation alone, resulted in a statistically significant improvement in SR to within 10% of the presubluxed joint.

CONCLUSIONS

Concomitant activation of the FDI and OP acts to reduce subluxation of the thumb CMC joint in a dose-dependent fashion. The OP is likely the predominant reducing force. Hand therapy programs that focus on selective strengthening programs likely function in part to encourage patients to activate the easily palpable and easily understood FDI. Concomitant coactivation of the OP may be the major reducing force to elicit clinical and radiographic reduction of subluxation, improved thumb positioning, and reduction of pain and arthritic symptoms.