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Tran J, Peng P, Ho L, von Schroeder H, Agur A. Innervation of thumb carpometacarpal joint: implications for diagnostic block and denervation procedures. Reg Anesth Pain Med 2024; 49:565-572. [PMID: 37875348 DOI: 10.1136/rapm-2023-105009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 09/30/2023] [Indexed: 10/26/2023]
Abstract
INTRODUCTION Osteoarthritis (OA) of the thumb carpometacarpal (CMC) joint is a common disorder that negatively impacts hand function. Denervation of the thumb CMC joint has emerged as a viable treatment option. However, the innervation pattern of the thumb CMC joint is controversial. Therefore, the objective of this study was to identify the articular branches supplying the thumb CMC joint and to document their relationship to anatomical landmarks to provide the foundation for image-guided diagnostic block and denervation procedures. METHODS In 10 formalin-embalmed upper limb specimens articular branches supplying the thumb CMC joint were dissected from their origin to termination. A frequency map documenting the number of articular branches was generated. The frequency map enabled visualization and comparison of the relative area of innervation of the thumb CMC joint by each articular branch. RESULTS The thumb CMC joint received innervation from six nerves. These were the deep branch of ulnar nerve (DBUN), dorsal articular nerve (DAN) of the first interosseus space, thenar branch of median nerve (TBMN), palmar cutaneous branch of median nerve (PCBMN), lateral antebrachial cutaneous nerve (LACN) and superficial branch of the radial nerve (SBRN) and/or their branches. Each nerve was found to innervate different aspects of the joint. The DBUN and DAN were found to innervate the posteromedial aspect of the thumb CMC joint, the TBMN and PCBMN anterior/anteromedial aspects, LACN posterolateral/lateral/anterior aspects and SBRN posterolateral/anterolateral aspects. CONCLUSIONS The thumb CMC joint was innervated by articular branches originating from the SBRN, DAN, LACN, PCBMN, TBMN and DBUN. The documented anatomical relationships provide the foundation to inform selective diagnostic block and denervation of the thumb CMC joint. Further investigations are needed to assess the clinical implications of the current study.
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Affiliation(s)
- John Tran
- Division of Anatomy, University of Toronto, Toronto, Ontario, Canada
- Department of Physical Medicine and Rehabilitation, Parkwood Institute, London, Ontario, Canada
| | - Philip Peng
- Department of Anesthesiology and Pain Medicine, University Health Network, Toronto, Ontario, Canada
| | - Loretta Ho
- Department of Anesthesiology and Pain Medicine, University Health Network, Toronto, Ontario, Canada
| | | | - Anne Agur
- Division of Anatomy, University of Toronto, Toronto, Ontario, Canada
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Lifchez SD, Shores JT, Tuffaha SH. Small Joint Denervation of the Hand and Thumb Base: History, Anatomy, Technique, and Outcomes. J Hand Surg Am 2024; 49:592-601. [PMID: 38323946 DOI: 10.1016/j.jhsa.2023.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 11/20/2023] [Accepted: 12/11/2023] [Indexed: 02/08/2024]
Abstract
Painful arthritis of the small joints of the hand is a common condition affecting older adults, with distal interphalangeal joint and thumb carpometacarpal joint being the two most common locations. Younger adults may also develop painful arthritis after trauma and with inflammatory arthropathy. Traditional surgical approaches address the structure of the joints with either arthrodesis or arthroplasty with or without an implant. In recent decades, denervation has been reported as an alternative treatment for painful small joints that are mobile and stable. Publications on denervation often report faster surgery and recovery times than traditional surgeries that manipulate the small joint bony structures. This article reviews the history, anatomy, surgical techniques, and outcomes of denervation of the small joints of the hand.
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Affiliation(s)
- Scott D Lifchez
- Department of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, MD.
| | - Jaimie T Shores
- Department of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, MD
| | - Sami H Tuffaha
- Department of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, MD
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Moradi A, Daliri M, Rezaeian A, Hafiz H, Hajiaghajani G, Hedjazi A, Akbarzadeh A. A new magnetic internal distractor: cadaveric study of changes in trapeziometacarpal joint forces. J Hand Surg Eur Vol 2024; 49:436-443. [PMID: 37882683 DOI: 10.1177/17531934231203301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
Distraction is a new treatment for trapeziometacarpal joint osteoarthritis. The purpose of this study was to test the efficiency of magnetic distraction using a new internal distractor in cadavers. The distractor consists of two magnets embedded inside titanium capsules that are implanted on either side of the trapeziometacarpal joint with the same poles facing each other, so that the force between the magnets distracts the joint. Intra-articular forces were recorded pre-implantation, immediately after implantation and again 10 minutes later. We also studied the changes in the forces before and after the procedure in different thumb positions. Our findings show that the trapeziometacarpal joint could be offloaded in all the studied trapeziometacarpal positions.
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Affiliation(s)
- Ali Moradi
- Orthopedics Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahla Daliri
- Orthopedics Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amin Rezaeian
- Orthopedics Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hamed Hafiz
- Mechanical Engineering Department, Ferdowsi University of Mashhad, Mashhad, Iran
| | | | - Arya Hedjazi
- Legal Medicine Research Center, Tehran, Iran, Legal Medicine Organization, Tehran, Iran
| | - Alireza Akbarzadeh
- Mechanical Engineering Department, Ferdowsi University of Mashhad, Mashhad, Iran
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Ghayyad K, Golovachev N, Sarli N, Hirsch D, Shojaie B, Kachooei AR. Effectiveness of Arthroscopic Debridement, Trapeziectomy, and Joint Replacement for Trapeziometacarpal Joint Osteoarthritis: A Meta-Analysis of Pre and Postoperative Pain Scores. Cureus 2024; 16:e54409. [PMID: 38510875 PMCID: PMC10954316 DOI: 10.7759/cureus.54409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2024] [Indexed: 03/22/2024] Open
Abstract
Trapeziometacarpal joint osteoarthritis (TMJO) affects up to 33% of postmenopausal women, leading to pain, reduced mobility, and grip strength, with initial treatments focusing on non-surgical options like injections, orthoses, and exercises before considering surgery. A major challenge in managing TMJO involves selecting the optimal surgical strategy that is customized to individual clinical conditions. This study aimed to compare the effectiveness of three common surgical interventions for TMJO in relieving pain, including arthroscopic debridement (AD), trapeziectomy (TRAP), and joint replacement (JR). PubMed, Cochrane, Embase, and MEDLINE databases were queried according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for studies that presented pain outcomes following intervention for TMJO. Pain scores were reported preoperatively and postoperatively using the visual analog scale (VAS). Inclusion criteria included studies published in Q1 and Q2 journals and those with a follow-up of > six months. The final selection comprised 18 studies with 763 patients treated with AD (n = 102, 13%), TRAP (n = 428, 56%), and JR (n = 233, 31%) between 2010 and 2023, with a mean follow-up period of 38 ± 28 months. The studies included a total of 24 groups, five of which received AD, 13 of which received TRAP, and six of which received JR. The mean preoperative VAS was 6.7 ± 1.7, and the mean postoperative VAS was 1.7 ± 1.3 for all groups (P < 0.001). The meta-analysis demonstrated a mean preoperative pain score of 5.8 (95% CI, 4.1-7.5) for AD, 6.6 (95% CI, 5.7-7.5) for TRAP, and 7.8 (95% CI, 7.0-8.7) for JR. Postoperatively, there was a mean pain score of 2.2 (95% CI, 0.1-4.2) for AD, 1.4 (95% CI, 1.1-1.7) for TRAP, and 0.9 (95% CI, 0.6-1.2) for JR. This study showed that, if appropriately indicated, joint preservation with AD may be as effective as TRAP and JR for reducing pain associated with TMJO in the short term. However, the rate of conversion or revision should be assessed in future studies.
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Affiliation(s)
- Kassem Ghayyad
- Orthopedic Surgery, Rothman Orthopaedics Florida at AdventHealth, Orlando, USA
| | - Nikita Golovachev
- Orthopedic Surgery, Rothman Orthopaedics Florida at AdventHealth, Orlando, USA
| | - Nathan Sarli
- Orthopedic Surgery, Rothman Orthopaedics Florida at AdventHealth, Orlando, USA
| | - David Hirsch
- Orthopedic Surgery, Rothman Orthopaedics Florida at AdventHealth, Orlando, USA
| | - Babak Shojaie
- Plastic and Reconstructive Surgery, Klinikum Bremen-Mitte, Gottingen University of Medical Science, Bremen, DEU
| | - Amir R Kachooei
- Orthopedic Surgery, Rothman Orthopaedics Florida at AdventHealth, Orlando, USA
- Orthopedics, University of Central Florida, Orlando, USA
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Ekram R, Nazer MS. Hospital Admission Profile Due to Osteoarthritis: An Ecological Study. Cureus 2023; 15:e38435. [PMID: 37273367 PMCID: PMC10234140 DOI: 10.7759/cureus.38435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2023] [Indexed: 06/06/2023] Open
Abstract
Background Osteoarthritis (OA) is also known as degenerative joint disease and is considered the major cause of joint pain and disability. Furthermore, OA is the most common, costly, and disabling form of joint diseases. The objective of this study is to explore the hospital admission profile due to OA between the period 1999 and 2019 in England and Wales. Method This is an ecological study that used health care data in the United Kingdom. Patients who were hospitalized for OA in England and Wales between 1999 and 2019 formed the study population. The Hospital Episode Statistics in England and the Patient Episode Database for Wales databases were used in this study. The difference in the admission rate during the study period was estimated using the chi-squared test. Results The admission rate during the study period increased by 112.1% for all hospital admission related to OA. The most common type of admission was related to gonarthrosis, which accounted for 46.7% of the total number of admissions for OA. The increase in admission rate across different types of admissions related to OA was not consistent. The highest increase in the admission rate was observed for polyarthrosis (604.6%). Admission rates related to OA were observed to be directly related to age. The highest increase in the admission rate during the study period was for the age group of 15-59 years (102.1%). Admission rate due to OA was higher among females compared to males. Conclusion The increase in admission rates for the various OA-related admissions was not consistent. This study found that the age range of 15 to 59 years experienced the greatest increase in admission rates. Female gender is a high risk factor for OA, especially in women around menopause.
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Affiliation(s)
- Rakan Ekram
- Department of Health Information Technology and Management, Faculty of Public Health and Health Informatics, Umm Al-Qura University, Makkah, SAU
| | - Mai S Nazer
- Department of Internal Medicine, King Abdullah Medical Complex, Jeddah, SAU
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Hustedt JW, Deeyor ST, Hui CH, Vohra A, Llanes AC, Silvestri BL. A Prospective Clinical Trial Comparing Denervation With Suspension Arthroplasty for Treatment of Carpometacarpal Arthritis of the Thumb. J Hand Surg Am 2023; 48:348-353. [PMID: 36737280 DOI: 10.1016/j.jhsa.2022.11.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 10/28/2022] [Accepted: 11/16/2022] [Indexed: 02/05/2023]
Abstract
PURPOSE Trapeziectomy with suspensionplasty is the most popular treatment for thumb carpometacarpal arthritis. However, carpometacarpal denervation has recently shown promise as an alternative treatment option. This study was designed to compare functional outcomes, pain reduction, and quality of life between denervation and suspension arthroplasty in patients treated for thumb carpometacarpal osteoarthritis. METHODS We conducted a prospective clinical trial between June 2020 and December 2021. Preoperative and postoperative evaluations were conducted on patients, including the evaluation of functional outcomes via the Michigan Hand Outcomes Questionnaire, pain with the visual analog score, quality of life with the EuroQol-5D, and the evaluation of time to return to function. Outcomes and complications were compared between patients undergoing denervation versus arthroplasty. RESULTS Forty-eight patients were included in the study, 34 of whom underwent denervation and 14 underwent suspension arthroplasty of the thumb carpometacarpal joint. Patients in the denervation group were younger, with an average age of 59 years compared with 67 years in the arthroplasty group. All other patient characteristics were similar. Pain reduction, functional outcomes, and quality of life scores showed equal improvement in both groups. Denervation patients had a reduced time to return to function (3.3 weeks vs 4.5 months in the arthroplasty group). CONCLUSIONS Carpometacarpal denervation appears to provide similar short-term outcomes as suspension arthroplasty for the treatment of thumb carpometacarpal arthritis. Treatment with denervation may offer a quicker return to function. The long-term outcomes of denervation remain unknown. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Joshua W Hustedt
- Department of Orthopedic Surgery, The University of Arizona College of Medicine-Phoenix, Phoenix, AZ.
| | - Sorka T Deeyor
- Department of Orthopedic Surgery, The University of Arizona College of Medicine-Phoenix, Phoenix, AZ
| | - Clayton H Hui
- Department of Orthopedic Surgery, The University of Arizona College of Medicine-Phoenix, Phoenix, AZ
| | - Arjun Vohra
- Department of Orthopedic Surgery, The University of Arizona College of Medicine-Phoenix, Phoenix, AZ
| | - Aaron C Llanes
- Department of Orthopedic Surgery, The University of Arizona College of Medicine-Phoenix, Phoenix, AZ
| | - Briana L Silvestri
- Department of Orthopedic Surgery, The University of Arizona College of Medicine-Phoenix, Phoenix, AZ
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Rath R, Haerle M, Stollberg C, Herrmann S, Lampert F. Denervation of the thumb carpometacarpal joint for symptomatic osteoarthritis in 46 patients. HAND SURGERY & REHABILITATION 2023; 42:51-55. [PMID: 36436810 DOI: 10.1016/j.hansur.2022.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/30/2022] [Accepted: 11/19/2022] [Indexed: 11/25/2022]
Abstract
We investigated the effect of an extended denervation procedure in the thumb carpometacarpal (CMC) joint in patients suffering from CMC osteoarthritis. Between 2006 and 2018, 46 patients underwent the procedure in our clinic and were included in this retrospective study. Pain, strength, range of motion, DASH score, complications and overall satisfaction were determined. Assessment showed a significant decrease in pain and excellent physical function at a median 5 years' follow-up. Twelve patients needed secondary surgery due to persistent pain. Overall, 28 of the 46 patients were satisfied with the results of the denervation. Even though the results of CMC denervation are poorer than with simple trapeziectomy, considerable pain relief can be achieved in selected young, physically active patients by exclusively soft-tissue surgery, conserving the biomechanical properties of the joint. In case of failure of the procedure, all other options remain available.
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Affiliation(s)
- R Rath
- Clinic for Hand Surgery and Plastic Surgery, Orthopädische Klinik Markgröningen, Kurt-Lindemann-Weg 10, 71706 Markgröningen, Germany; Clinic for Hand, Plastic and Aesthetic Surgery, Klinikum Bad Cannstatt, Prießnitzweg 24, 70374 Stuttgart, Germany.
| | - M Haerle
- Clinic for Hand Surgery and Plastic Surgery, Orthopädische Klinik Markgröningen, Kurt-Lindemann-Weg 10, 71706 Markgröningen, Germany.
| | - C Stollberg
- Clinic for Hand Surgery and Plastic Surgery, Orthopädische Klinik Markgröningen, Kurt-Lindemann-Weg 10, 71706 Markgröningen, Germany; Clinic for Plastic and Aesthetic Surgery, Pflugfelder Straße 22, 71636 Ludwigsburg, Germany.
| | - S Herrmann
- Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106 Freiburg, Germany.
| | - F Lampert
- Clinic for Hand Surgery and Plastic Surgery, Orthopädische Klinik Markgröningen, Kurt-Lindemann-Weg 10, 71706 Markgröningen, Germany; Department of Plastic and Hand Surgery, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106 Freiburg, Germany.
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