Basal thumb arthritis

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.

Proposed Radiographic Parameters to Optimize Clinical Outcomes in Trapezio-Metacarpal Prosthesis Placement Using CT Imaging, with 1-Year Follow-Up

PURPOSE

Addressing trapezio-metacarpal (TMC) osteoarthritis often involves considering TMC joint replacement. Utilizing TMC prostheses offers advantages such as preserving the thumb length and more accurately replicating the thumb's range of motion (ROM). TMC prostheses have an intrinsic risk of dislocation and aseptic loosening. Analyzing pre- and postoperative imaging can mitigate complications and improve prosthetic placement, providing insights into both successes and potential challenges, refining overall clinical outcomes.

MATERIALS AND METHODS

We conducted a prospective analysis of 30 patients with severe TMC arthritis treated with a Touch© (Kerimedical, Geneva, Switzerland) prosthesis in 2021-2023: X-ray and CT protocols were developed to analyze A) the correct prosthesis placement and B) its correlation with clinical outcomes (VAS, Kapandji and QuickDASH scores) by performing Spearman correlation analysis.

RESULTS

The average differences in trapezium height and M1-M2 ratio pre- and post-surgery were, respectively, 1.8 mm (SD ± 1.7; p < 0.001) and 0.04 mm (SD ± 0.04; p = 0.017). Pre-to-postoperative M1 axis length increased by an average of 2.98 mm (SD ± 3.84; p = 0.017). Trapezial cup sinking, indicated by the trapezium index, measured 4.6 mm (SD ± 1.2). The metacarpal index averaged at 11.3 mm (SD ± 3.3). The distance between the centers of the trapezium distal surface and the prosthesis cup was 2.23 mm (SD ± 1.4). The Spearman correlation analysis gave the following results: negative correlations were highlighted between postoperative VAS scores and the M1/M2 ratio and residual trapezium height (correlation coefficient: -0.7, p = 0.03 and -0.064, p = 0.03, respectively) at 6 months; a negative correlation was found at the 3-month mark between QuickDASH and the trapezium residual height (correlation coefficient: -0.07, p = 0.01); and a positive correlation was found for the trapezium index at 1 month (correlation coefficient: 0.07, p = 0.03) and 3 months (p = 0.04) using the Kapandji score. Similarly, we found a positive correlation between the distance between the prosthesis and trapezium centers and QuickDASH score at 1 and 3 months (correlation coefficient: 0.066, p = 0.03; correlation coefficient: 0.07, p = 0.05, respectively) and a positive correlation between prosthesis axis and the residual first metacarpal angle with QuickDASH score at 3 months (correlation coefficient: 0.07, p = 0.02).

CONCLUSIONS

Pre- and postoperative systematic imaging analysis should become a method for predicting complications and guiding recovery in TMC prosthesis: CT imaging could provide us with radiographical landmarks that are intrinsically linked to clinical outcomes. Further research is necessary to fuel a protocol for the correct intraoperative TMC prosthesis implantation.

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.

Outcomes of First Metacarpal Extension Osteotomy for Base of Thumb Arthritis

BACKGROUND

First metacarpal extension osteotomy (FMEO) aims to correct the adduction deformity associated with thumb arthritis, as well as improve the congruity at the first carpometacarpal (FCMC) joint. However, the benefits of this procedure are currently unclear. The purpose of this study is to investigate the outcomes of FMEO in the treatment of FCMC joint arthritis.

METHODS

Electronic databases were searched systematically for original data studies in the English language reporting outcomes following FMEO for base of thumb arthritis. Data were extracted from the text, tables, and figures of publications and meta-analyzed where possible.

RESULTS

Ten publications comprising 211 thumbs were included. FMEO was associated with an improvement in pain relief and patient-reported functional outcomes, however meta-analysis showed no significant long-term improvement in grip strength or lateral pinch grip. Although there was disease progression in one third of patients after FMEO, most did not require further procedures. Outcomes following secondary procedures was not analyzed in the literature. FMEO produced a range of minor complications, however, major complications were rare.

CONCLUSIONS

The available evidence suggests FMEO does not improve grip or pinch strength. However, it may have a role in analgesia and improvement in functional outcomes. Further studies should compare outcomes of FMEO to continued nonoperative treatment, or other surgical options including arthroscopy or ligamentous reconstruction.

A Meta-analysis of Surgical Interventions for Base of Thumb Arthritis

Background  There is a myriad of available surgical options for thumb carpometacarpal joint (CMCJ) arthritis and no robust evidence exists to guide the decisions of treating surgeons. Our aim was to assess the comparative effectiveness of different surgical interventions available for the treatment of thumb CMCJ arthritis. Methods  We performed a systematic review, pairwise, and network meta-analysis of all randomized studies comparing surgical interventions for thumb CMCJ arthritis. Our primary outcomes were pain, function, and key pinch strength at long-term follow-up (> 6 months). Risk of bias and certainty of evidence were assessed for each outcome measure of compared interventions separately. Clinical recommendations were based on evidence of strong or moderate certainty. Results  A total of 17 randomized studies were included in the systematic review. Where possible, pairwise and network meta-analyses were performed. Based on evidence of moderate certainty, trapeziectomy with a concomitant ligament reconstruction and tendon interposition (LRTI) does not appear to be associated with any long-term clinical benefits compared with simple trapeziectomy (function: mean difference [MD] -3.72 [-9.15, 1.71], p  = 0.64 favoring simple trapeziectomy; key pinch strength: MD 0.07 kg [-0.28, 0.43], p  = 0.68 favoring trapeziectomy with LRTI). Treatment rankings from the network meta-analysis favored trapeziectomy with and without LRTI, joint replacement, and arthrodesis. Trapeziectomy with LRTI appears to be associated with fewer major complications compared with joint replacement and arthrodesis, and more minor complications compared with simple trapeziectomy. Conclusion  Until further high-quality research indicates otherwise, simple trapeziectomy should be the preferred surgical modality for base of the thumb arthritis. Level of Evidence  This is a Level 1 study.

First Carpometacarpal Joint Denervation: A Systematic Review

PURPOSE

The first carpometacarpal (CMC) joint is a frequent location of osteoarthritis in the hand. The denervation of the first CMC joint has gained traction as a viable treatment for CMC arthritis. This study reviewed literature on CMC denervation for first CMC arthritis.

METHODS

A systematic review of papers and abstracts was conducted. The preferred reporting items for systematic reviews and meta-analyses guidelines were followed. Articles including the results of CMC denervation were included. We compiled data on patient demographics, preoperative testing, intraoperative technique, and postoperative outcomes. Anatomic literature was also reviewed to assess agreement on the innervation of the first CMC joint.

RESULTS

Six anatomic studies and 9 clinical studies were included in this systematic review. Pinch strength, grip strength, and Kapandji scores increased on average in patients. Pain relief was noted on average in patients in 5 studies that reported pain outcomes. In studies that reported postoperative complications, the most frequent complications were radial paresthesias, hypoesthesia dorsal and/or distal to the surgical site, and wound infection.

CONCLUSIONS

The innervation of the CMC joint is controversial. This is reflected in clinical practice, wherein varied surgical approaches are used. Carpometacarpal denervation shows promise as an option to treat patients with CMC arthritis without joint instability, but its results vary. Additional clinical studies with longer-term follow-up and control groups are necessary to better determine its longevity and efficacy.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic V.

Is superficial radial nerve affected in patients with hand osteoarthritis?

INTRODUCTION

Patients with superficial radial neuropathy (SRN) have pain and abnormal sensation on the hand similar to hand osteoarthritis (HOA).

PURPOSE OF THE STUDY

The aim of the present study was to evaluate the presence of SRN in patients with HOA and to determine the factors associated with electrophysiological parameters of the radial nerve.

STUDY DESIGN

This is a case-control study.

METHODS

A total of 138 patients were included in this study. Only the dominant hand of each patient was evaluated. Patients were divided into 2 groups: Group 1 (without SRN) or Group 2 (with SRN) by electrophysiological examination. The presence of osteoarthritis in the first carpometacarpal (1st CMC) joint was investigated. Radiological features of the hands were evaluated with Kellgren-Lawrence grading system. Sonographically, the presence of synovitis in the 1st CMC joint was examined with gray scale and synovial blood flow signal by power Doppler imaging. Erosion and osteophyte scoring were performed for 15 joints. The 1st extensor compartment of wrist's cross-sectional area was measured.

RESULTS

SRN was detected in 68.8% of the patients. High Kellgren-Lawrence scores (P = .027), presence of synovitis in the 1st CMC joint (P = .003), and increased cross-sectional area of the 1st extensor compartment of wrist (P = .005) were found to be independent risk factors for reduced superficial radial nerve conduction velocity.

CONCLUSIONS

Sensory symptoms in patients with HOA might be due to the involvement of the superficial branch of the radial nerve.

Clinical Overview of Arthritis with a Focus on Management Options and Preventive Lifestyle Measures for Its Control

ABSTRACT:

Arthritis is the spectrum of conditions that cause swelling and tenderness of one or more body joints with key symptoms of joint pain and stiffness. Its progression is closely tied to age. Although there are a number of arthritis types, such as, ankylosing, gout, joint infections, juvenile idiopathic, reactive and septic; the two most common types are osteoarthritis and rheumatoid arthritis. Osteoarthritis causes the articulating smooth cartilage that covers the ends of bones, where they form a joint, to breakdown. Rheumatoid arthritis is a disease in which the immune system attacks joints, beginning with the cartilaginous lining of the joints. The latter is considered a systemic disease, i.e. affecting many parts of the body, but the respiratory system is involved in 10 to 20 % of all mortality. Osteoarthritis is one of the leading causes of disability globally. Several preventive measures to control arthritis have been suggested, such as the use of analgesics, non-steroid anti-inflammatory drugs, moderate to vigorous physical activity and exercise, reducing sedentary hours, getting adequate sleep and maintaining a healthy body weight. Foods including, a Mediterranean diet rich in fruits and vegetables, fish oil, medicinal plants and microbiota are vital protective methods. The intake of vitamins such as A and C, minerals e.g., selenium and zinc; poly unsaturated and n-3 fatty acids is also a significant preventive measures.

Botulinum Toxin Injection for Painful Adductor Pollicis Contracture after Thumb Carpometacarpal Resection Arthroplasty

Pollux adductus deformity is an accompanying symptom of thumb carpometacarpal osteoarthritis. We describe a case of a patient who presented with increased muscle tone of the adductor pollicis muscle and chronic pain in the thenar musculature, i.e., recurrence of an adduction deformity. The patient reported a symptom-free period of 5.5 years after having received resection-suspension-arthroplasty for stage IV thumb carpometacarpal osteoarthritis until spasmodic pain appeared. Due to the functional impairment of this condition, we administered therapy including 100 units of Botox^® (onabotulinumtoxinA, Allergan, Dublin, Ireland) injected with a fanning technique into the adductor pollicis muscle. Thus, we observed a substantial improvement in the patient-reported outcome measures as well as pain levels compared with initial values. The current case shows the pivotal role of the adductor pollicis muscle when patients report pain at the base of the thumb, which can cause considerable impairments despite the complication-free surgical treatment of thumb CMC OA.

Concurrent validity and precision of the thumb disability examination (TDX) in first carpometacarpal osteoarthritis

STUDY DESIGN

A descriptive psychometric study of precision and concurrent validity of the Thumb Disability Examination (TDX).

INTRODUCTION

Thumb carpometacarpal osteoarthritis (CMC OA) is a painful joint condition impacting the functionality of the hand. Therapists use patient-reported outcome measures to evaluate change in disability and symptomology in response to interventions. The TDX is the only condition-specific outcome measure for persons with thumb CMC OA. Its responsiveness, test-retest reliability and concurrent validity with the DASH are published, yet it's precision and concurrent validity with a hand-region-specific tool has not yet been established.

PURPOSE OF THE STUDY

We aimed to determine the precision and concurrent validity of the TDX with a region-specific outcome measure in people with thumb CMC OA.

METHODS

Sixteen individuals with a medical diagnosis of CMC OA or a positive pressure-shear test completed the TDX across two visits and the Brief Michigan Hand Questionnaire (bMHQ) at the initial visit. The second visit was 7 to 21 days after the first. Self-administration of the TDX and bMHQ were observed by a licensed occupational therapist.

RESULTS

Across total and subscale scores of the TDX, standard error of measurement (SEM) values are used to indicate the precision of tool and demonstrate how confident a user can be that change in score exceeds the error inherent to the tool. Minimal detectable change percentage (MDC%) values for the TDX are acceptable (<30%). The TDX demonstrated high concurrent validity with the bMHQ (r_s = -0.733; P = .001).

DISCUSSION

Precision of the TDX is acceptable and the concurrent validity of the TDX with a commonly used region-specific scale is high. The study was limited by a small, demographically homogeneous sample due to difficulty in recruitment.

CONCLUSIONS

The TDX is a precise and valid outcome measure for individuals having a clinical diagnosis or indications of having thumb CMC OA.

Immobilization protocols following trapeziectomy for osteoarthritis of the thumb: 2 weeks versus 4 weeks

We compared the clinical outcomes of post-trapeziectomy protocols according to their duration. The main hypothesis was that there would be no significant difference in postoperative function whether immobilization duration was 2 or 4 weeks. The secondary hypotheses were that there would be no significant difference in postoperative pain, motion, or strength. 40 trapeziectomies were reviewed. Two weeks' postoperative commissural immobilization was systematic. Patients were then divided in two groups. For the first 20 patients (group I), immobilization stopped at 2 weeks. For the next 20 patients (group II) it was replaced by a splint for further 2 weeks. We compared mean pre- and post-operative (10-20 weeks) function (QuickDASH score), pain (visual analog scale - VAS), thumb opposition (Kapandji score) and strength (palmar pinch test) between the two groups. There was no significant difference between groups in postoperative values or in pre- to post-operative progression. The main hypothesis was confirmed: there was no significant difference in the postoperative function whether the immobilization was for 2 or 4 weeks. The secondary hypotheses regarding postoperative pain, motion and strength were also confirmed.

Radiosynovectomy is effective in thumb basal joint arthritis

OBJECTIVE

Radiosynovectomy (RSO) describes the internal low-dose radiotherapy of the synovia via intra-articular administration of small radioactive particles. Since the introduction of biologics, the main aetiology of arthritic joints for RSO changed to mostly osteoarthritis with concordant change in typically affected joints. Thus, the effect of RSO in thumb basal joint arthritis (BJTh) with focus on osteoarthritis needs to be explored.

DESIGN

From 2017 to 2020, 219 BJTh were treated in 125 patients, 17 patients with rheumatoid arthritis (RA) and 108 patients with osteoarthritis (OA). The therapeutic effect was assessed using a four-step subjective scoring.

RESULTS

20% of the treated joints were symptom free, 48% had a very good response, 16% slight and 16% no response. RSO was performed in 71 patients singularly and in 54 patients repetitively. The mean response duration was 6.8 months with a maximum of 48 months. 35% of patients had post-therapeutic pain relief followed by relapse after 3 months. Response duration showed no significant difference the between first and repetitive therapy, primary responder and primary non-responder and RA and OA.

CONCLUSION

In thumb basal joint arthritis, RSO leads to response rates from 66 to 79%, mean response duration from 6 to 12 months and individual response duration 48 months. The present results are in line with previously published response rates in smaller joints. In respect to 35% of patients with relapse within 3 months post-therapy, we recommend a primary follow-up after 3-4 months.

Cost Analysis and National Trends in the Treatment of Thumb Basal Arthritis: Comparing Ligament Reconstruction/Tendon Interposition and Trapeziectomy/Hematoma Distraction Arthroplasty

BACKGROUND

Thumb basal arthritis (TBA) is a common form of arthritis characterized by wearing away of cartilage in the crarpometacarpal joint at the base of the thumb. The purpose of the study was to analyze cost trends of the 2 common surgical treatments options: ligament reconstruction/tendon interposition (LRTI) and trapeziectomy/hematoma distraction arthroplasty (THDA).

METHODS

The Vizient Clinical Data/Resource Manager electronic database was reviewed for the 3 treatment procedures of TBA from January 1, 2016, to December 31, 2019. Cases were placed into 1 of 2 categories: LRTI or THDA. Total and direct costs were averaged and compared nationally and regionally. One-tailed t test and Pearson correlation analyses were performed (P < 0.05 and r > 0.9 or r < -0.9 was considered significant).

RESULTS

A total of 28,887 total cases (26,405 LRTI, 2482 THDA) were analyzed. There was a 49% increase in number of surgical procedures to treat TBA between 2015 and 2018. Ligament reconstruction/tendon interposition (91%) had larger market share than THDA (9%). However, market share percentage of each procedure stayed the same over time. Trapeziectomy/hematoma distraction arthroplasty had lower average cost (US $4157) compared with that of LRTI (US $4446, P = 0.06) However, THDA had a significant positive trend in cost, increasing 14% in 4 years. In 2019, 30% of procedures performed were in the Midwestern United States, 27% Northeastern United States, 24% Southern United States, and 19% Western United States.

CONCLUSIONS

Most patients with TBA seem to be treated with LRTI. The market share seems to be greatest for LRTI and lowest for THDA nationally and regionally. Although the average cost for THDA was less than that of LRTI, this difference was not significant.

Discrepancies in conservative treatment for thumb carpometacarpal arthritis: a comparison between different specialities and patient characteristics

Non-surgical treatment is successful in controlling pain and preventing disease progress in treating thumb carpometacarpal arthritis. We used Optum's de-identified Clinformatics® Data Mart Databases between 2015 and 2018 to conduct a study of the patient and provider characteristics associated with three types of non-surgical treatment (hand therapy, splinting and corticosteroid injection) prior to surgery. In this population-based cohort study, we found that non-surgical providers were more likely to provide three different types of non-surgical treatments, as compared with hand surgeons. In addition, women and patients with comorbid conditions, including carpal tunnel syndrome, obesity, chronic pain and depression, were less likely to exhaust the available non-surgical management options for thumb carpometacarpal arthritis. Therefore, we suggest that these specific patient populations can potentially benefit from additional non-surgical treatments that may delay or obviate surgery for this disease. These groups are target populations for future efforts to ensure that all patients receive equitable care.Level of evidence: II.

Metacarpophalangeal joint hyperextension in rhizartrosis: is surgical correction necessary?

BACKGROUND AND AIM

Rhizarthrosis represents 10% of all arthritic manifestations and its prevalence increases with age and in women. The hyperextension of the metacarpophalangeal joint (MCPj) is consequent to a progressive dorsoradial subluxation of the trapeziometacarpal joint (TMj) in advanced osteoarthritis. The aim of this retrospective study is to evaluate the clinical and functional results of 32 patients affected by advanced rhizarthrosis who underwent to modified Burton-Pellegrini's trapeziectomy in absence of surgical correction of MCPj hyperextension in order to understand when this last step is really necessary.

METHODS

Patients were assessed trough DASH and PRWHE questionnaires; the functionality of the hand was assessed by carrying out specific test (grip strength, key-pinch, kapandji test, reduction of wrist flexion strength) and the degree of MCP joint hyperextension was recorded.

RESULTS

Clinical evaluation and individual satisfactory were positive in most cases (mean DASH 19 and mean PRWHE 21.8, with a reduction of 77% of VAS pain score). Kapandji test was excellent in 26 patients and grip strength and key pinch were stackable in operated and non-operated hands. Twenty-five out 32 patients presented a MCP joint hyperextension between 0° and 5°, 5 of 10° and other 2 of 15°.

CONCLUSION

Modified Burton-Pellegrini's trapeziectomy is a valid option to treat patient with TMj osteoarthritis. The absence of surgical correction of the MCPj does not affect clinical and functional results in deformities <15°.

Musculoskeletal ultrasound in symptomatic thumb-base osteoarthritis: clinical, functional, radiological and muscle strength associations

Background

Thumb-base osteoarthritis (OA) is a common cause of pain and disability This study aimed to investigate the associations of musculoskeletal ultrasound OA pathologies with the extent of pain, function, radiographic scores, and muscle strength in symptomatic thumb-base osteoarthritis.

Methods

This is a cross-sectional study of an ongoing clinical trial with eligibility criteria including thumb-base pain on Visual Analogue Scale (VAS) ≥40 (0 to 100 mm), Functional Index for Hand OA (FIHOA) ≥ 6 (0 to 30) and Kellgren Lawrence (KL) grade ≥ 2. The most symptomatic side was scanned to measure synovitis and osteophyte severity using a 0–3 semi-quantitative score, power Doppler and erosion in binary score. A linear regression model was used for associations of ultrasound findings with VAS pain, FIHOA and hand grip and pinch strength tests after adjusting for age, gender, body mass index, disease duration and KL grade as appropriate. For correlation of ultrasound features with KL grade, OARSI ((Osteoarthritis Research Society International) osteophyte and JSN scores, Eaton grades, Spearman coefficients were calculated, and a significant test defined as a p-value less than 0.05.

Results

The study included 93 participants (mean age of 67.04 years, 78.5% females). Presence of power Doppler has a significant association with VAS pain [adjusted β coefficient = 11.29, P = 0.02] while other ultrasound pathologies revealed no significant associations with all clinical outcomes.

In comparison to radiograph, ultrasonographic osteophyte score was significantly associated with KL grade [r_s = 0.44 (P < 0.001)], OARSI osteophyte grade [r_s = 0.35 (P = 0.001)], OARSI JSN grade [r_s = 0.43 (P < 0.001)] and Eaton grade [r_s = 0.30 (P < 0.01)]. Ultrasonographic erosion was significantly related with radiographic erosion [r_s = − 0.49 (P = 0.001)].

Conclusion

From a clinical perspective the significant relationship of power Doppler with pain severity in thumb base OA suggests this might be a useful tool in understanding pain aetiology. It is important to recognise that power Doppler activity was only detected in 14% of the study so this might be an important subgroup of persons to monitor more closely.

Trial registration

Registered at Australian New Zealand Clinical Trials Registry (ANZCTR), http://www.anzctr.org.au/, ACTRN12616000353493.

The AUSCAN and PRWHE Demonstrate Comparable Internal Consistency and Validity in Patients With Early Thumb Carpometacarpal Osteoarthritis

BACKGROUND

The Australian/Canadian Osteoarthritis Hand Index (AUSCAN) and Patient-Rated Wrist-Hand Evaluation (PRWHE) are 2 patient-related outcome measures to assess pain and disability in patients with osteoarthritis (OA). The purpose of this study was to evaluate the AUSCAN and PRWHE in a large-scale, longitudinal cohort of patients with early thumb carpometacarpal (CMC) OA.

METHODS

We obtained baseline data on 135 individuals (92 with early CMC OA participants and 43 asymptomatic controls) and at follow-up (year 1.5) on 83 individuals. We assessed the internal consistency using Cronbach alpha, and construct and criterion validity using other pain scales and objective measures of strength, respectively. We also examined the correlation between the AUSCAN and PRWHE and correlation coefficients at baseline and follow-up, as well as the correlation between changes in these instruments over the follow-up period.

RESULTS

Internal consistency was high for both AUSCAN and PRWHE totals and subscales (Cronbach α > 0.70). Both instruments demonstrated construct validity compared with the Verbal Rating Scale ( r = 0.52-0.60, P < .01), an assessment of pain, and moderate criterion validity compared with key pinch and grip strength ( r = -.24 to -.33, P < .05). These instruments were highly correlated with each other at baseline and follow-up time points ( r = 0.76-.94, P < .01), and changes in a patient's total scores over time were also correlated ( r = 0.83, P < .01).

CONCLUSIONS

The AUSCAN and PRWHE are both valid assessments for pain and/or disability in patients with early thumb CMC OA.

Axial Rotation Test for Trapeziometacarpal Joint Hypermobility in the Normal Population

Background: The objective was to quantify joint laxity in healthy volunteers by measuring the passive axial rotation of the trapeziometacarpal joint using the axial rotation test.

Methods: Eighty volunteers (34 men and 46 women) were subjected to the axial rotation shear test and the degree of total rotational motion (TRM) was assessed. Volunteers were divided into Group I with a range of 18–50 years old and Group II for 51 years and older. Statistical analysis was performed.

Results: The average TRM in Group I was 32.3 mm for women, and 27.4 mm, for men (p = 0.04). The average TRM in women of Groups I and II, was 32.3 and 21.6 mm respectively, (p < 0.001). The average TRM in men of Groups I and II, was 27.4 and 19.4 mm (p < 0.001). In Group II the average TRM of women was 21.6 mm, and for men was 19.4 mm, which was not significantly different.

Conclusions: Young women have greater degree of rotational laxity in the TM joint compared to men of the same age group and to older women. The axial rotation test can quantify the degree of rotational laxity of the TM joint.

Are Carpal Tunnel Syndrome and Regional Degenerative Osteoarthritis Linked? Results of a Case-Control Study

Background: Causality has not been formally demonstrated between carpal tunnel syndrome and osteoarthritis of the wrist or at the base of the thumb. The purpose of this study was to assess the relationship between carpal tunnel syndrome and concomitant degenerative osteoarthritis of the wrist or basal thumb joint. We hypothesised that wrist osteoarthritis by reducing the free volume of the carpal tunnel would be associated with carpal tunnel syndrome, while basal thumb osteoarthritis would show no direct correlation with carpal tunnel syndrome.

Methods: A case-control study including 95 cases and 99 control subjects, has been carried out. Sixty-eight per group were matched for age and sex. Posterior-anterior and lateral plain wrist radiographs for the two matched groups were analysed.

Results: Except for scaphotrapeziotrapezoid location, degenerative osteoarthritis of the wrist was significantly linked with carpal tunnel syndrome, whereas there was no significant difference between case and control groups for prevalence of basal osteoarthritis of the thumb.

Conclusions: These results suggest that basal osteoarthritis of the thumb is not a causal factor in carpal tunnel syndrome. In contrast, degenerative osteoarthritis of the wrist was strongly associated with carpal tunnel syndrome, suggesting a causal relation.

Trapeziometacarpal joint contact varies between men and women during three isometric functional tasks

Trapeziometacarpal (TMC) joint osteoarthritis (OA) affects women two to six times more than men, and is influenced by stresses and strains in the cartilage. The purpose of this study was to characterise sex and age differences in contact area and peak stress location of the healthy TMC joint during three isometric tasks including pinch, grasp and jar twist. CT images of the hand from 50 healthy adult men and women were used to create a statistical shape model that was used to create finite element models for each subject and task. Force-driven simulations were performed to evaluate cartilage contact area and peak stress location. We tested for sex and age differences using Principal Component Analysis, linear regression, and Linear Discriminant Analysis. We observed sex differences in peak stress location during pinch (p = .0206), grasp (p = .0264), and jar twist (p = .0484). The greatest sex differences were observed during jar twist, where 94% of peak stresses in men were located in the centre compared with 50% in the central-volar region in women. These findings show that peak stress locations are more variable in women during grasp and jar twist than men, and suggest that women may employ different strategies to perform these tasks.

The effectiveness of orthoses in the conservative management of thumb CMC joint osteoarthritis: An analysis of functional pinch strength

STUDY DESIGN

The study was a retrospective cohort analysis for a 19-month period from May 2013 to December 2014.

INTRODUCTION

Although the use of orthoses has long been a staple of conservative treatment measures for individuals with osteoarthritis of the thumb carpometacarpal (CMC) joint, there remains little evidence exploring its effectiveness in improving functional outcomes for this client population.

PURPOSE OF THE STUDY

The purpose of this study was to assess the effectiveness of 3 frequently used orthoses in improving the functional pinch strength of adults with a diagnosis of thumb CMC joint osteoarthritis.

METHODS

A retrospective cohort analysis was conducted to determine whether pinch strength improved after orthotic fabrication, and fitting in patients referred to a hand therapy clinic.

RESULTS

Patients who received a Colditz design orthosis had a mean increase of 2.64 lb with regard to functional pinch strength after orthotic fabrication and fitting. Patients who received a Comfort Cool orthosis (North Coast Medical, Morgan Hill, CA) had a mean increase of 2.47 lb, whereas patients who received a Thumb Spica orthosis had a mean increase of 3.25 lb. There was no evidence of any statistically significant difference in the average improvements in pinch strength between the Colditz design orthosis and the Comfort Cool orthosis.

CONCLUSIONS

Results from this study demonstrate that orthosis wear consistently increases the functional pinch strength of individuals with thumb CMC joint osteoarthritis. Large-scale multisite research studies comparing various orthotic designs are necessary to help therapists determine best practice interventions for the conservative management of thumb CMC joint osteoarthritis.

LEVEL OF EVIDENCE

2(c).

Evaluation of Physical Examination Tests for Thumb Basal Joint Osteoarthritis

BACKGROUND

We compare the ability of 3 diagnostic tests to reproduce the pain of basilar joint arthritis (BJA): the grind test, the lever test (grasping the first metacarpal just distal to the basal joint and shucking back and forth in radial and ulnar directions), and the metacarpophalangeal extension test.

METHODS

Sixty-two patients with thumb BJA were enrolled. The 3 tests were performed in a random order on both hands of each patient. Prior to testing, patients reported their typical pain level and subsequently rated their pain after each test on a 0 to 10 scale, also specifying the extent to which the test reproduced their thumb pain (fully, partially, not at all). All patients had radiographs that displayed basal joint arthritis. A test was defined as positive for BJA if pain produced was greater than 0. Sensitivity and specificity for each test were calculated using the patients' history of pain localized to the basal joint and BJA diagnosis on radiographs as the gold standard.

RESULTS

The lever test produced the greatest level of pain and best reproduced the presenting pain. The lever test also had the highest sensitivity, high specificity, and the lowest false-negative rate. The grind test had the lowest sensitivity, highest specificity, and highest false-negative rate.

CONCLUSIONS

The lever test was the diagnostic test that best reproduced the pain caused by thumb basal joint osteoarthritis. We recommend using the lever physical examination test when evaluating the patient with suspected basal joint osteoarthritis. The often-quoted grind test is of limited diagnostic value.

Measuring thumb range of motion in first carpometacarpal joint arthritis: The inter-rater reliability of the Kapandji Index versus goniometry

Introduction

Goniometric measurement of thumb range of motion is often used as an outcome measure in assessing patients with first carpometacarpal osteoarthritis. Despite common use and demonstrated construct validity, the reliability of this technique has not been well established. The Kapandji Index is an alternate functional measure of thumb motion suitable for use with this client group. The purpose of this study was to examine the inter-rater reliability of the goniometric measures for thumb joint range of motion compared to the Kapandji Index in patients with first carpometacarpal joint osteoarthritis.

Methods

Two independent assessors, who were blind to each other’s measurements, measured thumb range of motion in 33 patients (54 thumbs). All participants were undergoing treatment for carpometacarpal joint osteoarthritis. Active range of motion was measured with a goniometer for all the thumb joints using a standardised measurement protocol. The Kapandji Index score was recorded. Relative reliability was assessed by using the intraclass correlation coefficient. Absolute reliability was also calculated by determining the standard error of measurement (SEM68) and the minimal detectable difference (MDD90).

Results

Inter-rater reliability for the goniometer was highly variable ranging from poor to excellent (intraclass correlation coefficient 0.128–0.860). The SEM68 ranged from 9° to 13°, and the resulting MDD90 varied from 21° to 31° for the different thumb joints. The Kapandji Index had excellent inter-rater reliability among the different raters (intraclass correlation coefficient 0.772–0.917).

Conclusions

Measurement of goniometric active range of motion of the thumb may have limited utility as a measure of clinical effectiveness for patients with carpometacarpal joint osteoarthritis. However, the Kapandji Index is a reliable measure of functional range of motion.

Efficacy of treatments and pain management for trapeziometacarpal (thumb base) osteoarthritis: protocol for a systematic review

INTRODUCTION

The thumb is essential for daily activities. Unfortunately, this digit is commonly affected by trapeziometacarpal osteoarthritis (TMO), handicapping a large number of individuals. TMO constitutes an increasing human and economic burden for our society whose population is ageing. Limited access to adequate treatment is among the most important obstacles to optimal TMO management. Poor understanding of TMO characteristics, lack of knowledge about evidence-based treatments, simplistic pain management plans based solely on the patient's physical condition, absence of interprofessional communication and lack of multidisciplinary treatment guidelines contribute to inadequate TMO management. On the long term, our research project aims at improving the quality of care and services offered to patients with TMO by developing a patient-centred, evidence-based multidisciplinary management clinical pathway coordinated across the healthcare system. This proposed systematic review is a prerequisite to ensuring evidence-based practices and aims to document the efficacy of all the existing modalities for TMO management.

METHODS AND ANALYSIS

The protocol of the systematic review is registered with PROSPERO and will be conducted using the guidelines Cochrane Handbook for Systematic Reviews of Interventions. We will identify studies in English and French concerning TMO treatments through searches in Cochrane Central, EMBASE, MEDLINE, PsychINFO, CINHAL, PubMed, OT Seekers, PEDRO and the grey literature. 2 reviewers will independently screen study eligibility, extract data and appraise studies using published assessment tools. Meta-analyses will be undertaken where feasible; otherwise, narrative syntheses will be carried out. The robustness of evidence will be assessed using the GRADE system.

ETHICS AND DISSEMINATION

Ethics approval is not required for this study. A comprehensive knowledge exchange and transfer plan incorporating effective strategies will be used to disseminate the findings of this review and utilise them to optimise TMO management.

TRIAL REGISTRATION NUMBER

PROSPERO CRD42015015623.

Men and women have similarly shaped carpometacarpal joint bones

Characterizing the morphology of the carpometacarpal (CMC) joint bones and how they vary across the population is important for understanding the functional anatomy and pathology of the thumb. The purpose of this paper was to develop a statistical shape model of the trapezium and first metacarpal bones to characterize the size and shape of the whole bones across a cohort of 50. We used this shape model to investigate the effects of sex and age on the size and shape of the CMC joint bones and the articulating surface area of the CMC joint. We hypothesized that women have similar shape trapezium and first metacarpal bones compared to men, following scaling for overall size. We also hypothesized that age would be a significant predictor variable for CMC joint bone changes. CT image data and segmented point clouds of 50 CMC bones from healthy adult men and women were obtained from an ongoing study and used to generate two statistical shape models. Statistical analysis of the principal component weights of both models was performed to investigate morphological sex and age differences. We observed sex differences, but were unable to detect any age differences. Between men and women the only difference in morphology of the trapezia and first metacarpal bones was size. These findings confirm our first hypothesis, and suggest that the women have similarly shaped trapezium and first metacarpal bones compared to men. Furthermore, our results reject our second hypothesis, indicating that age is a poor predictor of CMC joint morphology.

The effectiveness of the Push Brace™ orthosis and corticosteroid injection for managing first carpometacarpal joint osteoarthritis: A factorial randomised controlled trial protocol

Introduction

Various conservative treatments for first carpometacarpal joint osteoarthritis have been reported. We aim to investigate the short-term effectiveness of conservative management interventions used to improve pain and function for adults with first carpometacarpal joint arthritis in a randomised controlled trial.

Methods

A pragmatic 2 × 2 factorial randomised controlled trial will be conducted. This randomised controlled trial will have one control group (hand therapy) and three intervention groups. Interventions will include Push Brace™ orthosis and hand therapy, ultrasound-guided intra-articular corticosteroid injection and hand therapy and a combination of all three interventions. A total of 276 participants will be recruited for the trial. The primary outcomes will be pain (reported using a Visual Analogue Scale) and function (using the Patient Rated Wrist/Hand Evaluation). Secondary outcomes will include osteoarthritis specific function, pinch strength, global change and quality of life. Adverse events and complications will be reported. Outcomes assessments will be completed prior to the intervention and at 3, 6, 12 and 24 months post-intervention. The trial will be conducted at a private hand surgery clinic in Queensland, Australia.

Conclusions

Results from this trial will contribute to the evidence on conservative management of first carpometacarpal osteoarthritis.

Sonography of pathological changes in the hand

Everyday medical practice shows that most common problems within the hand result from overload, injuries and degeneration. Dorsal side pathologies such as de Quervain's and Wartenberg's disease, intersection syndrome or degenerative lesions of carpometa-carpal joint of the thumb discussed in the paper can be accurately diagnosed and differentiated by means of ultrasound examination. Ultrasound is similarly powerful in detection and grading of traumatic lesions involving extensor tendons and their sagittal bands or the flexor tendons and their pulleys. In the case of carpal tunnel syndrome one can not only visualize the median nerve but also other structures of the tunnel that may cause compression. Similarly ulnar nerve compression within the Guyon's canal can be well evaluated. In cases of nerve trauma one can precisely define the level, and in cases of nerve discontinuity, the distance between stumps can be measured which is important in surgery planning. Often nerve trauma is a sequelae of tendon reconstruction. In such cases scars and nerve entrapment can be depicted. Tumors within a hand are usually benign, of which the most common are ganglia. On ultrasound examination a connection between a ganglion and its source (usually a joint or sheath) can frequently be defined. The relationship of tumors to nerves, tendon sheaths or vessels may suggest their nature. Ultrasound with dynamic tissue assessment is a very valuable adjunct to clinical examination.

Trapezio-metacarpal arthritis: The price of an opposable thumb!

Trapezio-metacarpal arthritis is the most common arthritic problem of the hand for which patients seek surgical treatment. The current article reviews the etio-pathogenesis, epidemiology, classification and management of this widespread problem. The anatomy and unique biomechanics of this joint are also reviewed. In addition, the article provides a detailed description of our preferred method of trapezio-metacarpal arthroplasty.

Occupational therapy-based and evidence-supported recommendations for assessment and exercises in hand osteoarthritis

AIMS

The aims of this study were to develop recommendations for occupational therapy assessment and design of hand exercise programmes in patients with hand osteoarthritis.

METHODS

An expert group followed a Delphi procedure to reach consensus for up to 10 recommendations for assessment and exercises, respectively. Thereafter, an evidence-based approach was used to identify and appraise research evidence supporting each recommendation, before the recommendations were validated by the expert group.

RESULTS

The process resulted in 10 recommendations for assessment and eight for design of exercise programmes. The literature search revealed that there is a paucity of clinical trials to guide recommendations for hand osteoarthritis, and the evidence for the majority of the recommendations was based on expert opinions. Also, even if a systematic review demonstrates some evidence for the efficacy of strength training exercises in hand OA, the evidence for any specific exercise is limited to expert opinions.

CONCLUSIONS

A first set of recommendations for assessment and exercise in hand osteoarthritis has been developed. For many of the recommendations there is a paucity of research evidence. High-quality studies are therefore needed to establish a high level of evidence concerning functional assessment and the effect of hand exercises in hand osteoarthritis.

Treatment of scaphotrapezio-trapezoid arthritis

Arthritis of the scaphotrapeziotrapezoid (STT) joint presents with deep thenar eminence and thumb basilar pain and is often coexistent with carpometacarpal arthritis of the thumb. Conservative treatment includes splinting and corticosteroid injections. Operative treatment consists primarily of fusion of the STT joint, although alternatives include trapeziectomy, fibrous arthroplasty, and prosthetic replacements. When STT arthritis is coexistent with carpometacarpal arthritis, excision of the trapezium and proximal 2 mm of trapezoid has been recommended. Complications of surgery include pericarpal arthrosis, superficial radial nerve injury, and nonunion.