Treatment of Basilar Thumb Arthritis

Arthroscopic Total Trapeziectomy for Thumb Carpometacarpal Arthrosis

BACKGROUND

The purpose of this individual cohort study is to demonstrate safety and efficacy in removing the trapezium through minimally invasive arthroscopy.

METHODS

A prospective case series was performed on all arthroscopic total trapeziectomy procedures for thumb basal joint arthrosis between 2018 and 2022. Patients were followed for up to 1 year. All patients received an examination at each visit to include pain, range of motion, strength, and metacarpal height. Complications, concomitant procedures, and revision procedures were recorded as well.

RESULTS

A total of 49 arthroscopic trapeziectomy procedures were recorded for 46 patients. The average preoperative visual analog pain scale score was 8.8 out of 10, and the postoperative score was 1 out of 10. All patients had a resolution of the carpometacarpal grind test postoperatively. The average preoperative key pinch, 3-point chuck, and grip strength were 9.8 lbs/in2, 7.8 lbs/in2, and 45 lbs/in2, respectively. Final 6-month postoperative key pinch, 3-point chuck, and grip strength were 11.0 lbs/in2, 9.8 lbs/in2, and 49.2 lbs/in2, respectively. Metacarpal height subsided on average 50%. We report one revision and no cases of radial sensory neuritis or flexor tendon rupture.

CONCLUSIONS

Arthroscopic total trapeziectomy appears to be a safe and effective treatment for end-stage arthrosis of the thumb basal joint.

LEVEL OF EVIDENCE

2b Therapeutic; Individual Cohort Study.

Arthroscopic debridement, synovectomy, and thermal shrinkage for basal joint arthritis

BACKGROUND

Ligamentous laxity, cartilage wear, and diffuse synovitis are frequently seen in thumb basal joint arthritis. Although these degenerative changes may be mild for the majority, they have the potential to cause discomfort during movement and compromised hand function. This study assesses the long-term outcomes of arthroscopic debridement, synovectomy, and thermal shrinkage in managing early-stage basal joint arthritis.

METHODS

We retrospectively reviewed patients with basal joint arthritis who underwent arthroscopic debridement, synovectomy, and thermal shrinkage between November 2010 and January 2021 by a single surgeon at our medical institute. We assessed functional outcomes, thumb range of motion, perioperative nonsteroidal anti-inflammatory drug (NSAID) use, return to work and satisfaction level.

RESULTS

A total of 12 patients (13 hands), with a mean follow-up of 72 months, were included in this study. Significant improvements were observed in pain scores and functional outcomes, along with a reduction in postoperative NSAID use. Patients also reported a relatively quick return to work and a high satisfaction level.

CONCLUSION

The study highlights the benefits of arthroscopic intervention, providing a minimally invasive approach with favorable long-term outcomes for patients with symptomatic basal joint arthritis.

Efficacy of Abductor Pollicis Longus Suspension Arthroplasty Combined With Mini TightRope for Osteoarthritis of Thumb Carpometacarpal Joint

BACKGROUND

We aimed to evaluate the efficacy of abductor pollicis longus (APL) suspension arthroplasty with trapeziectomy combined with first and second metacarpal fixation using suture button device.

METHODS

Thirteen patients (14 thumbs) who underwent APL suspension arthroplasty combined with suture button device for osteoarthritis of the carpometacarpal joint of the thumb (Eaton grade III: 6 and IV: 8 thumbs) at our institution between 2015 and 2019 and were followed up for more than 24 months were included in the study. Preoperative and postoperative range of motion (ROM) of radial and palmar abduction, grip and key pinch strength, visual analog scale (VAS) scores for pain, and the trapezial space ratio (TSR) on radiographic images before and after surgery were statistically examined.

RESULTS

The mean age of the patients was 59.6 ± 8.1 years, and the mean follow-up period was 45.4 ± 12.2 months. While grip and pinch strength did not significantly change between preoperative and final follow-up measurements, the ROM of radial and palmar abduction and the VAS score at the latest follow-up were significantly better than the preoperative values (P < .05). The mean TSR immediately after surgery and at the latest follow-up was 0.28 ± 0.089 and 0.22 ± 0.084, respectively, indicating a mean reduction rate of 23.3 ± 15.2%.

CONCLUSIONS

This surgical technique showed significant improvement in the ROM of radial and palmar abduction and the VAS score for pain, and the combined fixation of the first and second metacarpals with suture button device suppressed the subsidence of the first metacarpal.

Arthroscopic Hemitrapeziectomy: Is an Internal Brace Worth It?

BACKGROUND

This article's purpose was to analyze clinical results obtained with thumb carpometacarpal (CMC) arthroscopic hemitrapeziectomy with temporary suspension with a Kirschner wire (K-wire).

METHODS

Seventy thumb CMC arthroscopic hemitrapeziectomies with a mean age of 59 and 18 months of follow-up were performed in our center during a 13-year period. All of them followed the same protocol. Surgical technique is described.

RESULTS

All patients were arthroscopically classified as Badia's III stage. No tendon interposition was used, and a K-wire was temporarily implanted for 5.1 weeks. Mean postsurgical Visual Analogue Scale of 1.6, Kapandji Opposition Score of 8.1, grip strength of 42.2 lbs, lateral pinch of 9.5 lbs, tip-to-tip pinch of 4.2 lbs and tripod pinch of 7.8 lbs were measured. All previous active workers resumed their previous job.

CONCLUSIONS

We conclude that thumb CMC arthroscopic hemitrapeziectomy with temporary suspension with K-wire reaches good results in terms of pain reduction, strength, and functionality, without the necessity of an internal brace which increases risks of a second metacarpal fracture.

Does the Number of Preoperative Corticosteroid Injections Affect Clinical and Radiographic Outcomes of Trapeziectomy and Suspensionplasty?

PURPOSE

This study aimed to determine whether an increasing number of preoperative corticosteroid injections is associated with greater radiographic subsidence of the thumb metacarpal at long-term follow-up after abductor pollicis longus suspensionplasty, secondary to steroid-induced pathologic weakening of capsuloligamentous restraints surrounding the thumb carpometacarpophalangeal joint and greater extension of the lunate, but neither affect patient-reported outcomes nor revision rates.

METHODS

A retrospective chart review was performed of patients who underwent primary trapeziectomy and abductor pollicis longus suspensionplasty by a single surgeon over a 10-year period. The number of preoperative corticosteroid injections in the trapeziometacarpal joint was documented, and patients were separated into 4 subgroups: 0, 1, 2, or 3 or more injections. Preoperative and final radiographs were evaluated for a change in the distance between the base of the thumb metacarpal and the distal pole of the scaphoid as a measure of thumb metacarpal subsidence and radiolunate angle as a measure of nondissociative carpal instability, which has been reported as a complication after basal joint arthroplasty. Additionally, the final patient-reported outcomes (Quick Disabilities of the Arm, Shoulder, and Hand and Patient-Rated Wrist Evaluation) and revision rates were also assessed.

RESULTS

Of a total of 60 patients with an average age of 64 years that were included in the study, 16 (26.7%) received 0, 19 (31.7%) received 1, 12 (20%) received 2, and 13 (21.7%) received 3+ preoperative injections. The median postoperative follow-up was 92 months. The mean distance between the base of the thumb metacarpal and the distal pole of the scaphoid decreased by 2 mm, and the mean radiolunate angle increased by 4° across the entire cohort. When comparing subgroups, no differences were observed in either parameter or the final Patient-Rated Wrist Evaluation and Quick Disabilities of the Arm, Shoulder, and Hand scores.

CONCLUSIONS

This study demonstrates no apparent detrimental effect of an increased number of preoperative corticosteroid injections on radiographic thumb metacarpal subsidence, increase in extension of radiolunate angle (nondissociative carpal instability), patient-reported outcomes, or revision rates at an average of almost 8 years after trapeziectomy and abductor pollicis longus suspensionplasty.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic IV.

Partial Denervation of the Thumb Carpometacarpal Joint: A New Technique

BACKGROUND

To report the clinical outcomes of partial denervation for the treatment of basilar thumb joint arthritis.

METHODS

Patients who underwent partial denervation of the basilar thumb joint for osteoarthritis from a single center between 2019 and 2021 were recruited into the study. This involved a technique that involved cauterization of the joint capsule and its innervation through the branches of the superficial radial, palmar cutaneous branch of the median, lateral antebrachial, and ulnar nerves. Patients were followed up postoperatively to record clinical (grip strength, thumb apposition and opposition pinch grip strength, Kapandji score) and patient-reported outcomes (visual analogue scale [VAS], Quick Disabilities of the Arm, Shoulder and Hand [QuickDASH], Patient-reported Wrist Evaluation [PRWE]).

RESULTS

Twelve patients (15 carpometacarpal joints; 9 female and 3 male patients) underwent a partial denervation of the thumb (Eaton stage 3-4). The mean age at the time of surgery was 63 ± 5 years (range 56-72). The mean clinical follow-up duration was 23 ± 11 months (range 9-42 months), and functional score follow-up duration was 27 ± 7 months (range 14-42 months). At the latest clinical follow, VAS score, Kapandji score, grip strength, and thumb apposition/opposition pinch strength all improved significantly (P < .05). The mean QuickDASH score was 30 ± 16, and PRWE score was 32 ± 17. Patients who had unilateral partial thumb denervation demonstrated greater improvement in grip strength than patients who had bilateral partial thumb denervation procedures (P = .01).

CONCLUSION

In this clinical case series, our method of basilar thumb joint partial denervation has been effective in improving clinical outcomes and reducing pain due to osteoarthritis.

LEVEL OF EVIDENCE

IV, case series.

Is Hand Therapy Associated With a Delay in Surgical Treatment in Thumb Carpometacarpal Arthritis?

PURPOSE

Thumb carpometacarpal (CMC) osteoarthritis (OA) causes functional disability and an increased health care burden in the aging population. The role of therapy in thumb CMC OA has been minimally analyzed in the literature. We hypothesized that patients treated with therapy for thumb CMC OA would demonstrate reduced rates of surgery for this diagnosis.

METHODS

We queried a national insurance dataset for all patients with an International Classification of Diseases, Ninth Revision, or International Statistical Classification of Diseases, Tenth Revision, code for thumb CMC OA, with a minimum of 2 years of follow-up. A 2:1 propensity-matched cohort of patients with CMC OA who did not receive therapy versus a therapy cohort was created, with a minimum of two sessions of hand therapy for inclusion. The primary outcome was the rate of thumb CMC OA surgery occurring within 2 years of diagnosis; time to surgery and use of thumb CMC injections were secondary outcomes. Multivariable logistic regression analysis was used to identify the risk factors for undergoing surgical treatment.

RESULTS

After matching, the therapy cohort comprised 14,548 patients, with a matched group of 28,930 patients who did not undergo therapy. In the overall sample, the rate of surgery within 2 years was 22.5%. Two-year surgical treatment rates were significantly higher for those who did not undergo therapy when compared with those who did (29.3% vs 13.1%). Patients treated with therapy had a significantly longer time to surgery, with no difference in the rate of surgery after one year. In multivariable regression of all included variables, lack of therapy intervention had the highest odds of surgery for thumb CMC OA (odds ratio 4.3).

CONCLUSIONS

We present the findings of a large insurance database evaluating the association of therapy with rates of surgical treatment for thumb CMC arthritis. On average, those treated with therapy had longer times to surgery, and the 2-year surgery rates for patients diagnosed with thumb CMC arthritis were significantly higher in those who did not undergo therapy treatment.

TYPE OF STUDY/LEVEL OF EVIDENCE

Prognostic II.

Treatment of First Carpometacarpal Osteoarthritis with Arthroscopy: A Systematic Review

Background First carpometacarpal (CMC) osteoarthritis or trapeziometacarpal osteoarthritis is a common debilitating hand condition. No one surgical technique has demonstrated superiority in managing this disease. Purpose This study performed a systematic review of arthroscopic techniques for treating first CMC arthritis to assess the effectiveness of different arthroscopic techniques. Methods Grip strength, pinch strength, visual analog scale, the Disability of Arm, Shoulder, and Hand (DASH) score, range of motion (ROM), and complications were recorded. Two subgroup analyses were performed, comparing outcomes of (1) trapeziectomy of any type versus debridement alone and (2) trapeziectomy alone versus interposition versus suspension techniques. Results Preoperative and postoperative scores significantly improved for DASH scores and pain at rest and with activity with variable improvements in ROM. Complications occurred in 13% of cases in publications that reported complications. When comparing studies that utilized techniques with any type of trapeziectomy to debridement alone, only the trapeziectomy subgroup showed significant improvements in pain. When comparing trapeziectomy alone to interposition and suspension techniques, mean DASH scores and pain levels significantly improved in interposition and suspension subgroups. Conclusions The existing literature describes a predominantly female population with Eaton-Littler stage II and III disease. In the subgroup analysis, arthroscopic techniques involving a trapeziectomy seem to be more effective at lowering pain scores compared to techniques involving debridement alone. Likewise, interposition and suspension techniques may show improved outcomes compared to techniques involving trapeziectomy alone. Level of evidence This is a Level III study.

The Surgical Treatment of Osteoarthritis

Osteoarthritis is a degenerative condition affecting the whole joint with the underlying bone, representing a major source of pain, disability, and socioeconomic cost worldwide. Age is considered the strongest risk factor, albeit abnormal biomechanics, morphology, congenital abnormality, deformity, malalignment, limb-length discrepancy, lifestyle, and injury may further increase the risk of the development and progression of osteoarthritis as well. Pain and loss of function are the main clinical features that lead to treatment. Although early manifestations of osteoarthritis are amenable to lifestyle modification, adequate pain management, and physical therapy, disease advancement frequently requires surgical treatment. The symptomatic progression of osteoarthritis with radiographical confirmation can be addressed either with arthroscopic interventions, (joint) preservation techniques, or bone fusion procedures, whereas (joint) replacement is preferentially reserved for severe and end-stage disease. The surgical treatment aims at alleviating pain and disability while restoring native biomechanics. Miscellaneous surgical techniques for addressing osteoarthritis exist. Advanced computer-integrated surgical concepts allow for patient personalization and optimization of surgical treatment. The scope of this article is to present an overview of the fundamentals of conventional surgical treatment options for osteoarthritis of the human skeleton, with emphasis on arthroscopy, preservation, arthrodesis, and replacement. Contemporary computer-assisted orthopaedic surgery concepts are further elucidated.

Retrospective Review of Long-term Outcomes of Patients Undergoing CMC Arthroplasty With Interposition Scaffold

Background: The treatment of rhizarthritis involves several surgical techniques; among them, bioabsorbable scaffolds have begun to be proposed to avoid the use of other biological tissues or artificial permanent devices. Methods: In this study, we evaluated the long-term outcomes of poly-ld-lactic acid scaffold in interposition arthroplasty in a series of patients treated in our department. Results: Strength, range of motion, and pain improved after the intervention and lasted over the years; nonetheless, most of the radiographs showed a progressive collapse of the first metacarpal. Conclusions: Despite radiological findings, we believe that poly-ld-lactic acid scaffold can be considered a good alternative to traditional trapeziectomy with tendon interposition and suspensionplasty, with long-lasting satisfactory clinical results.

Arthroscopic Hemitrapezectomy and Suspension with Mini TightRope for the Treatment of Rhizarthrosis: Outcome in patients in stages Eaton-Littler 2 to 3

Introduction Rhizarthrosis is a common cause of pain and impaired function of the hand. Most patients present an excellent response to the conservative treatment, although a small percentage requires a surgical procedure due to the persistence of symptoms. Different surgical procedures have been described; however, there is still no consensus in the literature regarding the superiority of one technique over the others.

Objective To evaluate the clinical and radiological results of patients with a diagnosis of rhizarthrosis in stages 2 to 3 of the Eaton-Littler classification, submitted to arthroscopic hemitrapezectomy and suspension with Mini TightRope (Arthrex, Naples, FL, US).

Materials and methods We conducted a retrospective evaluation of the clinical and radiological results of patients operated on through the technique proposed in Clínica INDISA, in Santiago, Chile, between 2017 and 2019. The pre- and postsurgical assessments were performed using the visual analog scale (VAS) for pain, the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, and the Kapandji score. The state of the articular cartilage was also evaluated intraoperatively according to the Badia classification.

Results A total of 12 patients (3 men and 9 women) met the inclusion criteria. Their mean age was 56 years, the mean duration of the follow-up was of 21 months. There were 7 patients in stage 2 and 5 in stage 3 according to the Eaton-Littler classification. Intraoperatively, there were 6 patients in stage II and 6 in stage III of the Badia classification. The mean preoperative score on the Kapandji index was of 3.6, and the mean postoperative score was of 9. The mean preoperative score on the VAS was of 8.8, and the mean postoperative score was of 1.2. The mean preoperative score on the DASH was of 33.3, and the mean postoperative score was of 4.7.

Conclusion Arthroscopic and suspension hemitrapezectomy with Mini TightRope for the treatment of stage 2-3 rhizarthrosis is a minimally-invasive, reproducible technique, effective in reducing pain and improving function, with sustained effects on the short and middle terms (6 to 36 months).

Arthroscopic Management of Thumb Carpometacarpal Joint Arthritis and Pathology

Basilar thumb arthritis is a debilitating condition characterized by pain, reduced joint stability, and reduced capacity for daily activities. Various arthroscopic approaches have been described based on patient factors, as well as radiographic and arthroscopic staging criteria. Here we provide an overview of arthroscopic management of basilar thumb arthritis, including patient evaluation, surgical techniques, outcomes, and new developments. We describe our preferred approach for Eaton stage I-III disease, consisting of arthroscopic hemitrapeziectomy with suture button suspensionplasty. This technique is safe, reliable, and allows for early range of motion and quicker recovery while minimizing scarring and reducing the risk of nerve injury.

Effects of Magnetic Resonance Imaging With Axial Traction of the Thumb Carpometacarpal Joint on Articular Cartilage Visibility: A Feasibility Study

Objectives

The objective of this study was to verify the usefulness of magnetic resonance imaging (MRI) with axial traction of the thumb for observing articular cartilage.

Materials and methods

Eleven healthy adult volunteers (39.7 ± 7.4 years) without thumb carpometacarpal joint arthritis or trauma were included in this study. A 3-tesla (3T) MRI (Magnetom Skyra, Siemens Healthineers AG, Munich, Germany) of the right thumb with axial traction applied by a finger trap with three traction weights (0, 2, and 5 kg) was performed. A 3D T2* multiecho data imaging combination (MEDIC) was selected to visualize the articular cartilage. After multiplanar reconstruction, sagittal and coronal images of the thumb carpometacarpal joint were used to evaluate the articular cartilage visibility and joint space widths at five locations. Articular cartilage visibility was evaluated using our original classification method that used the percentage of the cartilage detectable area. The Friedman test was used to compare the differences between each traction weight and location.

Results

Articular cartilage visibility significantly improved with axial traction. The average joint space widths with the 5-kg application were 1.9 ± 0.8, 3.9 ± 0.6, 2.0 ± 0.9, 3.9 ± 1.1, and 2.5 ± 1.4 mm at the center, volar edge, dorsal edge, radial edge, and ulnar edge, respectively. The joint space widths significantly increased proportionally with the traction weight at all locations. The joint space widths at the volar and radial edges were significantly greater than those at other locations.

Conclusion

Applying axial traction to the thumb increased the joint space widths and improved the visibility of the articular cartilage in the carpometacarpal joint on MRI.

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.

Precision of the Wilson corrective osteotomy of the first metacarpal base using specific planning and instruments for treatment of basal thumb arthritis

INTRODUCTION

Arthritis of the basal thumb is a relatively common condition also affecting younger patients. Wilson et al. described a 20°-30° closing wedge osteotomy of the first metacarpal bone to unload the trapeziometacarpal joint. It was the purpose of this study to analyze the clinical and radiographic outcome of patients who underwent proximal extension osteotomy of the first metacarpal bone using patient-specific planning and instruments (PSI).

METHODS

All patients who underwent proximal metacarpal osteotomy for basal thumb arthritis at our tertiary referral center were retrospectively included. The patients underwent preoperative planning using computed tomography and 3D segmentation to build patient-specific guides and instruments for the operative treatment. Stable fixation of the osteotomy was achieved by internal plating. The inclusion criterion was a minimum follow-up of 1 year with clinical examination, including the Michigan Hand Outcomes Questionnaire (MHQ), and computed tomography to validate the correction. Complications and reinterventions were recorded.

RESULTS

A total of eight Wilson osteotomies in six patients could be included at a mean follow-up duration of 33±16 months (range, 12 to 55 months). The patients were 49±8 years (range, 36 to 58 years) at the surgery and 88% were female. The postoperative MHQ for general hand function was 77±8 (range, 45 to 100) and the MHQ for satisfaction was 77±28 (range, 17 to 100). The working status was unchanged in 7/8 hands (6/7 patients). Radiographic analysis revealed successful correction in all cases with unchanged Eaton-Littler stage in 7/8 hands. No complications were recorded.

CONCLUSION

The combined extending and ulnar adducting osteotomy using patient-specific guides and instrumentation provides an accurate treatment for early-stage thumb arthritis.

LEVEL OF EVIDENCE

Type IV-retrospective, therapeutic study.

Trapeziectomy with suture-button suspensionplasty versus ligament reconstruction and tendon interposition: a randomized controlled trial

The purpose of the present study was to compare the results of patients operated with trapeziectomy and ligament reconstruction and tendon interposition (LRTI) using flexor carpi radialis tendon versus trapeziectomy followed by suspension of the first metacarpal to the second metacarpal using a Mini TightRope® suture button (suture button suspension: SBS). A single-center prospective randomized controlled trial was performed, comparing 37 patients with SBS and 39 with LRTI. All surgeries were performed by the same fellowship-trained hand surgeon. Patients were assessed by an independent observer at 40 months' follow-up. Pre- and postoperative strength, trapezial space ratio (TSR), range of motion, QuickDASH and visual analogue pain score were recorded. Both procedures improved functional parameters of pain, key strength, tip strength and grip strength while maintaining range of motion, without significant differences. In the SBS group, TSR decreased by 17%, compared to 28% in the LRTI group. The mean operative time was shorter in SBS (63 vs 91 minutes; p < 0.0001), as was immobilization time (2 vs 6 weeks; p < 0.0001), and patients resumed normal activity sooner (10 vs 12 week; p = 0.0138) and required less physical therapy (19.3 vs 13.1 weeks; p < 0.0001). We believe that our results are related to the hypothesis suggested by biomechanical studies that revealed better initial load bearing profile and maintenance of trapezial space following serial loading in cadaver models.

Double trapeziometacarpal and scaphotrapeziotrapezoidal pyrocarbon interposition implants for pantrapezial arthritis: Midterm results and surgical technique

BACKGROUND

Pantrapezial osteoarthritis of the thumb (OA) includes involvements of scaphotrapezoidtrapezoidal (STT) and trapeziometacarpal (TM) joints which are source of disabling pain and function loss. Whilst radical procedures or arthroplasties are available, more conservative techniques have been developed recently and have gain popularity. They aim of this study was to know the midterms results of patients presenting peritrapezial OA treated with a double interposition pyrocarbon implant at the STT and TM joints. Our hypothesis was that patients suffering from pantrapezial OA treated with this technique would improve their functional scores at the last follow-up.

PATIENTS AND METHODS

This descriptive, retrospective, observational study analysed 31 patients treated with a double STT and TM pyrocarbon interposition implant ("Burger arthroplasty") between 2009-2018. Patients were clinically and radiologically diagnosed with pantrapezial OA before surgery (Eaton stage I or II). The primary endpoint was the comparison of the preoperative and postoperative values of the functional scores QuickDASH and PRWE. Epidemiological data and radiological results were reported. Pain, range of motion, pinch and grip strength, were analysed with standardised tools. The surgical technique was described in detail and reinforced with a didactic supplementary video.

RESULTS

Eighteen patients were available for analysis (58%) with a mean age of 62 years (range: 49-79). At last follow-up (44 months, range: 9-95) we found significant reduced pain, significant improvement of QuickDASH and PRWE scores and of pinch strength (p<0.05). Range of motion, grip and pinch strength did not improve significantly (p>0.05). Two patients required revision surgery.

DISCUSSION

The double STT and TM pyrocarbon interposition offer good results at midterm on patient suffering from early stages of pantrapezial OA with preserved trapezium structure.

LEVEL OF EVIDENCE

IV.

Snapping Extensor Pollicis Longus Tendon Subluxation Secondary to Trapeziometacarpal Instability: Case Report and Technique

CASE

A 20-year-old woman presented with painful, snapping extensor pollicis longus (EPL) tendon subluxation and trapeziometacarpal (TMC) joint instability. Hemi-extensor carpi radialis longus (ECRL) tendon autograft stabilized the TMC joint, reconstructing the 1-2 intermetacarpal ligament. The subluxed EPL tendon was centralized over the dorsal first metacarpal by tightening the metacarpophalangeal radial sagittal band and creating a dorsal first metacarpal "neosheath" pulley using ECRL graft remnant. Postoperative rehabilitation included Spica bracing and immediate thumb interphalangeal joint exercises.

CONCLUSION

The patient's pain due to EPL tendon subluxation and TMC joint instability completely resolved. Postoperative thumb range of motion and function were equivalent to the nonaffected side.

Thumb Carpometacarpal Arthritis: Prognostic Indicators and Timing of Further Intervention Following Corticosteroid Injection

PURPOSE

Corticosteroid injections are commonly used to treat thumb carpometacarpal arthritis in adults. We aimed to define the timing of surgery following an initial corticosteroid injection and identify patient-specific factors that influence the likelihood of repeat injection or surgery.

METHODS

We performed a retrospective analysis of all patients who underwent a first-time corticosteroid injection for carpometacarpal arthritis between 2009 and 2017. Demographic information, radiographic classification, additional nonsurgical therapies, complications, and outcomes were collected. Primary outcomes were repeat injection and surgical reconstruction. Kaplan-Meier survival analysis was used to characterize the timing of surgical intervention and Cox regression modeling was used to identify predictors of subsequent intervention.

RESULTS

Two-hundred thirty-nine patients (average age, 62.9 years) were identified, of which 141 (59.0%) had a repeat injection and 90 (37.6%) underwent surgery. There were no patient-specific characteristics associated with repeat injection. Eaton stage III/IV arthritis at initial presentation, current smoking status, and prior ipsilateral hand surgery were associated with an increased likelihood of surgery. By Kaplan-Meier analyses, 87.7% of patients who presented with Eaton III/IV arthritis did not have surgery within a year and 66.7% of these patients did not have surgery within 5 years.

CONCLUSIONS

In this retrospective observational cohort study with 10-year follow-up from a 4-surgeon practice, advanced radiographic arthritis, current smoking status, and a history of ipsilateral hand surgery were patient-specific factors that predicted progression to surgery following injection. Of patients who presented with advanced radiographic arthritis, one-third underwent surgery within 5 years of initial injection. Although injection efficacy and causality cannot be inferred based on an observational longitudinal analysis, these data identify patient-specific factors that may have an impact on surgical decision-making and a potential timeframe for future intervention.

TYPE OF STUDY/LEVEL OF EVIDENCE

Prognostic IV.

Design and Evaluation of Magnetic Hall Effect Tactile Sensors for Use in Sensorized Splints

Splinting techniques are widely used in medicine to inhibit the movement of arthritic joints. Studies into the effectiveness of splinting as a method of pain reduction have generally yielded positive results, however, no significant difference has been found in clinical outcomes between splinting types. Tactile sensing has shown great promise for the integration into splinting devices and may offer further information into applied forces to find the most effective methods of splinting. Hall effect-based tactile sensors are of particular interest in this application owing to their low-cost, small size, and high robustness. One complexity of the sensors is the relationship between the elastomer geometry and the measurement range. This paper investigates the design parameters of Hall effect tactile sensors for use in hand splinting. Finite element simulations are used to locate the areas in which sensitivity is high in order to optimise the deflection range of the sensor. Further simulations then investigate the mechanical response and force ranges of the elastomer layer under loading which are validated with experimental data. A 4 mm radius, 3 mm-thick sensor is identified as meeting defined sensing requirements for range and sensitivity. A prototype sensor is produced which exhibits a pressure range of 45 kPa normal and 6 kPa shear. A proof of principle prototype demonstrates how this can be integrated to form an instrumented splint with multi-axis sensing capability and has the potential to inform clinical practice for improved splinting.