Is increased trapezial slope a cause of early trapeziometacarpal osteoarthritis?

OBJECTIVES

Thumb carpometacarpal joint osteoarthritis is one of the most common forms of osteoarthritis in the hand. The underlying causes are multifactorial. We investigated whether increased trapezial slope could be a causal factor.

MATERIAL AND METHODS

We measured trapezial slope and 1st metacarpal slope in 37 patients with early thumb carpometacarpal joint osteoarthritis and compared results with 41 patients without osteoarthritis, using computer-supported 3D-analysis based on CT scans.

RESULTS

There was a significant intergroup difference in trapezial slope (111° in patients with osteoarthritis, and 107° in patients without) and in 1st metacarpal slope (17° versus 14°).

CONCLUSION

Steeper trapezial slope seemed to be a risk factor for thumb carpometacarpal joint osteoarthritis. Therefore, correction of trapezial slope by trapezium osteotomy could be a valuable surgical approach in early thumb carpometacarpal joint osteoarthritis.

Biomechanical analysis of three techniques of suspensionplasty after trapeziectomy: a cadaveric study

The aim of the present cadaveric study was to assess resistance to first metacarpal subsidence of three techniques of suspensionplasty after trapeziectomy. In total, 18 forearms (mean age 60 years [range 20-89]) were used with six specimens per surgical technique: palmar oblique ligament reconstruction with tendon interposition (LRTI), abductor pollicis longus (APL) suspensionplasty, or suture suspensionplasty. There was no significant difference in mean trapezial space height after trapeziectomy and suspensionplasty compared to the preoperative trapezial height. However, after simulation of physiological lateral pinch, there was a significant (p < 0.05) difference in mean trapezial space height between the APL suspensionplasty and the suture suspensionplasty compared to the LRTI group. After axial loading, there was significantly greater metacarpal subsidence in the LRTI group compared to the APL and suture suspensionplasty groups but no statistically significant difference between the suture suspensionplasty and the APL suspensionplasty groups.Level of evidence: V.

The Effect of Thumb Metacarpophalangeal Hyperextension on Thumb Axial Load and Lateral Pinch Force in a Cadaver Model of Thumb Trapeziectomy and Flexor Carpi Radialis Suspensionplasty

PURPOSE

The purpose of our study was to investigate, in a cadaver model, the effect of increasing thumb metacarpophalangeal (MCP) joint hyperextension on thumb axial load and key pinch force after thumb trapeziectomy and flexor carpi radialis suspensionplasty. We developed a cadaveric model to test whether thumb MCP joint hyperextension after trapeziectomy would have a negative effect on key pinch force and increase loads across a reconstructed thumb carpometacarpal (CMC) joint.

METHODS

We created a cadaveric biomechanical model that varied thumb MCP joint hyperextension while measuring thumb CMC axial and key pinch force under standardized loads. Direct observations were made of how key pinch and axial thumb CMC force change with increasing thumb MCP joint hyperextension. We measured the thumb key pinch force and axial thumb CMC joint load with the thumb MCP joint in 0°, 10°, 20°, 30°, 40°, 50°, and 60° of hyperextension.

RESULTS

There was a 0.88 N (2.4%) increase in axial force across the thumb CMC per every 10° of increasing thumb MCP joint hyperextension. We found a 0.53 N (4.4%) reduction in key pinch force for every 10° of increasing thumb MCP joint hyperextension. Therefore, at 60° of thumb MCP joint hyperextension, the axial force across the thumb CMC increased by 5.3 N (14.6%) and the key pinch force was weakened by 3.2 N (26.6%).

CONCLUSIONS

With progressive thumb MCP joint hyperextension after thumb CMC arthroplasty, we found a decrease in key pinch force and an increase in axial thumb CMC joint force. The decrease in key pinch force was larger than the relatively small increase in thumb CMC force.

CLINICAL RELEVANCE

This study helps elucidate the biomechanics of the thumb CMC joint after resection arthroplasty with thumb MCP joint hyperextension and helps understand the interplay between these 2 conditions.

Convergent validity and responsiveness of the Canadian Occupational Performance Measure for the evaluation of therapeutic outcomes for patients with carpometacarpal osteoarthritis

STUDY DESIGN

This is a longitudinal, observational, multicenter, cohort study.

INTRODUCTION

Thumb carpometacarpal (CMC) osteoarthritis (OA) is associated with more pain and restrictions than other hand OA. The use of patient-identified occupational performance goals to guide hand therapy treatment and to measure clinical outcomes is fundamental for a patient-centered intervention. The COPM enables subjects to identify goals for hand therapy and engage in a subject-specific therapeutic process.

PURPOSE OF THE STUDY

The purpose of this study is to evaluate the convergent validity and responsiveness of the COPM to evaluate the relationship between the patient's self-perception and satisfaction of performance in everyday living and pain intensity, upper limb function, and manual ability.

METHODS

Eligible participants to multiple hand therapy centers were recruited. Outcomes measures (VAS scale, QuickDASH, MAM-36, and the COPM questionnaire) were measured at the baseline and 3 months after.

RESULTS

One hundred forty-five (n = 145) consecutive patients for five different hand rehabilitation centers with symptomatic thumb CMC OA were screened for eligibility criteria. COPM-P and COPM-S were the most responsive instruments, with an area under the curve of 0.88 (95% CI 0.79-0.96) and 0.88 (95% CI 0.80-0.96), respectively.

CONCLUSIONS

Although more investigation in this area is necessary to conclude that the COPM is the best option to evaluate the effectiveness of hand therapy interventions for thumb OA. The COPM focuses on function and occupation and, in comparison with others upper limb scales, does not require the use of another complementary scale for addressing both satisfaction and ADL status. COPM is an instrument with a good convergent validity and responsiveness to evaluate the relationship between the patient's self-perception and satisfaction in thumb CMC OA.

Effectiveness of manual therapy in patients with thumb carpometacarpal osteoarthritis: a systematic review and meta-analysis

Background: The effectiveness of Manual Therapy (MT) in thumb carpometacarpal osteoarthritis (OA) is unclear.Objective: This study aimed to determine the effectiveness of MT for functional outcomes in patients with thumb carpometacarpal OA. Design: Systematic review and meta-analysis of randomized clinical trials. Methods: An electronic search was performed in the Medline, Central, Embase, PEDro, Lilacs, Cinahl, SPORTDiscus, and Web of Science databases. The eligibility criteria for selecting studies included randomized clinical trials that compared MT versus other interventions in functional outcomes, such as thumb and/or hand function questionnaires, pinch and/or grip strength, thumb and/or hand range of motion, and pain intensity or pressure pain threshold in patients with thumb carpometacarpal OA. Results: Five clinical trials met the eligibility criteria; for the quantitative synthesis, four studies were included. The mean difference (MD) for grip strength was 0.87kg (95% CI = 0.29-1.44, p = .003), for pinch strength was 0.10kg (95% CI = -0.01-0.20, p = .06), and for the pressure pain threshold was 0.64kg/cm² (95% CI = 0.07-1.20, p = .03). All differences were in favor of the MT group. Conclusions: In the short-term, there was moderate to high evidence, with statistically significant differences in the functional outcomes, in favor of MT versus sham interventions in patients with thumb carpometacarpal OA. However, these differences are not clinically important.

Geographical differences in carpometacarpal joint osteoarthritis treatment of the thumb: A survey of 1138 hand surgeons from the USA and Europe

BACKGROUND

Carpometacarpal osteoarthritis of the thumb (CMC OA) is treated with various therapeutic approaches. However, the literature remains inconclusive regarding the ideal procedure for each disease stage. In this study, we assessed the international application of surgical treatment options including CMC I implants and non-surgical treatment options for CMC OA depending on the disease stage, with a strong focus on the detection of geographical disparities.

METHODS

We conducted a large international online survey with members of hand surgical societies of the International Federation of Societies for Surgery of the Hand (IFSSH). The first part of the survey asked about general therapy options of CMC OA depending on the severity of the disease, whereas the second part specifically dealt with the use of prostheses.

RESULTS

We could include 10 of 56 IFSSH member societies (6807 surgeons) and received answers from 1138 members (16.7%). Significant differences were detected in an increased use of corticosteroid injections in the USA, and a growing frequency of fat injections in Europe. Regarding use and frequency of the resection arthroplasty, we found similar results in all participating countries. Prosthetic implantation showed a significant difference between the USA and Europe, with far larger numbers stated by European hand surgeons.

CONCLUSION

CMC OA is treated differently in the participating countries depending on the stage of the disease. We give an insight into geographical differences in treatment paradigms, with corticosteroid injections being more prevalent in the USA, and prosthesis implantation being more frequently chosen in the selected European countries.

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

BACKGROUND

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

METHODS

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

FINDINGS

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

INTERPRETATION

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

Reliability of handgrip strength test in elderly subjects with unilateral thumb carpometacarpal osteoarthritis

BACKGROUND

The grip strength test is widely used; however, little has been investigated about its reliability when used in elderly with subjects thumb carpometacarpal (CMC) osteoarthritis (OA). The purpose of this study was to examine the test-retest reliability of the grip strength test in elderly subjects with thumb CMC OA.

METHODS

A total of 78 patients with unilateral thumb CMC OA, 84.6 % female (mean ± SD age 83 ± 5 years), were recruited. Each patient performed three pain free maximal isometric contractions on each hand in two occasions, 1 week apart. Intraclass correlation coefficient (ICC), standard error of measurement (SEM), and 95 % limits of agreement (LOA) were calculated.

RESULTS

Test-retest reliability was excellent for side affected (ICC = 0.947; p = 0.001) and contralateral (ICC = 0.96; p = 0.001) thumb CMC OA.

CONCLUSIONS

The present results indicate that maximum handgrip strength can be measured reliably, using the Jamar hand dynamometer, in patients with thumb CMC OA, which enables its use in research and in the clinic to determine the effect of interventions on improving grip.

Ulnar digits contribution to grip strength in patients with thumb carpometacarpal osteoarthritis is less than in normal controls

BACKGROUND

Grip testing is commonly used as an objective measure of strength in the hand and upper extremity and is frequently used clinically as a proxy measure of function. Increasing knowledge of hand biomechanics, muscle strength, and prehension patterns can provide us with a better understanding of the functional capabilities of the hand. The objectives of this study were to determine the contribution of ulnar digits to overall grip strength in individuals with thumb carpometacarpal (CMC) osteoarthritis (OA).

METHODS

Thirty-seven subjects participated in the study. This group consisted of 19 patients with CMC OA (aged 60-88 years) and 18 healthy subjects (60-88 years). Three hand configurations were used by the subjects during grip testing: use of the entire hand (index, middle, ring, and little fingers) (IMRL); use of the index, middle, and ring fingers (IMR); and use of only the index and middle fingers (IM).

RESULTS

Grip strength findings for the two groups found that compared to their healthy counterparts, CMC OA patients had, on average, a strength deficiency of 45.6, 35.5, and 28.8 % in IMRL, IMR, and IM, respectively. The small finger contribution to grip is 14.3 % and the ring and small finger contribute 34 % in subjects with CMC OA.

DISCUSSION

Grip strength decreases as the number of digits contributing decreased in both groups. The ulnar digits contribution to grip strength is greater than one third of total grip strength in subjects with CMC OA. Individuals with CMC OA demonstrate significantly decreased grip strength when compared to their healthy counterparts.

Contralateral sensory and motor effects of unilateral kaltenborn mobilization in patients with thumb carpometacarpal osteoarthritis: a secondary analysis

[Purpose] The aim of this study was to determine changes in pressure sensitivity and pinch strength in patients with thumb carpometacarpal (CMC) osteoarthritis (OA) in the contralateral hand after unilateral Kaltenborn mobilization on the symptomatic hand. [Subjects and Methods] Twenty-nine females with dominant hand thumb CMC osteoarthritis participated (age 70–90), and were randomized into 2 groups. The experimental group received a Kaltenborn mobilization, and the placebo group received a nontherapeutic dose of intermittent ultrasound. Pressure pain thresholds (PPT) at the thumb CMC joint, scaphoid bone and hamate bone and tip and tripod pinch strength were assessed before and after the intervention and 1 week (1st follow-up) and 2 weeks (2nd follow-up) after the intervention. [Results] Significant increases in PPT in the experimental group at all follow-up periods as compared with baseline data were found. The post-intervention between-group mean differences for PPT were 1.1 (95%CI 0.4–1.8) for the CMC joint, 1.1 (95%CI 0.2–2.1) for the scaphoid, and 1.5 (95%CI 0.5–2.8) for the hamate. The post-intervention between-group mean differences were 0.5 (95%CI 0.2–0.9) for the tip pinch and 0.3 (95%CI 0.1–0.6) for the tripod pinch. [Conclusion] The current secondary analysis found that Kaltenborn mobilization for the symptomatic hand reduces pressure pain sensitivity (PPT increases) and also produces motor changes in the contralateral non-treated hand compared with a placebo group.

Early outcomes of arthroplasty of the first carpometacarpal joint using pyrocarbon spherical implants

The first carpometacarpal joint (CMC) is the most common hand joint to develop osteoarthritis. A survey found that many hand surgeons have revisited implant arthroplasty because it preserves critical structures. However, there is currently no implant with an ideal design and material composition. The present study was the first to use and evaluate early outcomes of pyrocarbon spherical implants for arthroplasty of the first CMC in patients with Eaton-Littler stage II and III osteoarthritis. A single surgeon performed 24 arthroplasties (23 patients [20 women, three men] with a mean age of 56 years [range 46 to 75 years]) of the first CMC (nine right hands and 15 left hands) using pyrocarbon spherical implants from May 2010 to April 2013. All patients failed conservative management. At a mean (± SD) of 18.5±11.16 months postoperatively (range 4.3 to 38.9 months), the mean Kapandji score was 8.8 of 10 (range 7 to 10), the average pre- and postoperative values on the visual pain scale were 8.96±0.64 of 10 (range 8 to 10) and 1.13±1.22 of 10 (range 0 to 4), respectively. All patients were either very satisfied (score = 5) or satisfied (score = 4) with the procedure, with a mean satisfaction score of 4.76±0.44 of 5.00 (range 4 to 5). The mean postoperative Disabilities of the Arm, Shoulder and Hand (DASH) score was 11.79±14.29 (range 0 to 49.17). The most recent radiographic evaluations confirmed that all implants were stable with no erosion of nearby cancellous bone. There were no implant subluxations, dislocations or revisions. Early outcomes show promising results and support continued use of this implant for arthroplasty. However, longer-term follow-up will be needed to confirm these results.