Abstract
Thumb base osteoarthritis (OA) is a prevalent hand OA phenotype, associated with specific risk factors, treatment strategies, and requiring a distinct subset of evaluative approaches. This paper aimed at surveying our clinical evaluative methods and identifying gaps in our ability to capture the thumb's unique attributes and how they could impact our treatment recommendations. A scoping review was conducted in accordance with the Joanna Briggs Institute methodology to gather relevant published and non-published articles regarding clinical tests currently available to assess the physical presentation of thumb base OA with special consideration of its specific multifactorial parameters namely architecture, ligaments, biomechanics, neuromuscular control, and proprioception. A full search strategy of MEDLINE, CINAHL, EMBASE, Scopus, Google Scholar, and Clinical Trials.gov from their inception through May 2020 was performed. Of 1936 citation identified, 54 met the inclusion criteria. Fifty-two clinical physical tests for the evaluation of thumb base OA were extracted, most of which well suited to address research questions regarding efficacy of clinical intervention, however providing limited information regarding the underlying impairments of ligaments, biomechanics, neuromuscular or proprioceptive components. The tests and measures specific to the basal thumb OA phenotype, and capable of isolating its multifactorial contributors are scarce. Our limited physical assessment repertoire impedes our ability to describe and answer explicative research questions. Without these we cannot evaluate the effect of conservative management and provide specific treatment recommendations. Further research is needed to develop and validate distinct clinical tools for this debilitating pathology.
Highlights
Thumb base osteoarthritis (OA) is a prevalent hand OA phenotype, associated with specific risk factors, treatment strategies, and requiring a distinct subset of evaluative approaches
Thumb base osteoarthritis (OA) is a prevalent distinct hand OA subset that results in considerable clinical burden.[1]
To move the research efforts towards the explanatory end of the spectrum, we propose to refine the physical function and hand strength domains and associated outcome measures specific to the thumb base OA phenotype, looking at clarifying the presentation of the problematic thumb chain
Summary
Thumb base osteoarthritis (OA) is a prevalent hand OA phenotype, associated with specific risk factors, treatment strategies, and requiring a distinct subset of evaluative approaches. Fifty-two clinical physical tests for the evaluation of thumb base OA were extracted, most of which well suited to address research questions regarding efficacy of clinical intervention, providing limited information regarding the underlying impairments of ligaments, biomechanics, neuromuscular or proprioceptive components. Our limited physical assessment repertoire impedes our ability to describe and answer explicative research questions Without these we cannot evaluate the effect of conservative management and provide specific treatment recommendations. Thumb base osteoarthritis (OA) is a prevalent distinct hand OA subset that results in considerable clinical burden.[1] Hand OA encompasses three different phenotypes (thumb base OA, nodal OA, erosive OA) each associated with different risk factors requiring different treatment strategies.[2]. With its kinematic structure organized in a serial chain of five, invariant, nonorthogonal and nonintersecting rotational degrees of freedom (one at the interphalangeal joint, two at the metacarpophalangeal joint and two at the carpometacarpal joint), nine activating muscles (5 intrinsics, 4 extrinsics), and elaborate neuromuscular and proprioceptive network, it translates into a diverse crowd of kinematic model types affecting its functionality,[8,9] which challenges our understanding of its pathomechanics
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