Sex differences in orthosis wear on pain, function, and grip in patients with thumb carpometacarpal joint osteoarthritis.

Background The thumb carpometacarpal joint (CMCJ) osteoarthritis is one of the most common pathologies in the hand with controversial treatment options. Description of Technique Describe the use of arthroscopic technique for thumb CMCJ arthrodesis and the clinical outcome. Patients and Methods Cases with Eaton III thumb CMCJ osteoarthritis treated with arthroscopic arthrodesis were reviewed. Patient evaluations include: grip strength, pinch strength, range of motion, Kapandji score, Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, and the visual analog scores for pain. All cases were assessed before the surgery and at 3, 6, 12, and 24 months after surgery. Radiographs were reviewed. Results There were total 16 patients with 18 arthrodesis performed. The average age was 62.2 years with M:F ratio of 2:7. The average follow-up time was 57.2 months. There was improvement of pain score as early as at postop 3 months ( p < 0.001) and continued to improve at 6, 12, and 24 months. There was improvement of grip strength and pinch strength at 12 and 24 months (p < 0.001). The DASH score showed improvement as early as at 3 months ( p = 0.012). There was a reduction of Kapandji score and interphalangeal joint motion at 3 months postop, but these returned to normal at 6 months. There was no major complication. There was one case of nonunion (5.6%). Conclusion Arthroscopic arthrodesis is a feasible treatment option and provides excellent pain relief, restore thumb strength and stability, retain functional thumb mobility, and hence improvement in hand function.

First Carpometacarpal Joint Denervation for Primary Osteoarthritis: Technique and Outcomes

The majority of students spend time in writing, which is a prime performance measure in examinations. Enhancement in handwriting should benefit students to attain better academic performance. To assess the effectiveness of taping and exercises on hand function, writing speed, self-perception of writing and to compare these techniques. A randomized control trial was conducted using cluster sampling in adolescent children across four schools in an urban city. A 4-week intervention study was conducted on 123 students divided into taping, exercise and control groups. Outcome measures were grip strength, pinch strength, 12-min writing speed test and the Writer Self-Perception Scale (WSPS). For intra-group analysis, a paired t-test was used for parametric values and the Wilcoxon signed rank test was used for non-parametric values. For inter-group analysis, one-way analysis of variance (ANOVA) for parametric values and the Kruskal-Wallis test for non-parametric values was used. The taping group showed a significant improvement in grip strength (1.79 kg; p = 0.00), pinch strength [1.67 lb (757.4 g); p = 0.00] and writing speed (39.77 words/12 min; p = 0.00). The exercise group showed significant improvement in grip strength (2.09 kg; p = 0.00), pinch strength (1.28 lb; p = 0.00), writing speed (28.38 words/12 min; p = 0.00). In the control group, there was a significant increase in pinch strength (1.023 lb; p = 0.01) and writing speed (12.94 words/12 min; p = 0.02). Inter-group analysis showed significant difference in writing speed (p = 0.002) and grip strength (p = 0.00). There was no significant difference in perception (p = 0.071). Taping and exercise are equally effective for enhancement of hand function, writing speed and self-perception in adolescent school children.

Purpose: This study investigated the clinical and radiologic outcomes of partial trapeziectomy and suspensionplasty with a suture button for thumb carpometacarpal (CMC) joint osteoarthritis over a 2-year follow-up period.Methods: This retrospective study involved 17 patients with thumb CMC joint osteoarthritis (Eaton and Littler stage II or III) treated with partial trapeziectomy and suspensionplasty using a suture button. Clinical outcomes were evaluated using a visual analog scale for pain, the Quick DASH score, pinch and grip strength, and thumb range of motion. The trapezial space ratio (TSR) was used as a radiologic parameter to evaluate radiologic outcomes immediately postoperatively, at 6 months, and at the final follow-up.Results: The study included 17 patients (female, 16 and male, 1) with an average age of 63.2 years (range, 56–70 years). Surgery was performed on the dominant hand in nine cases and the nondominant hand in eight. Significant improvements were observed in clinical outcomes. The TSR significantly decreased up to 6 months postoperatively, but there was no significant change from 6 months onward. Complications included button irritation (n=1), a metacarpal fracture (n=1), and flexor carpi radialis tendon rupture (n=1), which were subsequently treated. At the last follow-up, significant improvements in functional outcomes were observed in comparison to the preoperative status. Conclusion: The procedure demonstrated significantly improved clinical outcomes over a 2-year follow-up. This method is less invasive than other surgical techniques because it preserves part of the trapezium, making it a favorable surgical option in patients with early basal thumb arthritis (below Eaton stage III).

Nonsurgical therapeutic approaches for thumb carpometacarpal (CMC) osteoarthritis (OA) often offer only inconsistent symptom relief and fail to restore hand function. Intra-articular platelet-rich plasma (PRP) injections have recently emerged as a promising alternative, with encouraging outcomes in knees and hips. This systematic review and meta-analysis aims to highlight the safety and efficacy of PRP injections in thumb CMC OA. A systematic review was completed using Medline, Embase, and Cochrane. Primary outcomes focused on patients with basal thumb osteoarthritis treated with intra-articular PRP injections. Patient characteristics, product administration, functional outcomes and complications were analyzed as means of central tendency. A meta-analysis was performed focusing on pain relief and improvement in hand function. Seven articles were included, comprising 115 patients with an average age of 62.6 years, predominantly female (67.0%). Patients received an average of 1.4 PRP injections per joint, with an average follow-up of 14.1 months. Control groups were administered corticosteroids, normal saline, and hyaluronic acid. All PRP-treated patients resumed their prior activities of daily living with a satisfaction rate at 73.7% (n=76). Statistically significant pain reduction (n=98) and improvement in pinch strength were reported, while no statistically significant improvement in grip strength was observed (n=39). No adverse events occurred, with only one complication (a palmar wrist ganglion) reported. Intra-articular PRP injections in thumb CMC OA yields favorable outcomes for pain relief and hand function without major complications. However, procedural and data heterogeneity affect reliability. Further randomized controlled trials comparing PRP and cortisone injections are needed.

Autologous chondrocyte transplantation in the treatment of thumb CMC joint osteoarthritis

Objective To discuss the effects of elastic band exercise on the frailty states in pre-frail elderly people. Methods This study was a randomized controlled trial. Trial registration number is ChiCTR-IOC-17012579. Seventy pre-frail elderly people were randomly divided into elastic band group (n = 35) and control group (n = 35). Elastic band exercise was applied to elastic band group, 45–60 min per time for 8 weeks by 3 days a week; no exercise was applied to the control group. The frailty states, grip strength (female/male), walking speed, and physical activity were measured by the Fried frailty phenotype at pre-intervention, 4, and 8 weeks after intervention to assess the effects of exercise. Results The elastic band group showed significant improvements in the frailty states, grip strength (female) and walking speed both after 4-week and 8-week intervention (P< 0.001), and significant improvements in grip strength (male) and physical activity after 8-week intervention (P< 0.05). Within-group analysis (pre-intervention vs. after 4-week, after 4-week vs after 8-week, pre-intervention vs after 8-week) showed significant improvements (P< 0.001) in grip strength (female/male) and walking speed in the elastic band group over time, while no significant differences in the control group (P > 0.05). Conclusion Elastic band exercise can improve frailty states in pre-frail elderly people, make them broke away from pre-frailty and restore them to non-frailty through improving the grip strength, walking speed and physical activity, and the effects after 8 weeks are better than those after 4 weeks.

OP0313 THERAPEUTIC APPROACHES TO OSTEOSARCOPENIA: DENOSUMAB EFFECT ON FALLS RISK, PHYSICAL PERFORMANCE AND WALKING SPEED

Background: High radial nerve injuries present complex challenges in upper extremity reconstruction, impacting both motor and sensory functions. The decision-making process for choosing the appropriate surgical intervention involves careful consideration of various factors, including the type of nerve repair and the potential need for adjunct procedures like tendon transfer. Aim: To compare patient satisfaction outcomes between these two surgical approaches, assessing grip strength, pinch strength, Disabilities of the Arm, Shoulder, and Hand (DASH) scores, and Quality of Life (QOL) scores. Methodology: This prospective, comparative, and observational study included 62 participants, equally divided into two groups: Group 1 undergoing Primary Nerve Repair plus Tendon Transfer (n=31) and Group 2 undergoing Primary Nerve Repair Alone (n=31). Data collection involved patient interviews, medical records review, and standardized questionnaires, covering variables such as age, gender, occupation, type of surgery, duration of injury, post-operative pain levels, and patient-reported satisfaction scores. Statistical analysis using SPSS vr 23.0 included descriptive statistics, independent samples t-tests, and chi-square tests. Results: Results indicated significant improvements in grip strength (Mean ± SD: 35.2 ± 4.2 pounds, p &lt; 0.001), pinch strength (Mean ± SD: 7.9 ± 1.4 pounds, p = 1.081), DASH scores (Mean ± SD: 11.5 ± 2.9, p = 2.59), and QOL scores (Mean ± SD: 93.8 ± 7.3, p = 0.73) in both groups, emphasizing the positive impact of surgical interventions on functional outcomes and patient satisfaction. These findings contribute valuable insights into refining surgical strategies for high radial nerve injuries, emphasizing the enhancement of patient outcomes and satisfaction. Practical implication:The study's findings offer crucial guidance for surgeons in selecting optimal surgical strategies, ultimately leading to improved functional outcomes and higher patient satisfaction in individuals with high radial nerve injuries. Conclusion: Both surgical approaches demonstrated significant improvements in grip strength, pinch strength, disabilities of the arm, shoulder, and hand (DASH) scores, and Quality of Life (QOL) scores. Notably, grip strength showed a substantial increase (Mean ± SD: 35.2 ± 4.2 pounds, p &lt; 0.001) in both groups, emphasizing the positive impact of surgical interventions on upper limb function. While pinch strength and QOL scores showed non-significant changes, the overall findings underscore the effectiveness of both surgical strategies in enhancing functional outcomes and patient satisfaction in the early post-operative periods for high radial nerve injuries. Keywords: High radial nerve injury, nerve repair, tendon transfer, patient satisfaction, early return to work, observational study.

Reporting Outcomes and Outcome Measures in Thumb Carpometacarpal Joint Osteoarthritis: A Systematic Review

Corbett Targeted Coin Test norms with thumb carpometacarpal osteoarthritis and outcomes post suture suspension arthroplasty.

This study aimed to evaluate the validity of a frailty control program for the elderly at a newly established center. The subjects were 30 patients who underwent training between January 2022 and January 2023 and who could be evaluated 3 times. The first step of the program was to diagnose frailty and sarcopenia. Training in the training room and individual home exercise programs were proposed. We also provided support for the prevention of oral frailty and nutritional guidance. Body composition was measured, and the skeletal muscle mass index (SMI) was used as an index of muscle mass. Physical functions (e.g., grip strength and normal walking speed) were also measured. Adverse events that occurred during training were also investigated. The analysis of 30 subjects showed a significant improvement in grip strength after 3 months (P<0.05) and 6 months (P<0.01). Walking speed significantly improved after 3 months (P<.01) and 6 months (P<0.001). In women, grip strength and walking speed significantly improved after 3 months and 6 months, while significant improvement was observed after 6 months in men. Subjects without sarcopenia showed significant improvement in walking speed at 3 months and 6 months. Subjects with sarcopenia showed a significant improvement in grip strength at 6 months. No adverse events were observed during the training. The results showed statistically significant improvements in grip strength and gait speed in subjects in the anti-frailty program, and the safety of the program was confirmed.

To investigate the efficacy of phonophoresis with nonsteroid anti-inflammatory drugs (P-NSAID) and corticosteroids (P-CS) in the treatment for carpal tunnel syndrome (CTS) and to compare the efficacy of phonophoresis with local CS injection (LCSI) and splinting with a 3-month follow-up. 84 hands of 51 patients with CTS were treated by applying LCSI, P-CS, P-NSAID, and wrist splinting. Electrophysiological studies, grip strength, hand dexterity, and sensory recovery of the first three digits were assessed. Duruöz hand index (DHI) was used to assess the functional hand disability. For clinical evaluation, we used Phalen and Tinnel signs. Pain intensity was evaluated by visual analog scale. The LCIS group showed a significant improvement in pain relief and DHI, but this group had significant deterioration in the results of monofilament and pegboard tests. The P-CS group showed improvement in sensory nerve conduction velocity, distal latency, grip strength, and DHI parameters. There was a significant improvement in grip strength, pegboard test, and pain intensity in the P-NSAID group. There was improvement only in pain intensity in the splinting group. We identified marked improvement in the electrophysiological studies in the P-CS group. Splinting had no effect on hand functions, disability, and electrophysiological studies.

PurposeThe primary treatment goals for advanced-stage thumb carpometacarpal (CMC) joint osteoarthritis are complete pain relief and restoration of thumb strength. The purpose of the present study was to introduce a variation of the abductor pollicis longus (APL) suspension arthroplasty using a single looping of a radial slip from the APL tendon around the flexor carpi radialis (FCR) tendon combined with RegJoint™ interposition and to determine its efficacy in the treatment of thumb CMC joint osteoarthritis.MethodsBetween 2015 and 2017, 21 patients were included. The average age was 60.8 years (range 48–79). The mean follow-up was 27.7 months (range 8–50). Evaluation included pain, radial and palmar abduction, tip pinch and grip strength, and Disabilities of the Arm, Shoulder, and Hand (DASH) score.ResultsPain averaged 0.3 (range 0–4) at rest and 1.4 (range 0–4) on exertion. The radial and palmar abduction were 97% and 99% compared to the contralateral side. The tip pinch and grip strength were 4.1 kg (range 3–6.5) and 22 kg (range 13.3–40), respectively. The DASH score accounted for 18.5 (range 0.8–41.7).ConclusionThe modified APL suspension interposition arthroplasty was an efficient and simplified option for the treatment of thumb CMC joint osteoarthritis, with results comparable or better than other published procedures. The APL suspension technique was easy to perform avoiding difficult bone tunneling and incision of the FCR tendon. The RegJoint™ interposition as spacer prevented impingement of the first metacarpal base on the second metacarpal base or the trapezoid bone.

Purpose There is a real need to find less invasive therapeutic options for young patients suffering from osteoarthritis of the first carpometacarpal joint. We wanted to assess the effectiveness of targeted partial arthroscopic trapeziectomy with distraction of the trapeziometacarpal (TM) joint with Kirschner wires (K-wires) in 39 thumbs impacted by TM osteoarthritis. Methods We conducted a retrospective study in which preoperative and postoperative data on pinch strength, grip strength, and pain on a visual analogue scale were collected. Subgroup analysis was performed based on two different K-wire distraction techniques. Only patients suffering from primary osteoarthritis and younger than 70 years were included. Second, we compared the frequency of complications relative to the position of the pins. Results We found a significant improvement in pain ( p = 0.005) and grip strength ( p = 0.0021) as well as an improvement in pinch strength ( p = 0.5704). There was reduction in pain for all Badia levels, which was significant for stages 2 ( p = 0.002) and 3 ( p = 0.032) as well as an overall improvement in grip strength and pinch strength for all Badia levels. Conclusion Partial trapeziectomy with K-wire distraction in young patients suffering from TM osteoarthritis is a simple technique that requires minimal equipment and yields satisfactory outcomes. Conversion to another surgical treatment is still possible if this less invasive technique is unsuccessful. Level of Evidence This is a Level IV study.