Abstract
BackgroundHypermobility of the first carpometacarpal joint is mostly surgically treated with a volar approached stabilization by Eaton, but recent studies indicate the importance of the dorsoradial and intermetacarpal ligaments (DRL and IML) for carpometacarpal joint stability. The aim of this study was to compare a dorsal and volar technique for primary carpometacarpal hypermobility regarding pain and functional outcome.MethodsPatients with non-degenerative, painful carpometacarpal hypermobility were included and were randomly assigned to either the volar technique using the FCR, or a dorsal technique using the ECRL. After premature termination of the trial, we followed all patients treated with the volar approach. Pain, strength, and ADL function using DASH and Michigan Hand Questionnaires (MHQ) were measured at baseline and 3 and 12 months after surgery.ResultsAfter including 16 patients, the randomized trial comparing the volar and dorsal technique was terminated because of significant increased pain in the dorsal group. Although none of the other outcome measures were significant in the underpowered comparison, in line with the pain scores, all variables showed a trend towards a worse outcome in the dorsal group. Between 2009 and 2012, 57 thumbs were surgically stabilized. We found significant better pain and MHQ scores, and after 1 year improved grip and key pinch strength. Patients returned to work within 8 (±7) weeks, of which 85 % in their original job.ConclusionsSurgical stabilization of the thumb is an effective method for patients suffering from hypermobility regarding pain, daily function, and strength. We recommend a volar approach.Level of Evidence: Level I, therapeutic study
Highlights
Joint laxity or hypermobility of the first carpometacarpal (CMC) joint is a common disorder
Surgical stabilization of the thumb is an effective method for patients suffering from hypermobility regarding pain, daily function, and strength
This generalized joint hypermobility combined with subluxation of the joint can cause severe pain and can result in osteoarthritis of the first CMC joint later in life [1,2,3,4]
Summary
Joint laxity or hypermobility of the first carpometacarpal (CMC) joint is a common disorder. This study focuses on the surgical treatment of young, female patients, suffering from generalized joint laxity without an underlying specific (systematic) disease These patients commonly present with pain, functional problems, instability, and loss of strength. The technique supports the beak ligament and the intermetacarpal ligament (IML) with the flexor carpi radialis (FCR) tendon in this volar technique and is reported to be effective in this specific patient group for pain reduction and for prevention of CMC degeneration [8, 9]. We slightly modified the technique of Eaton and Littler [8], which uses a slip of the flexor carpi radialis (FCR) to reconstruct the beak ligament using a Wagner incision. We used a short period of cast splinting of 2 weeks after which a protective splinting was provided for 8 weeks
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