Thumb Base Osteoarthritis Research Articles

Nouveautés médicales et prise en charge chirurgicale dans l’arthrose digitale

Hand osteoarthritis (OA) is a very frequent and heterogeneous disease. Its medical management is currently based on European recommendations and includes pharmacological (topical NSAIDs, and infiltrations) and non-pharmacological measures (orthotics, and ergonomics). Conventional synthetic or biological treatments used in rheumatoid arthritis have not demonstrated any efficacy. The only positive trial in recent years is low-dose corticosteroid therapy, which has demonstrated a suspensive effect. However, new therapeutic options such as botulinum toxin infiltrations or vagus nerve stimulation are currently being evaluated. As far as surgical treatment is concerned, arthrodesis remains the intervention of choice for distal interphalangeal OA and new fixation methods allow immediate mobilization. At the proximal interphalangeal level, joint denervation is an interesting conservative solution, while the best functional result is obtained with a prosthesis. The new models of resurfacing implants give higher amplitudes than hinged silicone implants, but we do not yet have the hindsight we have for the latter. For thumb base OA, trapezectomy with or without suspension ligamentoplasty has been confronted in recent years with severe competition from trapeziometacarpal prostheses, which allow faster functional recovery despite a higher complication rate and a long-term survival that is still poorly known. In total, surgical decision-making is based on multiple factors: functional demand of the patient, stability of the osteoarthritic joint, radiographic anatomical parameters.

Base of thumb osteoarthritis in UK interface services-a cohort and survey-based study to assess current practice.

ObjectiveBase of thumb OA (BTOA) is a common age-related disease that has a significant negative impact on quality of life, while little is known about the structure and pathways of interface services. Our aim was to assess disease burden, referral pathways, service structure and management pathways in UK interface services.MethodsA structured questionnaire was carried out with a participating clinician at each centre to detail the local guidelines and management of BTOA. Five patients referred with BTOA were prospectively identified in each of 32 UK interface centres.ResultsMost centres (72%) had a local guideline and a standardized treatment regime consisting of education (100%), joint protection (100%), range of motion exercises (84%), strengthening exercises (88%), splintage (100%) and use of assistive devices (78%). No centre routinely offered a steroid injection at the first appointment and no centre had a specific threshold for offering an injection. Injection delivery was variable. Most patients had not been referred previously (82%). Most patients used analgesia (72%), but a minority of patients had been treated with a splint (46%), therapy (43%) and steroid injection (27%) prior to their latest attendance.ConclusionMost BTOA patients newly referred to interface services have been treated with analgesics and have not received comprehensive multimodal intervention. The management of BTOA at interface services is standardized in terms of education, splintage and therapy. However, there is a lack of standardization in terms of both the threshold for, timing of and mode of delivery of injection therapy.

The clinical and cost effectiveness of splints for thumb base osteoarthritis: a randomized controlled clinical trial.

To investigate the clinical effectiveness, efficacy and cost effectiveness of splints (orthoses) in people with symptomatic basal thumb joint OA (BTOA). A pragmatic, multicentre parallel group randomized controlled trial at 17 National Health Service (NHS) hospital departments recruited adults with symptomatic BTOA and at least moderate hand pain and dysfunction. We randomized participants (1:1:1) using a computer-based minimization system to one of three treatment groups: a therapist supported self-management programme (SSM), a therapist supported self-management programme plus a verum thumb splint (SSM+S), or a therapist supported self-management programme plus a placebo thumb splint (SSM+PS). Participants were blinded to group allocation, received 90 min therapy over 8 weeks and were followed up for 12 weeks from baseline. Australian/Canadian (AUSCAN) hand pain at 8 weeks was the primary outcome, using intention to treat analysis. We calculated costs of treatment. We randomized 349 participants to SSM (n = 116), SSM+S (n = 116) or SSM+PS (n = 117) and 292 (84%) provided AUSCAN Osteoarthritis Hand Index hand pain scores at the primary end point (8 weeks). All groups improved, with no mean treatment difference between groups: SSM+S vs SSM -0.5 (95% CI: -1.4, 0.4), P = 0.255; SSM+PS vs SSM -0.1 (95% CI: -1.0, 0.8), P = 0.829; and SSM+S vs SSM+PS -0.4 (95% CI: -1.4, 0.5), P = 0.378. The average 12-week costs were: SSM £586; SSM+S £738; and SSM+PS £685. There was no additional benefit of adding a thumb splint to a high-quality evidence-based, supported self-management programme for thumb OA delivered by therapists. ISRCTN 54744256 (http://www.isrctn.com/ISRCTN54744256).

Psychological Characteristics, Female Sex, and Opioid Use Predict Acute Postoperative Pain in Patients Surgically Treated for Thumb Base Osteoarthritis: A Cohort Study.

It is unclear which factors predict acute postoperative pain in patients surgically treated for thumb base osteoarthritis. The authors investigated the influence of type of surgery, preoperative sociodemographics, preoperative patient-reported outcome measures, psychological characteristics, and postoperative opioid use on acute postoperative pain 24 hours postoperatively following surgery for thumb carpometacarpal osteoarthritis. In addition, preoperative and acute postoperative pain were compared. In this prospective cohort study, 215 patients surgically treated for thumb carpometacarpal osteoarthritis were included. Data were collected in 16 clinics for hand surgery and therapy in The Netherlands. Hierarchical regression was used to identify whether type of surgery, preoperative sociodemographics, preoperative patient-reported outcome measures, psychological characteristics (including treatment credibility and expectations, illness perception, pain catastrophizing, anxiety, and depression), and postoperative opioid use predicted acute postoperative pain 24 hours postoperatively, measured using the Numeric Pain Rating Scale (range, 0 to 10). Female sex, opioid use, higher preoperative satisfaction with hand, and higher self-reported consequences and coherence predicted greater postoperative pain, with 31 percent explained variance in the final model including psychological factors. Mean postoperative Numeric Pain Rating Scale score was lower (5.1 ± 2.4) than preoperative pain, measured using visual analogue scales (during the past week, 6.7 ± 1.7; physical load, 7.5 ± 1.7) and the Michigan Hand Outcomes Questionnaire (6.4 ± 1.4; p < 0.001). Psychological factors, female sex, and opioid use enhance the prediction of acute postoperative pain beyond surgery type, preoperative sociodemographics, and patient-reported outcome measures. Female sex and opioid use were the strongest predictors, even after controlling for psychological factors. Future studies may investigate sex-based approaches and patient education for reducing acute postoperative pain. Risk, II.

Arthroscopic Trapeziectomy and Suture Button Suspensionplasty: A Review of the Literature and Description of the "Three-Step Arthroscopic Trapeziectomy Technique".

In the last two decades, surgeons have rapidly developed arthroscopic techniques to treat basal joint osteoarthritis. Such techniques spare the joint capsule and ligaments, allow more accurate staging of cartilage degeneration to determine the most appropriate treatment, and decrease the risk of injury to the radial artery and superficial branch of the radial nerve. Arthroscopic resection arthroplasty of the trapezium can be performed as either partial or complete trapeziectomy. Many papers have described partial trapeziectomy but few have discussed complete trapeziectomy. Suture button implants avoid the drawbacks of temporary fixation using Kirschner wire, as well as the drawbacks of ligament reconstruction, which necessitates the sacrifice of a tendon and involves both wide exposure and scar tissue. This paper aimed to review the published data on the arthroscopic treatment of basal thumb osteoarthritis, with a special focus on stabilization using suture button suspensionplasty, and to present a technique that structures this procedure into three steps, allowing it to be performed in an easier, more organized, and faster way.

Scaphotrapezial Prosthesis: A New Salvage Technique for Failed Trapeziectomy

First metacarpal collapse is the main cause of recurrent pain after a total trapeziectomy. The most frequent surgical revision is through trapeziometacarpal arthrodesis. We present the case of a woman of 62 years old who presented pain and functional impairment of the thumb due to the collapse of the first metacarpal after two previous surgeries for basal thumb osteoarthritis (OA). The case was treated by implanting a cup in the distal scaphoid to create a scaphometacarpal prosthesis. After a follow-up of 8 months, the patient recovered complete mobility, VAS of 0 and an improvement in DASH and compared to the pre-surgical scores. Radiographic studies showed a correct implantation of the prosthesis. This is a new therapeutic option that can be used as a rescue procedure in case of a failure of trapeziectomy.

Trapeziectomy and Abductor Pollicis Longus Suspensionplasty Combined with Extensor Pollicis Brevis Tenodesis for Management of Thumb Basal Joint Osteoarthritis and Metacarpophalangeal Hyperextension

Metacarpal joint hyperextension is common cause of postoperative dissatisfaction after trapeziectomy in the management of basal thumb osteoarthritis. The senior author uses this technique to address this biomechanical problem at the time of trapeziectomy.

Management of osteoarthritis at the base of the thumb.

Base of thumb osteoarthritis (BTOA) is a common age-related disease which has a significant negative impact upon quality of life. Our aim was to assess current UK practice in secondary care with regard to the nature of non-surgical treatments, the surgical procedures most commonly performed, and factors influencing the surgical decision-making process. Ten consecutive patients undergoing surgery for BTOA between March 2017 and May 2019 were prospectively identified in 15 UK centres. Demographic details, duration of symptoms, radiological grade, non-surgical management strategies, and surgery conducted were recorded. A supplementary consultant questionnaire consisting of four multiple-choice-questions (MCQ) based on hypothetical clinical scenarios was distributed. A total of 150 patients were identified with a mean age of 64 years (SD 9), comprising 119 females and 31 males. Median duration of symptoms prior to surgery was 24 months (Interquartile range (IQR) 12 to 40). Hand therapy was used in 67 patients (45%), splints in 80 (53%), and 121 patients (81%) received one or more intra-articular injections, of which 81 (67%) were image-guided (14 (12%) ultrasound and 67 (55%) fluoroscopic). Only 48 patients (32%) received all three non-surgical treatments. Simple trapeziectomy (79 patients) and trapeziectomy with ligament reconstruction and/or tendon interposition (69 patients) were the most commonly performed operations. One patient was treated with arthrodesis, and one with arthroplasty. The supplementary questionnaire revealed that no specific patient or disease characteristics significantly influenced the type of surgery undertaken. We found considerable variation in practice of both non-surgical and surgical management of BTOA. The proportion of patients exhausting non-surgical strategies before being offered surgery is low. Surgeons tend to favour a single type of surgery irrespective of patient or disease characteristics. Cite this article: Bone Joint J 2020;102-B(5):600-605.

Partial Versus Total Trapeziectomy With Interposition Arthroplasty for Trapeziometacarpal Osteoarthritis Grade II to III Eaton-Littler: A Clinical Trial

PurposeTotal trapeziectomy is the most widely used technique to treat isolated thumb trapeziometacarpal joint osteoarthritis. However, this technique has been associated with proximal migration of the thumb metacarpal, which has led some physicians to consider partial trapeziectomy as a valid alternative. The purpose of this study was to assess whether partial trapeziectomy improves final key pinch strength compared with total trapeziectomy.MethodsWe randomized 34 patients with basal thumb osteoarthritis into 2 groups to undergo partial or total trapeziectomy with interposition arthroplasty. Key pinch strength at 12 months was the primary outcome measure. Other variables measured included trapezial space height, range of motion, grip strength, change in key pinch strength, patient-reported outcome measures, and pain.ResultsNo difference between groups was detected regarding final pinch strength, trapezial space height, grip strength, range of motion, change in pinch strength, patient-reported outcomes (Quick–Disabilities of the Arm, Shoulder, or Hand), or pain.ConclusionsWe cannot conclude that partial trapeziectomy provides an advantage over total trapeziectomy at 1 year after surgery. Although trapeziometacarpal space was substantially preserved in the partial trapeziectomy group at 12 months, this difference was not statistically or clinically significant.Type of study/level of evidenceDiagnostic III.

Cost-utility analysis of multimodal occupational therapy in patients with thumb base osteoarthritis

Purpose: Patient education, hand exercises, and use of assistive devices and orthoses are regarded as first-line treatment for patients with hand osteoarthritis (OA), however there is limited evidence for the cost-effectiveness of such treatment. The purpose of this study is to assess the cost-utility of a multimodal occupational therapy treatment delivered in the waiting period before surgical consultation in patients with thumb base OA compared to usual care. Methods: This study presents an economic evaluation assessing the difference in health care use and quality-of-life during a 24-month period in a Norwegian multicenter randomized controlled trial designed to assess if multimodal occupational therapy in the waiting period before surgical consultation is more cost-effective compared to usual care. The outcomes in this study was to measure the quality adjusted life years (QALYs) in both the intervention and control group. All patients referred to surgical consultation due to thumb base OA at three departments of rheumatology between 2013 and 2015 were eligible for inclusion. In total, 180 patients were included and randomized to a control group or a multimodal occupational therapy group (90 patients in each group). During the waiting period between referral and actual surgical consultation, the control group continued with usual care which was staying on the waiting list and receiving information on hand OA. The intervention group got information on hand OA, ergonomic principles and use of assistive devices, and they were instructed in home-based hand exercises and received a prefabricated day orthosis and a customized night orthosis. The intervention group was instructed to use the orthoses and assistive devices as much as possible and perform home exercises three times per week for 12 weeks. They returned for adjustment of the exercise program and orthoses after 14 days. The patients were assessed at baseline, before surgical consultation (after approximately 4 months) and after 18 and 24 months. The within-trial economic analysis reports the incremental cost-effectiveness ratio (ICER) reflecting the between-group difference in incremental cost per QALY over 24 months. ICER is defined as the ratio of the difference in costs to the difference in effectiveness between two strategies. A generic health-related quality of life questionnaire, the EuroQol 5 Dimension (EQ-5D-5L) was used to calculate the QALYs at baseline, 4, 18 and 24 months. Costs were collected from different sources, taking a health care perspective; The occupation therapist reported the number of consultations related to the intervention; surgical procedure and post-operative follow-up were collected from patients’ journals; and additional consumption of primary and specialist health care was self-reported by the patient. Sensitivity analyses were performed to assess the robustness of the reported Results. The results are presented in a cost-effectiveness plane using bootstrapping. Willingness-to-pay threshold is set to be € 27 500 linked to the severity of this condition. Results: The mean age of the included patients was 63 years (SD 7.6) and 142 (79%) were women. There was a total between-group difference in QALYs of 0.07 utilities after 24 months, in favour of the intervention group. Operations constituted the main costs with 22 operations in the intervention group compared to 33 in the control group. The between-group difference in costs due to health care consumption was estimated to € 500 in favour of the intervention group (Figure 1). Conclusions: The Results in this within-trial analysis indicate that multimodal occupational therapy in the waiting period before surgical consultation compared to usual care is a cost-effective alternative taking a health care perspective.

Self-reported adherence is not influenced by pain or functional outcomes in thumb base osteoarthritis trial

Self-reported adherence is not influenced by pain or functional outcomes in thumb base osteoarthritis trial

O03 The OA thumb therapy trial: a three arm multi-centre randomised controlled trial of the clinical effectiveness and efficacy of splints for symptomatic thumb base OA

Abstract Background Symptomatic thumb-base osteoarthritis (OA) affects 20% of people aged &amp;gt;55 years. Patients with thumb-base OA may experience pain, work disability, hand dysfunction and reduced quality of life (QoL). Although hand splints are a recommended intervention, this is supported by only low level evidence. Furthermore, the impact of placebo hand splints in OA remains unclear. This is the first trial powered to determine the efficacy of active versus placebo thumb splints, when added to a programme of self-management, for patients with symptomatic thumb-base OA. Methods A pragmatic, multi-centre, superiority randomised controlled clinical effectiveness and efficacy trial was conducted. Patients with symptomatic thumb-base OA and at least moderate thumb-base pain referred to UK out-patient occupational and physiotherapists were included. Patients with recent fractures, intra-articular joint injections and medical red flags were excluded. Eligible participants were randomised equally to either: (A) 8 weeks of self-management; (B) 8 weeks of self-management plus a verum splint; or (C) 8 weeks of self-management plus a placebo splint. The self-management programme was designed and delivered by therapists, based on recommended evidence-based practice. Participants in groups B and C were blinded to the type of splint received; clinical outcome assessors were also blinded. Participants were followed-up for 12 weeks from randomisation. The primary outcome was AUSCAN hand pain at 8 weeks. Secondary outcomes included work productivity, QoL, hand stiffness, hand function, disability and satisfaction. The trial was registered (ISRCTN. No 54744256). Results 17 UK NHS therapy departments assessed 751 patients for eligibility. 349 patients were randomised: 116, 116 and 117 to groups A, B and C, respectively. Treatment groups were well balanced for baseline characteristics. At baseline, no participants in group A received a splint; 99% and 97% of participants in groups B and C received the correct allocated splint. 80% of all participants attended their 4 week follow-up appointment. 8 week primary endpoint data were available for 84% of randomised participants; missing data were balanced across the groups. There was no evidence of clinically or statistically significant differences between treatment arms (B vs. C: -0.4 (95% CI -1.4, 0.6 p = 0.41), B vs. A: -0.5 (95% CI -1.4, 0.4 p = 0.26), C vs. A: -0.1 (95% CI -1.0, 0.8 p = 0.78). The per-protocol analysis, sensitivity analysis for missing data and analyses of secondary endpoints supported these findings. Ten participants reported adverse reactions: 3, 5 and 2 in groups A, B and C, respectively. Conclusion The addition of splinting to the recommended self-management package delivered by therapists did not confer additional benefit. Patients randomised to receive verum splints did not report better outcomes than those randomised to placebo splints. Disclosures J. Adams None. P. Barratt None. N.K. Arden None. S. Barbosa Bouças None. S. Bradley None. M. Doherty None. S. Dutton None. K. Dziedzic None. R. Gooberman-Hill None. K. Hislop None. C. Hutt-Greenyer None. V. Jansen None. R. Lunego None. I. Rombach None. M. Wiliams None.

Basal thumb osteoarthritis surgery improves health state utility irrespective of technique: a study of UK Hand Registry data.

We used UK Hand Registry data to study two aspects of basal thumb osteoarthritis surgery: first, whether health-related quality of life improves after surgery. Second, whether results from trials comparing simple trapeziectomy and trapeziectomy with ligament reconstruction and tendon interposition are reproducible in routine clinical practice. Prospectively collected EQ5D index and Patient Evaluation Measure part 2 data were compared at baseline and at 3, 6, and 12 months postoperatively in 1456 patients (median age 67 years; 78% female). A mixed-effects regression model was also used to determine the postoperative trajectory of these variables. There was a significant improvement in the EQ5D index (median + 0.15; (interquartile range 0 to 0.40)) and Patient Evaluation Measure (–22; (–33 to –10)) by 1 year postoperatively and with no meaningful difference between the two techniques. This study demonstrates health state utility gains after basal thumb osteoarthritis surgery regardless of surgical techniques used.Level of evidence: III

Impact of thumb osteoarthritis on pain, function, and quality of life: a comparative study between erosive and non-erosive hand osteoarthritis.

The study was aimed to compare the impact of thumb base osteoarthritis (TBOA) on pain, function, and quality of life in patients with erosive or non-erosive hand osteoarthritis (HOA). This observational retrospective study included 232 patients: 64 with erosive HOA (EHOA) and concomitant TBOA, 36 with isolated EHOA, 97 with non-erosive HOA (non-EHOA) and TBOA, and 35 with isolated non-EHOA. Hand pain by a visual analogue scale (VAS), Functional Index for Hand Osteoarthritis (FIHOA) score, Health Assessment Questionnaire (HAQ), the Medical Outcomes Study 36-Item Short Form (SF-36), and the possible correlations between VAS and FIHOA with radiological score were assessed. No differences were found between EHOA with TBOA and isolated EHOA in VAS and FIHOA scores; opposite, there was a significant difference in VAS (p < 0.01) and FIHOA (p < 0.001) between subjects with non-EHOA and TBOA and patients with only non-EHOA. VAS and FIHOA values resulted slightly higher in patients with EHOA and TBOA vs non-EHOA and TBOA; they were significantly more elevated in EHOA and TBOA group compared to isolated non-EHOA (p ≤ 0.001) and in isolated EHOA vs isolated non-EHOA (p < 0.01 and p < 0.001, respectively). HAQ, SF-36 resulted significantly better in isolated non-EHOA patients compared to the other groups. Finally, we observed a significant correlation between FIHOA and all the Kallman scales in EHOA patients with TBOA and between FIHOA and Kallman's thumb score in non-EHOA-TBOA group. EHOA has a more severe clinical burden than non-EHOA; the presence of TBOA appeared an important determinant of pain and disability in non-EHOA.Key Points• Each subset of HOA can have a different impact on pain and functionality, with EHOA determining more severe effects on hand symptoms and disability than non-EHOA.• The presence of TBOA appeared an important determinant of pain and disability in non-EHOA, but not in EHOA.• Our findings support the need for an individualized therapy for each phenotype of hand osteoarthritis.

The Osteoarthritis Thumb Therapy (OTTER) II Trial: a study protocol for a three-arm multi-centre randomised placebo controlled trial of the clinical effectiveness and efficacy and cost-effectiveness of splints for symptomatic thumb base osteoarthritis

IntroductionThe economic cost of osteoarthritis (OA) is high. At least 4.4 million people have hand OA in the UK. Symptomatic thumb base OA affects 20% of people over 55 years,...

CORR Insights®: Patients With Thumb-base Osteoarthritis Scheduled for Surgery Have More Symptoms, Worse Psychological Profile, and Higher Expectations Than Nonsurgical Counterparts: A Large Cohort Analysis.

CORR Insights®: Patients With Thumb-base Osteoarthritis Scheduled for Surgery Have More Symptoms, Worse Psychological Profile, and Higher Expectations Than Nonsurgical Counterparts: A Large Cohort Analysis.

Patients With Thumb-base Osteoarthritis Scheduled for Surgery Have More Symptoms, Worse Psychological Profile, and Higher Expectations Than Nonsurgical Counterparts: A Large Cohort Analysis.

Psychological characteristics, such as depression, anxiety or negative illness perception are highly prevalent in patients with several types of OA. It is unclear whether there are differences in the clinical and psychological characteristics of patients with thumb carpometacarpal (CMC-1) osteoarthritis (OA) scheduled for nonsurgical treatment and those with surgical treatment. (1) What are the differences in baseline sociodemographic characteristics and clinical characteristics (including pain, hand function, and health-related quality of life) between patients with thumb CMC-1 OA scheduled for surgery and those treated nonoperatively? (2) What are the differences in psychological characteristics between patients scheduled for surgery and those treated nonsurgically, for treatment credibility, expectations, illness perception, pain catastrophizing, and anxiety and depression? (3) What is the relative contribution of baseline sociodemographic, clinical, and psychological characteristics to the probability of being scheduled for surgery? This was a cross-sectional study using observational data. Patients with CMC-1 OA completed outcome measures before undergoing either nonsurgical or surgical treatment. Between September 2017 and June 2018, 1273 patients were screened for eligibility. In total, 584 participants were included: 208 in the surgery group and 376 in the nonsurgery group. Baseline sociodemographic, clinical, and psychological characteristics were compared between groups, and a hierarchical logistic regression analysis was used to investigate the relative contribution of psychological characteristics to being scheduled for surgery, over and above clinical and sociodemographic variables. Baseline measures included pain, hand function, satisfaction with the patient's hand, health-related quality of life, treatment credibility and expectations, illness perception, pain catastrophizing, and anxiety and depression. Patients in the surgery group had longer symptom duration, more often a second opinion, higher pain, treatment credibility and expectations and worse hand function, satisfaction, HRQoL, illness perception and pain catastrophizing compared with the non-surgery group (effect sizes ranged from 0.20 to 1.20; p values ranged from < 0.001 to 0.044). After adjusting for sociodemographic, clinical, and psychological factors, we found that the following increased the probability of being scheduled for surgery: longer symptom duration (standardized odds ratio [SOR], 1.86; p = 0.004), second-opinion visit (SOR, 3.81; p = 0.027), lower satisfaction with the hand (SOR, 0.65; p = 0.004), higher treatment expectations (SOR, 5.04; p < 0.001), shorter perceived timeline (SOR, 0.70; p = 0.011), worse personal control (SOR, 0.57; p < 0.001) and emotional response (SOR, 1.40; p = 0.040). The hierarchical logistic regression analysis including sociodemographic, clinical, and psychological factors provided the highest area under the curve (sociodemographics alone: 0.663 [95% confidence interval 0.618 to 0.709]; sociodemographics and clinical: 0.750 [95% CI 0.708 to 0.791]; sociodemographics, clinical and psychological: 0.900 [95% CI 0.875 to 0.925]). Patients scheduled to undergo surgery for CMC-1 OA have a worse psychological profile than those scheduled for nonsurgical treatment. Our findings suggest that psychological characteristics should be considered during shared decision-making, and they might indicate if psychological interventions, training in coping strategies, and patient education are needed. Future studies should prospectively investigate the influence of psychological characteristics on the outcomes of patients with CMC-1 OA. Level III, therapeutic study.

Importance of ST arthroplasty in the treatment of STT osteoarthritis and concomitant basal thumb osteoarthritis

Basal thumb osteoarthritis is one of the most prevalent forms of osteoarthritis worldwide and is frequently associated with osteoarthritis of the STT joint. The surgical gold standard comprises various modifications of arthroplasty resection. A retrospective study compared the postoperative results of Lundborg's resection-suspension-arthroplasty, modified by Wulle, with and without additional ST arthroplasty. In this study, 50 patients with symptomatic basal thumb osteoarthritis (stages III and IV) were examined. Twenty-one of them were treated with conventional resection-suspension-arthroplasty (RSA) and 29 patients were treated with the same technique and additional ST arthroplasty (RSA-plus). The analysis included an assessment of the Thumb Disability Examination (TDX) score, the Kapandji Thumb Opposition score, the Visual Analogue Scale (VAS) pain score as well as grip force, key pinch force, two-point and three-point pinch force. In both groups, the duration of the operation was comparable. The overall TDX score was 15.9 ± 19.5 in the RSA-plus group and 20.8 ± 24.3 in the RSA group (p > 0.05). A marginally significant difference was noted for the Kapandji score, which was 9.5 ± 1.1 in the RSA-plus group and 8.9 ± 1.6 in the RSA group (p = 0.08). There was no significant difference between both groups for grip strength (RSA-plus: 48.3 ± 21 kPa, RSA: 55.2 ± 24.9 kPa (p > 0.05)), key pinch force (RSA-plus: 32.6 ± 15 kPa, RSA: 37.3 ± 15.4 kPa (p > 0.05)), two-point pinch force (RSA-plus: 30.6 ± 12.9 kPa, RSA: 34.8 ± 12.4 kPa (p > 0.05)) and three-point pinch force (RSA-plus: 36.2 ± 14.2 kPa, RSA: 42 ± 13.6 kPa (p > 0.05)). Both groups demonstrated insignificant differences in pain intensity at rest (RSA-plus: 0.4 ± 1.3, RSA: 1 ± 2.1 (p > 0.05)), during movement (RSA-plus: 0.7 ± 1.8, RSA: 1.6 ± 2.7 (p > 0.05)) and under stress (RSA-plus: 1.6 ± 2.5, RSA: 2.9 ± 3.4 (p > 0.05)). The followed-up patient groups demonstrated no significant differences in the examined variables. This leads us to the conclusion that there are no disadvantages associated with performing ST arthroplasty in addition to conventional RSA. In fact, based on the collected data, we suggest that ST arthroplasty should be more widely indicated in the context of RSA.

Musculoskeletal ultrasound in symptomatic thumb-base osteoarthritis: clinical, functional, radiological and muscle strength associations

BackgroundThumb-base osteoarthritis (OA) is a common cause of pain and disability This study aimed to investigate the associations of musculoskeletal ultrasound OA pathologies with the extent of pain, function, radiographic scores, and muscle strength in symptomatic thumb-base osteoarthritis.MethodsThis is a cross-sectional study of an ongoing clinical trial with eligibility criteria including thumb-base pain on Visual Analogue Scale (VAS) ≥40 (0 to 100 mm), Functional Index for Hand OA (FIHOA) ≥ 6 (0 to 30) and Kellgren Lawrence (KL) grade ≥ 2. The most symptomatic side was scanned to measure synovitis and osteophyte severity using a 0–3 semi-quantitative score, power Doppler and erosion in binary score. A linear regression model was used for associations of ultrasound findings with VAS pain, FIHOA and hand grip and pinch strength tests after adjusting for age, gender, body mass index, disease duration and KL grade as appropriate. For correlation of ultrasound features with KL grade, OARSI ((Osteoarthritis Research Society International) osteophyte and JSN scores, Eaton grades, Spearman coefficients were calculated, and a significant test defined as a p-value less than 0.05.ResultsThe study included 93 participants (mean age of 67.04 years, 78.5% females). Presence of power Doppler has a significant association with VAS pain [adjusted β coefficient = 11.29, P = 0.02] while other ultrasound pathologies revealed no significant associations with all clinical outcomes.In comparison to radiograph, ultrasonographic osteophyte score was significantly associated with KL grade [rs = 0.44 (P < 0.001)], OARSI osteophyte grade [rs = 0.35 (P = 0.001)], OARSI JSN grade [rs = 0.43 (P < 0.001)] and Eaton grade [rs = 0.30 (P < 0.01)]. Ultrasonographic erosion was significantly related with radiographic erosion [rs = − 0.49 (P = 0.001)].ConclusionFrom a clinical perspective the significant relationship of power Doppler with pain severity in thumb base OA suggests this might be a useful tool in understanding pain aetiology. It is important to recognise that power Doppler activity was only detected in 14% of the study so this might be an important subgroup of persons to monitor more closely.Trial registrationRegistered at Australian New Zealand Clinical Trials Registry (ANZCTR), http://www.anzctr.org.au/, ACTRN12616000353493.

Short-term effect of occupational therapy intervention on hand function and pain in patients with thumb base osteoarthritis - Secondary analyses of a randomized controlled trial

Short-term effect of occupational therapy intervention on hand function and pain in patients with thumb base osteoarthritis - Secondary analyses of a randomized controlled trial