Thumb Carpometacarpal Arthritis Research Articles

Partial Trapeziectomy and Suture-Button Suspensionplasty for the Treatment of Thumb Carpometacarpal Joint Arthritis

Partial Trapeziectomy and Suture-Button Suspensionplasty for the Treatment of Thumb Carpometacarpal Joint Arthritis

Suture Button Suspensionplasty

Traditional techniques for surgical treatment of thumb carpometacarpal arthritis require sacrifice either the flexor carpi radialis or abductor pollicis longus tendons. Although loss of these tendons appears to be well tolerated, maintenance of normal anatomy would be preferable. In addition, these techniques require 6-8 weeks of immobilization to allow or healing of the autograft reconstructions to occur. These factors led to the application of a suture button technique to facilitate suspension of the thumb metacarpal while allowing early range of motion. This article describes trapeziectomy with endobutton suspensionplasty, outcomes, and complications of this technique.

Trapeziectomy and Suspensionplasty Using an Acellular Dermal Matrix Allograft

Trapeziectomy and suspensionplasty with or without interposition is the most commonly performed surgery in the United States for symptomatic thumb carpometacarpal joint arthritis that has failed conservative treatment. The anterior oblique ligament is traditionally reconstructed using tendon autograft to stabilize the first ray after trapeziectomy, but concerns regarding donor site morbidity have led to the use of commercially available products. Acellular dermal matrix (ADM) allograft has been successfully and safely used in several orthopaedic procedures including anterior oblique ligament reconstruction and interposition following trapeziectomy. The use of ADM negates the need to harvest tendon autograft and therefore reduces both morbidity and operative time while also providing the ability to perform a consistent procedure in both primary and revision cases. In this article, we describe our preferred surgical technique of trapeziectomy and suspensionplasty using an ADM allograft.

Abductor Pollicis Longus to Flexor Carpi Radialis Tenodesis Suspensionplasty

Numerous techniques have been described for the surgical treatment of thumb carpometacarpal arthritis. Most of these techniques require bone tunnels, which may result in increased postoperative pain, increased surgical dissection and trauma, and increased operative time. This article describes a technique for suspensionplasty that does not require the use of bone tunnels. This technique has similar outcomes to more traditional techniques that sacrifice the flexor carpi radialis or abductor pollicis longus.

Hematoma Distraction

Surgery for thumb carpometacarpal arthritis is indicated after nonoperative interventions fail to provide relief. Trapeziectomy with temporary K-wire distraction is a simple technique that provides equivalent outcomes to ligament reconstruction techniques.

The diagnostic clinical value of thumb metacarpal grind, pressure-shear, flexion, and extension tests for carpometacarpal osteoarthritis

Study designClinical measurement. IntroductionCommon provocative maneuvers to differentiate thumb carpometacarpal (CMC) osteoarthritis from other sources of pain are the grind, metacarpal (MC) flexion, and MC extension tests. A maneuver known as the pressure-shear test is described here. Purpose of the studyTo compare the diagnostic value of the grind, metacarpal flexion, metacarpal extension, and pressure-shear tests for CMC osteoarthritis of the thumb. MethodsThe diagnostic accuracy of each test was compared in 127 thumbs from 104 patients. Sensitivity, specificity, and predictive values of each test were calculated. In a secondary analysis, polychoric correlation coefficients were used to assess the correlation of each test with severity defined by Eaton-Littler stage. ResultsThe overall diagnostic accuracy of the thumb MC grind, pressure-shear, flexion, and extension tests were 70%, 98%, 47%, and 55%, respectively. The sensitivities were 64%, 99%, 36%, and 46%, respectively, and specificities were 100%, 95%, 100%, and 100%, respectively. For the diagnosis of Thumb CMC arthritis, the MC pressure-shear test was superior overall in terms of overall diagnostic accuracy and sensitivity, while having comparable specificity to the other maneuvers. ConclusionThe pressure-shear test was found to be superior to the commonly used grind maneuver and the provocative maneuvers of MC flexion and extension tests to confirm diagnosis of CMC osteoarthritis.

Optimal management of thumb basal joint arthritis: challenges and solutions.

Up to 15% of the population older than 30 years suffers from symptomatic thumb carpometacarpal (CMC) osteoarthritis (OA), with the incidence increasing to ~33% in postmenopausal women. The thumb CMC joint has been reported as the most painful joint when compared to other hand joints affected by OA. It is therefore no surprise that this is a common chief complaint of patients and has a significant effect on work and life satisfaction. The purpose of this article was to review currently available literature to discuss nonoperative and operative techniques utilized to treat the various stages of thumb CMC arthritis. A variety of nonoperative and operative techniques have been described in the literature, each with its own benefits and pitfalls. This review concludes that while many treatment options exist, there remains no perfect treatment, but the goal of improving quality of life and patient satisfaction remains the same.

Selective Denervation to Treat Pain and Disability Associated with Thumb Carpometacarpal Arthritis

Selective Denervation to Treat Pain and Disability Associated with Thumb Carpometacarpal Arthritis

Surgeon Preference, Influence, and Treatment of Thumb Carpometacarpal Arthritis.

The purpose of this study was to evaluate current surgical practice patterns, the factors that influence these patterns, and overall trends in the treatment of thumb carpometacarpal osteoarthritis. An online survey containing 14 questions was sent to all active members of the American Society for Surgery of the Hand. Information on demographics and treatments was collected. Results were anonymously uploaded to an online spreadsheet. A total of 823 responses were recorded. Trapeziectomy with ligament reconstruction and tendon interposition (LRTI) using whole flexor carpi radialis was the most popular technique at 37.44%. In all, 26.38% of surgeons with fewer than 5 years of experience utilize trapeziectomy with suture suspension (bone anchor based or tendon based); 55.76% choose a particular procedure because of "Personal Clinical Experience" over "Current Evidence" and "Training." In addition, 24.17% of surgeons who have been practicing for longer than 5 years have changed procedures in the last 5 years. In the United States, 97.2% of hand surgeons prescribe either oxycodone or hydrocodone postoperatively compared with just 23.75% of international hand surgeons. The results show that trapeziectomy with LRTI remains the most popular treatment of choice. The use of trapeziectomy with suture suspension is on the rise, particularly in younger surgeons. International hand surgeons rely more on current evidence, utilize less postoperative therapy and opioid medications, and change procedures more often than US hand surgeons.

Radiographic Analysis of Simulated First Dorsal Interosseous and Opponens Pollicis Loading Upon Thumb CMC Joint Subluxation: A Cadaver Study

Therapy programs to treat thumb carpometacarpal (CMC) arthritis may engage selective activation and reeducation of thenar muscles, particularly the first dorsal interosseous (FDI) and opponens pollicis (OP) to reduce subluxation of the joint. We describe the effect of simulated selective activation of the FDI and OP muscles upon radiographic subluxation of the thumb CMC joint. In a cadaver model of CMC subluxation, loads were applied to the FDI, the OP, and then concomitantly at 0%, 25%, 50%, 75%, and 100% maximal loads and radial subluxation of the joint and reduction in subluxation was measured. Selective activation of the OP, alone, improved the subluxation ratio (SR) in a dose-dependent manner. Selective activation of FDI, alone, demonstrated minimal effects on SR. Concomitant activation of OP and FDI improved the SR across all loading states, and activation of 75% and greater, when compared with FDI activation alone, resulted in a statistically significant improvement in SR to within 10% of the presubluxed joint. Concomitant activation of the FDI and OP acts to reduce subluxation of the thumb CMC joint in a dose-dependent fashion. The OP is likely the predominant reducing force. Hand therapy programs that focus on selective strengthening programs likely function in part to encourage patients to activate the easily palpable and easily understood FDI. Concomitant coactivation of the OP may be the major reducing force to elicit clinical and radiographic reduction of subluxation, improved thumb positioning, and reduction of pain and arthritic symptoms.

Evidence-Based Practice in the Surgical Treatment of Thumb Carpometacarpal Joint Arthritis

Thumb carpometacarpal (CMC) arthritis contributes considerably to functional disability in the aging adult United States (US) population. Owing to the increasing growth in this segment of our population, its burden on health care resources will increase in the future. Variations exist in the degree of complexity and cost among different surgical treatments. We examined the national trends of the surgical treatment of thumb CMC arthritis and hypothesized that current practice patterns are not supported by evidence favoring the simpler trapeziectomy-only procedure. Using a random 5%, nationally representative, sample of Medicare fee-for-service beneficiaries diagnosed with thumb CMC arthritis between 2001 and 2010, we used a multinomial logistic regression model to assess the association between patients' characteristics and the surgical treatment. Furthermore, we used surgeons' unique identifiers to examine how their practice preferences have changed over time. Our findings demonstrated an increasing trend in the utilization of trapeziectomy with ligament reconstruction and tendon interposition (LRTI) from 84% in 2001 to 90% in 2010. Ninety-five percent of surgeons performed only 1 type of surgical procedure, and among those, 93% of surgeons performed only trapeziectomy with LRTI. Compared with 2001, the odds of a patient undergoing thumb CMC arthrodesis or prosthetic arthroplasty slightly increased between 2007 and2010. The majority of hand surgeons in the US use trapeziectomy with LRTI as the surgical treatment of choice for thumb CMC arthritis. Although clinical trials from the United Kingdom support the use of the less complex trapeziectomy-only procedure, US surgeons are still reticent to change their practice, which favors LRTI. National comparative studies are still needed to examine the effectiveness of various surgical options for the treatment of thumb CMC joint arthritis. Prognostic II.

Interposition sous arthroscopie dans la rhizarthrose du pouce : à propos d’une série de 26 cas

We published in 2011 good results on a series of 25 patients who underwent surgery for thumb carpometacarpal arthritis, by interposing a poly L-lactic acid implant arthroscopically with a mean follow-up of 14 months. Our new series included 26 patients, average age 60 years, operated under arthroscopy with the interposition of an implant made of poly L-lactic acid in 12 cases and tendon interposition in 14 cases. With an average follow-up of 20 months, the pain was an average of 6.61/10 before and 6.03/10 after surgery, the quick DASH was 56.36/100 before and 53.65/100 after, grip strength was 15.34 kg before and 12.8 kg after, pinch strength was 3.7 kg before and 2.18 kg after, Kapandji score was 8.96/10 before and 8.26/10 after. The radiological stage did not change. We noted a complex regional pain syndrome type I, 12 bad results were reoperated and 11 times by trapezectomy. According to our results and in the absence of series published with a sufficient level of evidence, the interest of arthroscopy in the surgical treatment of thumb carpometacarpal arthritis remains to be demonstrated.

The “Pillow” Technique for Thumb Carpometacarpal Joint Arthritis: Cohort Study With 10- to 15-Year Follow-Up

Arthritis of the carpometacarpal joint of the thumb is common, and there are many studies regarding its treatment. We investigated the long-term outcome of interposition arthroplasty with a fascia lata allograft (pillow technique), without ligament reconstruction, to treat thumb carpometacarpal arthritis. The technique consisted of complete trapeziectomy, use of alloplastic tensor fascia lata, and K-wire immobilization for 5 weeks. The outcomes of 31 thumbs in 24 female patients were measured at a mean follow-up of 12.5 years (range, 10-15 years). Grip strength, key pinch, pulp-to-pulp pinch, tripod pinch, and range of motion were all improved. The Disabilities of the Arm, Shoulder, and Hand median score, which was only measured postoperatively, was an average of 5 (range, 0-52.6). No extrusion of the graft material was noted, and no revisions were performed. Our results indicate that a fascia lata allograft can be used as an interposition material in thumb carpometacarpal arthroplasty. This technique provides pain relief and satisfactory function at an average of 12.5 years after surgery. Therapeutic IV.

Arthroscopic Trapeziectomy With Suture Button Suspensionplasty: A Retrospective Review of 153 Cases.

Arthroscopic trapeziectomy with suture button suspensionplasty (ATBS) is a relatively new surgical option for the treatment of thumb carpometacarpal (CMC) osteoarthritis. Although ATBS has many potential benefits over alternative surgical treatments for CMC arthritis, little data exist regarding its safety and complication rates. The purpose of this study was to demonstrate that ATBS is associated with a low risk of complications within 1 year of surgery. A retrospective review of patients treated with ATBS by one senior hand surgeon over a span of 3 years was performed. A total of 153 cases of ATBS were performed in 136 patients. Ninety-seven cases involved arthroscopic hemitrapeziectomies, and 56 involved arthroscopic complete trapeziectomies. There were 44 males and 92 females with a mean age of 62. Thirty-eight percent of the cases were graded as Eaton stage IV, 46% stage III, and 14% stage II CMC arthritis, while 3 cases (2%) were performed as revisions. Mean follow-up duration was 58 weeks. Mean preoperative key pinch strength of the affected versus the unaffected side was 92% compared with 95% postoperatively. Revision surgery was performed in 9 out of 153 cases (<6%). Of those 9 cases, 5 had additional minor bony debridement with subsequent improvement in pain, 3 had the implant repositioned due to button prominence, and 1 patient presented with osteomyelitis of the first and second metacarpals that was successfully treated with button removal and an antibiotic regimen. ATBS is a safe, minimally invasive procedure for treatment of symptomatic stages II through IV thumb CMC arthritis.

The outcome of suspension arthroplasty in Thumb Carpometacarpal joint arthritis

The trapeziometacarpal joint is most often affected by primary osteoarthritis or post-traumatic arthritis. The aims and objectives of the study was to evaluate the subjective and objective results of thumb carpometacarpal arthritis treated with Suspension arthroplasty and comparison of the results at our institution with those mentioned in the literature. This is the study of 10 patients who were treated with suspension arthroplasty and followed up postoperatively at six months or more, the average being 14.2 months. The test of significance applied was Wilcoxon signed-rank test. A p-value of < 0.05 was considered as significant. The patients were evaluated after surgery in the terms of Mayo's wrist score, grip strength, pinch strength and pain.

Arthroscopic partial trapeziectomy and tendon interposition for thumb carpometacarpal arthritis.

BackgroundThe purpose of this study was to introduce arthroscopic partial trapeziectomy and tendon interposition for the treatment of symptomatic thumb carpometacarpal arthritis of Eaton stage II or III.MethodsFrom August 2001 to April 2009, 23 patients with thumb carpometacarpal arthritis were treated using this technique. Pain score, range of motion, and pinch strength were clinically evaluated and compared with the preoperative values after a minimum follow-up duration of 24 months.ResultsSignificant reduction in pain score and increases in range of motion and pinch strength were found (all p < 0.001) after a 2-year follow-up. The mean ± SD (median) postoperative pain score was 1.0 ± 0.7 (1.0) at rest and 1.3 ± 0.9 (1.0) during daily activities. The postoperative range of motion was 19.1° ± 4.2° (20°) for extension and 35.7° ± 7.1° (35.0°) for flexion, and the postoperative pinch strength was 86.5 % ± 19.9 % (90.0 %). No complications were observed in our patient series.ConclusionsArthroscopic partial trapeziectomy and soft tissue interposition could be an alternative treatment method for patients with symptomatic thumb carpometacarpal arthritis of Eaton stage II or III.

Patients With Thumb Carpometacarpal Arthritis Have Quantifiable Characteristic Expectations That Can Be Measured With a Survey.

Although patient expectations associated with major orthopaedic conditions have shown clinically relevant and variable effects on outcomes, expectations associated with thumb carpometacarpal (CMC) arthritis have not been identified, described, or analyzed before, to our knowledge. We asked: (1) Do patients with thumb CMC arthritis express characteristic expectations that are quantifiable and have measurable frequency? (2) Can a survey on expectations developed from patient-derived data quantitate expectations in patients with thumb CMC arthritis? The study was a prospective cohort study. The first phase was a 12-month-period involving interviews of 42 patients with thumb CMC arthritis to define their expectations of treatment. The interview process used techniques and principles of qualitative methodology including open-ended interview questions, unrestricted time, and study size determined by data saturation. Verbatim responses provided content for the draft survey. The second phase was a 12-month period assessing the survey for test-retest reliability with the recruitment of 36 participants who completed the survey twice. The survey was finalized from clinically relevant content, frequency of endorsement, weighted kappa values for concordance of responses, and intraclass coefficient and Cronbach's alpha for interrater reliability and internal consistency. Thirty-two patients volunteered 256 characteristic expectations, which consisted of 21 discrete categories. Expectations with similar concepts were combined by eliminating redundancy while maintaining original terminology. These were reduced to 19 items that comprised a one-page survey. This survey showed high concordance, interrater reliability, and internal consistency, with weighted kappa values between 0.58 and 0.78 (95% CI, 0.39-0.78; p < 0.001); intraclass correlation coefficient of 0.94 (95% CI, 0.94-0.98; p < 0.001), and Cronbach's alpha values of 0.94 and 0.95 (95% CI, 0.91-0.96; p < 0.001). The thumb CMC arthritis expectations survey score is convertible to an overall score between 0 to 100 points calculated on the basis of the number of expectations and the degree of improvement expected, with higher scores indicating higher expectations. Patients with thumb CMC arthritis volunteer a characteristic and quantifiable set of expectations. Using responses recorded verbatim from patient interviews, a clinically relevant, valid, and reliable expectations survey was developed that measures the physical and psychosocial expectations of patients seeking treatment for CMC arthritis. The survey provides a calculable score that can record patients' expectations. Clinical application of this survey includes identification of factors that influence fulfilment of these expectations. Level II, prospective study.

Suture Suspension Arthroplasty for Thumb Carpometacarpal Arthritis Reconstruction: Long-term Outcome: Level 4 Evidence

A simple reconstructive method for treating advanced arthritis of the thumb carpometacarpal (CMC) joint with suture suspension arthroplasty (SSA) is a reliable, low morbidity procedure, providing a simpler alternative with similar long-term outcomes, compared to trapeziectomy procedures, with or without ligament reconstruction. SSA technique for thumb CMC arthritis reconstruction consists of trapeziectomy via a single volar incision and a four-strand intra-articular suture (0 gauge non-absorbable) suspension sling, creating a “hammock” between the distal-most insertions of the abductor pollicis longus and the flexor carpi radialis. This construct is pulled firmly, tethering the base of the thumb towards the base of the index metacarpal, correcting the subluxation deformity and maintaining arthroplasty space. All procedures were performed by the senior author, averaging 22 minutes operative time, followed by 14 days of post-operative immobilization, then short opponens splinting for four weeks and rehabilitation protocol (1DelSignore J.L. Accardi K.Z. Suture suspension arthroplasty technique for basal joint arthritis reconstruction.Tech Hand Upper Extrem Surg. 2009; 13: 166-172Crossref PubMed Scopus (29) Google Scholar), progressing to unrestricted use by 12 weeks. Long-term evaluation of 117 thumbs (average 89.4 months) with strength measurement and QuickDASH questionnaire, were analyzed with a paired t test. Final Xrays were obtained. 117 out of 153 thumbs in 110 patients (76% recall) were available for long-term follow up averaging 89.4 months (80-104 months). 96 patients were female, 21 male. Statistically significant (P < 0.05) improvement in pain relief, patient satisfaction, grip, key and tip pinch strength, and functional improvement was noted in the majority of patients. Average QuickDASH score (0.3) at final follow up indicated good to excellent satisfaction and functional use in the majority of patients. Xray evidence of subsidence averaged 30% (0-90%). One patient (0.8%) required revision surgery. Flexor carpi radialis rupture occurred in 7 (6%) thumbs after a sudden stress activity around 4-6 weeks post op, requiring no additional treatment. •Suture suspension arthroplasty for thumb CMC arthritis reconstruction is a simple, reliable method. Patient advantages include lower morbidity as a result of a single incision without tendon sacrificing, and avoidance of potential complications related to multiple incisions, tendon harvesting, drill hole formation, hardware implantation, pin fixation, or prolonged immobilization. Most patients are able to resume normal, unrestricted use at 12 weeks post-operative.•This method is cost-effective, utilizing less operative time, and does not require additional cost of implants or anchors.•Long-term results of suture suspension arthroplasty show similar outcomes as described with other methods of trapeziectomy, with or without ligament reconstruction (2Vermeulen G.M. Slijper H. Feitz R. Hovius S.E. Moojen T.M. Selles R.W. Surgical management of primary thumb carpometacarpal osteoarthritis: a systematic review.J Hand Surg Am. 2011; 36: 157-169Abstract Full Text Full Text PDF PubMed Scopus (265) Google Scholar), resulting in a very high degree of patient satisfaction, with a simple, minimally invasive, and cost-effective option.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Basal joint arthroplasty decreases carpal tunnel pressure.

There is a well-documented association between carpal tunnel syndrome (CTS) and thumb carpometacarpal (CMC) arthritis, and these conditions commonly coexist. We have observed that patients who have previously undergone thumb basal joint arthroplasty (BJA) seem rarely to present subsequently with CTS. Our hypothesis is that BJA decreases the pressure within the carpal tunnel. Twenty-eight patients (6 with coexistent CTS) undergoing BJA were enrolled in the study. The pressure within the carpal tunnel immediately before and after BJA was measured using a commercially available pressure monitor device (Stryker STIC; Kalamazoo, MI). In patients with concomitant CTS undergoing both BJA and carpal tunnel release (CTR), the pressure was measured after BJA but prior to release of the transverse carpal ligament. The pressure within the carpal tunnel decreased after BJA in all patients. There were 3 patients with stage II arthritis, 15 patients with stage III arthritis, and 10 patients with stage IV arthritis. The mean pressure prior to BJA among all patients was 23.9mmHg and decreased to 11.0mmHg after BJA. Patients with concomitant CTS had a mean pre-BJA pressure of 26.5mmHg, which decreased to 7.3mmHg after BJA. BJA decompresses the carpal tunnel and decreases the pressure within. In patients with concomitant CTS, the BJA alone (without additional release of the transverse carpal ligament) decreases the carpal tunnel pressure. Further study is warranted to determine the need for discrete release of the transverse carpal ligament in patients with CTS who are undergoing BJA. Level II, diagnostic.

First and Second Metacarpal Bone Fusion for First Carpometacarpal Joint Arthritis in Rheumatoid Arthritis: A Case Report

A case of rheumatoid thumb carpometacarpal (CMC) arthritis with advanced osteolysis is reported. Although CMC joint arthrodesis was performed, bone union was not achieved, and pain and instability persisted. Therefore, first and second metacarpal bone fusion was performed with satisfactory results. While CMC joint arthrodesis or arthroplasty is typically performed, first and second metacarpal bone fusion appears to be a useful treatment option when there is marked osteolysis.