Trapeziometacarpal Arthrosis Research Articles

Comparative Analysis of Prosthetic (Touch) and Arthroplastic Surgeries for Trapeziometacarpal Arthrosis: Functional Outcomes and Patient Satisfaction With a 2-Year Follow-Up

Trapeziometacarpal (TMC) joint prosthesis poses its own challenges for the treatment of TMC arthrosis, especially when compared with the present gold standard, arthroplasty. The aim of this study was to highlight possible outcome differences and patients' satisfaction regarding the treatment of TMC arthrosis. We evaluated 100 patients with TMC arthrosis treated in two centers and divided into two groups: group A received TMC prosthesis (Touch), whereas group B was treated with arthroplasty, with a 2-year follow-up period. In a comparative analysis, findings revealed group A's superiority in the shortened disabilities of the arm, shoulder and hand questionnaire scores at 1 and 6 months, with significant differences: 34.6% vs 67.1% and 2% vs 9.1%, respectively (P < .0001). Although group A also showed lower the shortened disabilities of the arm, shoulder and hand questionnaire scores at 3 months, this was not statistically significant. Notably, at 1 and 2 years, group A demonstrated better scores without statistical significance. The Kapandji score differed significantly at 6 months: 9.8 vs 9.1 (P= .029). Although the visual analog scale showed generally lower values for the prosthesis group, no statistical differences emerged. Additionally, the M1/M2 ratio became significant postoperatively, favoring group A (P < .05). Trapeziometacarpal prosthesis shows promise for TMC arthrosis, enhancing function, thumb length, and patient recovery, warranting further research and x-ray guidance. Therapeutic III.

Assessing Responsiveness of the Trapeziometacarpal Arthrosis Symptoms and Disability Questionnaire.

This study aimed to assess the responsiveness of the Trapeziometacarpal Arthrosis Symptoms and Disability (TASD) questionnaire after corticosteroid injections and operative management for trapeziometacarpal osteoarthritis (TMC-OA). This longitudinal cohort study included patients with TMC-OA who underwent treatment (corticosteroid injection or surgery). Measurements occurred at baseline and follow-up time points: 6 weeks, 3 months, 6 months, and 1 year. Patient measures were collected electronically using a data repository platform. The TASD is a validated psychometric patient-administered scale. We examined responsiveness by correlating the TASD scores with another known effective indicator of change (shortened Disabilities of the Arm, Shoulder, and Hand [QuickDASH]). Repeated score measurements over time were analyzed using analysis of variance, and correlations between questionnaires were reported with repeated measures correlation and Pearson correlation coefficients. The nonsurgical cohort undergoing corticosteroid injections included 31 (66%) women and 16 (34%) men, and the surgical cohort included 29 (71%) women and 12 (29%) men. Both the QuickDASH and the TASD captured a statistically significant improvement in symptom burden postoperatively (P < .0001 for both questionnaires), whereas no statistical significance was noted after corticosteroid injections (P = .45 and P = .34, respectively). There was a strong correlation between QuickDASH and TASD questionnaires (r = 0.87, P < .0001). The TASD is a promising TMC-OA-specific questionnaire to capture responsiveness following treatment, particularly following surgery. The responsiveness of TASD was demonstrated in the TMC-OA cohort. Further research is needed to define a minimal clinically important difference.

Minimal clinically important difference of the Trapeziometacarpal Arthrosis Symptoms and Disability questionnaire.

The Trapeziometacarpal Arthrosis Symptoms and Disability questionnaire is a recently developed disease-specific instrument designed to measure patient-reported symptoms. Our aim was to establish a minimal clinically important difference for this questionnaire. This prospective study included 95 patients undergoing operative (n = 39) or non-operative (n = 56) treatments for primary trapeziometacarpal osteoarthritis. Patients completed a battery of tests including the Trapeziometacarpal Arthrosis Symptoms and Disability questionnaire at the initial clinic visit and follow-up visits. Two anchor-based methods were used to arrive at the minimal clinically important difference. Twenty-four scores met criteria for minimal clinically important change, with a median overall score rounding to 15 points. This finding is an important step in facilitating the application of this disease-specific instrument in practice.Level of evidenceIII

Prospective Evaluation of Low-Dose External Beam Radiotherapy (LD-EBRT) for Painful Trapeziometacarpal Osteoarthritis (Rhizarthrosis) on Pain, Function, and Quality of Life to Calculate the Required Number of Patients for a Prospective Randomized Study.

Background: Retrospective studies have described the effectiveness of low-dose radiotherapy (LD-EBRT) in painful arthrosis of small finger joints, but two recent prospective studies have yielded ambiguous results. To generate accurate data for the planning of a trial, we conducted a prospective, monocentric, observational study to describe the effects of LD-EBRT as precisely as possible. Methods: Twenty-five consecutive patients with symptomatic trapeziometacarpal (TMC) arthrosis were irradiated with 6 × 0.5 Gy. Before, 3, and 12 months after LD-EBRT, we assessed subjective endpoints (modified “von-Pannewitz score”, 10-point visual analogue scale (VAS), “patient-rated wrist evaluation” (PRWE)), and objective measurements (“active range of motion” (AROM), Kapandji index, grip strength, pinch grip). Results: At 3/12 months, 80%/57% reported partial and 4%/18% complete remission according to the “von-Pannewitz” score. VAS “overall pain” significantly decreased from a median of seven (IQR 4) at baseline to three (IQR 6; p = 0.046) and to two (IQR 2; p = 0.013). Similar results were obtained for VAS “pain during exercise”, VAS “pain during daytime”, and VAS “function”. “PRWE overall score” was reduced from 0.5 at baseline (SD 0.19) to 0.36 (SD 0.24, p = 0.05) and to 0.27 (SD 0.18, p = 0.0009). We found no improvements of the objective endpoints (AROM, Kapandji, grip strength) except for flexion, which increased from 64° (SD 12°) at baseline to 73° (SD 9.7°, p = 0.046) at 12 months. Conclusions: We recommend the PRWE score as a useful endpoint for further studies for this indication. To prove a 15% superiority over sham irradiation, we calculated that 750 patients need to be prospectively randomized.

Translation and cross-cultural adaptation of \u201cTrapeziometacarpal Arthrosis Symptoms and Disability\u2014TASD\u201d into Brazilian Portuguese

BackgroundOsteoarthritis is the most common form of hand arthritis and arthritis of the carpometacarpal joint of the thumb is a potentially limiting disease. There is no homogeneity in the evaluation of outcomes for the rhizarthrosis treatment. In an attempt to standardize the evaluation of results, some subjective questionnaires, non-specific, were used to evaluate rhizarthrosis. Trapeziometacarpal Arthrosis Symptoms and Disability (TASD) was described by Becker et al.with the purpose of evaluating symptom intensity and degree of disability, as to compare results after treatment. Our objective is to translate, validate and do the cultural adaptation of the questionnaire TASD into the Brazilian Portuguese.MethodsThe questionnaire was translated, with reverse translation. The translations were evaluated and synthesized by a committee, arriving at TASD-BR. Thirty-one patients with a diagnosis of rhizarthrosis answered the questionnaire. We evaluated, the internal consistency, reliability, agreement and ceiling and floor effect for validation.ResultsThe questionnaires were translated and adapted according to defined protocols. The internal consistency, through Cronbach's α coefficient for TASD-BR, was 0.927. The questionnaire's reliability, through the Intraclass Correlation Coefficient, was also shown to be quite high, with κ = 0.961 (0.954–0.967). The agreement, measured through the Standard Error Measurement, remained with standardized values below 5%. There was no ceiling and floor effect.ConclusionThrough specific methodology we consider TASD-BR translated and valid for the Brazilian Portuguese.

Variation in Treatment for Trapeziometacarpal Arthrosis.

Treatment recommendations for trapeziometacarpal (TMC) arthrosis are highly variable from surgeon to surgeon. This study addressed the influence of viewing radiographs on a decision to offer surgery for TMC arthrosis. In an online survey, 92 hand surgeons viewed clinical scenarios and were asked if they would offer surgery to 30 patients with TMC arthrosis. Forty-two observers were randomly assigned to review clinical information alone and 50 to review clinical information as well as radiographs. The degree of limitation of daily activities, time since diagnosis, prior treatment, pain with grind, crepitation with grind, and metacarpal adduction with metacarpophalangeal hyperextension were randomized for each patient scenario to determine the influence of these factors on offers of surgery. A cross-classified binary logistic multilevel regression analysis identified factors associated with surgeon offer of surgery. Surgeons were more likely to offer surgery when they viewed radiographs (42% vs. 32%, P = 0.01). Other factors associated variation in offer of surgery included greater limitation of daily activities, symptoms for a year, prior splint or injection, deformity of the metacarpophalangeal joint. Factors not associated included limb dominance, prominence of the TMC joint, crepitation with the grind test, and pinch and grip strength. Surgeons that view radiographs are more likely to offer surgery to people with TMC arthrosis. urgeons are also more likely to offer surgery when people do not adapt with time and nonoperative treatment. Given the notable influence of surgeon bias, and the potential for surgeon and patient impatience with the adaptation process, methods for increasing patient participation in the decision-making process merit additional attention and study.

Trapeziometacarpal Arthrosis

* Trapeziometacarpal arthrosis is an expected part of normal human aging.* The radiographic severity of trapeziometacarpal arthrosis may not correlate with symptom intensity or magnitude of limitations.* Psychosocial factors may be important drivers of symptom intensity, magnitude of limitations, and seeking of treatment.* Nonoperative treatment is palliative and not disease-modifying, but may facilitate long-term adaptation.* Current surgical treatment strategies center around trapeziectomy, but it is unclear whether the addition of other stabilization or interposition techniques changes overall outcomes.

Trapeziometacarpal Arthrodesis Using a Combination of Chevron Osteotomy, Longitudinal K-wire, and K-wire Compression Staples.

Among surgical methods for advanced trapeziometacarpal arthrosis, arthrodesis may benefit high-demand patients such as laborers because it preserves the osseous foundation of the thumb. The authors achieved successful trapeziometacarpal arthrodesis in 3 patients by a combination of chevron osteotomy, longitudinal K-wire, and K-wire compression staples without using bone graft. There were no complications specifically associated with the surgery other than asymptomatic slight pull-out of a staple. This combination is a good option for trapeziometacarpal arthrodesis, having the advantages of using a small incision and common devices and being low cost. [Orthopedics. 2018; 41(6):e894-e896.].

Factors Associated With Quality of Online Information on Trapeziometacarpal Arthritis.

People increasingly search the Internet for information about common medical problems such as trapeziometacarpal (TMC) joint arthritis. But this information can be biased, inaccurate, and misleading. Medical professionals should be aware of what patients may be reading about their condition because concepts and beliefs can affect symptoms, limitations, and decision making. This study sought factors associated with the quality of design and content of health information Web sites about TMC arthritis. Using 3 search engines we entered "thumb arthritis" and measured the quality of design and content of 67 Web sites using the DISCERN and LIDA tools, dominant tones using the IBM Watson Tone Analyzer, and readability, and we recorded Web site characteristics. All but 1 Web site exceeded the recommended sixth-grade reading level. We created 2 backward stepwise regression models to identify independent factors associated with Web site design and content quality. In multivariable analysis, the Web site not having a clear preference for treatment was independently associated with greater design and content quality measured by DISCERN. Health On the Net (HON) code certification-a code of conduct for medical Web sites-and nonprofit Web sites had higher LIDA scores. Online information on TMC arthrosis is difficult to read, often biased in favor of a particular treatment and influenced by profit and HONcode. Hand surgeons should prepare to gently correct misconceptions established or reinforced, in part, by material found on the Internet.

Factors Associated With Radiographic Trapeziometacarpal Arthrosis in Patients Not Seeking Care for This Condition.

A common adage among hand surgeons is that the symptoms of trapeziometacarpal (TMC) arthrosis vary among patients independent of the radiographic severity. We studied factors associated with radiographic severity of TMC arthrosis, thumb pain, thumb-specific disability, pinch strength, and grip strength in patients not seeking care for TMC arthrosis. Our primary null hypothesis was that there are no factors independently associated with radiographic severity of TMC arthrosis according to the Eaton classification among patients not seeking care for TMC arthrosis. We enrolled 59 adult patients not seeking care for TMC arthrosis. We graded patients' radiographic TMC arthrosis and asked all patients to complete a set of questionnaires: demographic survey, pain scale, TMC joint arthrosis-related symptoms and disability questionnaire (TASD), and a depression questionnaire. Metacarpophalangeal hyperextension and pinch and grip strength were measured, and the grind test and shoulder sign were performed. Older age was the only factor associated with more advanced radiographic pathophysiology of TMC arthrosis. One in 5 patients not seeking care for TMC arthrosis experienced thumb pain; no factors were independently associated with having pain or limitations related to TMC arthrosis. Youth and male sex were associated with stronger pinch and grip strength. There are a large number of patients with relatively asymptomatic TMC arthrosis. Metacarpophalangeal hyperextension and female sex may have a relationship with symptoms, but further study is needed. Our data support the concept that TMC arthrosis does not correlate with radiographic arthrosis.

Gradual Onset Diseases: Misperception ofDisease Onset.

Gradual onset diseases (eg, carpal tunnel syndrome, cubital tunnel syndrome, and trapeziometacarpal arthrosis) tend to go unnoticed for years. When a slowly progressive disease transitions from asymptomatic to symptomatic, it may seem like an acute event. The primary aim of this study was to determine the percentage of patients who perceive the slowly progressive disease as having started within 1 year. We also hypothesized that (1) there would be no factors associated with perception of an onset of disease within 1 year, more specifically among patients with advanced disease; and (2) there would be no difference in a decision to pursue operative treatment between patients who perceived the onset of the disease to be recent and those who perceived it to be long-standing. In this retrospective study, we reviewed the medical records of 732 patients newly diagnosed with carpal tunnel syndrome (n= 114), cubital tunnel syndrome (n= 276), or trapeziometacarpal arthrosis (n= 342), for the onset of symptoms. Multiple factors were assessed for (1) association with perception of disease onset within 1 year, and (2) choice for operative treatment in bivariate and multivariable analyses. A total of 69% of all subjects and 68% of patients with advanced disease perceived the disease as having started within 1 year. A perceived provocation (such as an injury or surgery) was associated with a perception of recent onset. A decision to pursue operative treatment was not different between the 2 groups. Slowly progressive diseases are often misperceived as relatively new. Effective communication strategies are important to ensure that people make choices consistent with their values and not based on misconceptions.

The Incidence of Arthroplasty After Initial Arthroscopy for Trapeziometacarpal Arthrosis.

It remains unclear how many patients undergo secondary surgery after initial arthroscopy for trapeziometacarpal (TMC) arthrosis. We studied the factors related to secondary TMC arthroplasty after TMC arthroscopy. We also examined secondary questions of: (1) what percentage of patients underwent secondary TMC arthroplasty; and (2) how much time elapsed from initial arthroscopy to arthroplasty. In this retrospective study, we included all adult patients who were treated with arthroscopy of the TMC joint at 2 level I hospitals and affiliates. Factors were assessed for their independent association with secondary TMC arthroplasty using bivariate and multivariable analyses. Fourteen of 84 (17%) thumbs underwent secondary TMC arthroplasty an average of 11 months after the initial arthroscopy. Synovectomy alone and smoking tobacco were independently associated with secondary TMC arthroplasty when compared with arthroscopic (partial) trapeziectomy with additional tendon interposition or allograft. This study demonstrated that 1 in 6 thumbs underwent secondary TMC arthroplasty, an average of 11 months after the initial arthroscopy. Coupling arthroscopy with partial trapeziectomy, interposition, or extension osteotomy may be a preferable strategy to isolated synovectomy. In addition, smoking tobacco is associated with inferior outcomes regardless of surgical procedure.

Locking Plate Arthrodesis Compares Favorably with LRTI for Thumb Trapeziometacarpal Arthrosis: Early Outcomes from a Longitudinal Cohort Study.

Trapeziometacarpal arthrodesis (TMA) has been complicated by nonunion and hardware failure. We hypothesized that modification of the TMA technique with a locking cage plate construct would afford reliable bony union while producing greater hand function than trapeziectomy with ligament reconstruction and tendon interposition (LRTI) at early follow-up. We enrolled 36 consecutive patients with trapeziometacapal osteoarthritis (14 TMA patients (15 thumbs), 22 LRTI patients (22 thumbs)). The study was powered to detect a minimal clinically important difference on the QuickDASH questionnaire between groups. Secondary outcomes included Michigan Hand Questionnaire (MHQ), VAS-pain, and EQ-5D-3L scores. Patients were examined to evaluate thumb motion and strength. TMA patients were evaluated clinically and radiographically for union. Mean follow-up was 15.6months, and the mean age was 59.2years. Union was achieved in 14/15 (93%) of TMA thumbs. Improvement in QuickDASH scores was similar after TMA and LRTI (49 to 28 and 50 to 18, respectively). Postoperative patient-rated upper extremity function, health status, and pain were similar between groups. Pinch strength was significantly greater after TMA (5.9 vs 4.7 kg). No differences in thumb or wrist range of motion were observed postoperatively with the exception of greater total metacarpophalangeal joint motion after TMA. Complications after TMA included nonunion (7%), development of symptomatic scaphotrapezotrapezoidal (STT) arthrosis (7%), symptomatic hardware (7%), and superficial branch of the radial nerve (SBRN) paresthesia (7%). Complications after LRTI included subsidence (5%), MP hyperextension deformity (5%), and SBRN paresthesias (5%). At early follow-up, patient-rated function was similar among patients undergoing TMA and LRTI. TMA produced 25% greater pinch strength compared with LRTI. Despite historical concerns regarding global loss of ROM with arthrodesis, motion was similar between groups. Our observed TMA nonunion rate of 7% is low relative to historically reported nonunion rates (7-16%). Locking cage plate technology affords rigid fixation for TMA with promising early results noting reliable bony union while minimizing complications.

QuickDASH Score Is Associated With Treatment Choice in Patients With Trapeziometacarpal Arthrosis.

Trapeziometacarpal (TMC) arthrosis has a variety of treatment options, including nonoperative (eg, education, splint, injection) and operative management. Symptoms and limitations vary greatly among patients. The purpose of this study was to determine an association of symptoms and limitations, quantified using the Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, with treatment choice in patients newly diagnosed with TMC arthrosis. We also addressed the association of the QuickDASH score with radiographic severity and sought factors associated with higher QuickDASH scores. As part of the routine new patient intake paperwork, all new patients completed a QuickDASH form. We included 81 new patients with newly diagnosed TMC arthrosis visiting the office of 1 of 5 orthopedic hand surgeons between March 1, 2015, and November 30, 2015. Eight patients were excluded because of incomplete QuickDASH forms. Based on QuickDASH tertiles, patients with a low QuickDASH score were more likely to choose education alone than patients with intermediate and high QuickDASH scores; no patients in the lowest QuickDASH tertile chose injection or surgery. Patients who chose education alone also had a lower mean QuickDASH score than patients who chose splint or surgery. Radiographic severity and other patient-related factors were not associated with greater symptoms and limitations. More adaptive patients (lower QuickDASH) are less likely to choose injection or surgery, irrespective of disease severity. The psychosocial factors known to correlate with greater symptoms and limitations might lead patients to feel they have fewer options or to choose more interventional options than they would if they were more at ease. In other words, inadequate attention to psychosocial factors may increase the risk of misdiagnosis of patient preferences.

Trapeziometacarpal Arthrosis: Predictors of a Second Visit and Surgery

Trapeziometacarpal arthrosis is expected with advancing age and a limited percentage of people seek medical attention for it. We studied patients after their first appointment to address trapeziometacarpal arthrosis with a hand surgeon to determine factors associated with return for a second visit and eventual election of operative treatment. A billing database identified 306 patients in the practice of three hand surgeons with a new diagnosis of TMC arthrosis and no associated diagnoses. Bivariate and multivariable logistic regression analyses sought factors associated with a second visit and operative treatment among demographic and visit related factors. One hundred and forty-three patients (47%) returned for one or more additional visits and 46 (15%) eventually elected operative treatment within the study period. Independent predictors of a return visit included injection at first visit, splint at first visit, and doctor's recommendation for a return visit. The predictors of surgery were treating surgeon and prescription of a splint at the first visit, but splint at first visit was only predictive for one of the three surgeons. When patients first learn about their trapeziometacarpal arthrosis, the behavior of the hand surgeon may have a strong influence on return visits and eventual choice of operative treatment.

Pain and Disability Related to Osteoarthrosis of the Trapeziometacarpal Joint

We investigated the relationship between trapeziometacarpal arthrosis, pain, and upper extremity specific disability by surveying patients from a prior prevalence study. The 456 adult (age 18 or greater) patients from a prior prevalence study were mailed a questionnaire consisting of the full DASH outcome measure as well as additional questions to identify sources of pain other than the thumb, pain in the thumb and whether the patient has received treatment for thumb arthritis. A response rate of 27% was achieved (122 responses). Thumb pain correlated with pain elsewhere in the arm (r = 0.354, p < 0.001), but not with higher grades of arthrosis. The average DASH score was 9.9 [range 0-60.0]. Higher grades of arthrosis (p = 0.013), pain in the thumb (r = 0.602, p < 0.001) and pain elsewhere in the arm (r = 0.665, p < 0.001) were found to be predictors of a higher DASH score. Arthrosis grade explained only 3% of the variation of DASH scores in linear regression modeling, but was included in the best multivariable model-along with thumb pain and pain elsewhere in the arm-which explained 52% of the variation in DASH scores. Higher grades of trapeziometacarpal arthrosis do not correlate with complaints of thumb pain and have a significant, but very limited affect on arm-specific disability, compared to pain elsewhere in the arm.

The Trapeziometacarpal Arthrosis Symptoms and Disability Questionnaire: Development and Preliminary Validation.

Symptoms and disability at the trapeziometacarpal (TMC) joint are typically assessed with general measures that may not be able to accurately discriminate between TMC arthrosis-specific versus other hand and arm condition concerns. The objective was to develop and preliminary validate the Trapeziometacarpal Arthrosis Symptoms and Disability (TASD) questionnaire designed to assess symptoms and disability at the TMC joint. English-speaking patients (50 years or older) were enrolled in 1 of 2 samples (sample 1, 64 patients specifically presented for treatment of TMC arthrosis; sample 2, 64 patients received an incidental diagnosis of previously undiagnosed TMC arthrosis when presenting for treatment of another, not thumb-related condition). Principal component analysis identified the number of subscales (factors) and factor loadings of all items (ie, structural construct validity). Internal consistency was assessed with Cronbach alpha. Convergent, discriminant, and known-groups construct validity of the subscales were assessed with Spearman correlations. The final TASD has 12 items and 2 subscales, as confirmed by principal component analysis: symptoms (7 items) and disability (5 items). The subscales' internal consistency was good to excellent in both samples. The TASD showed good convergent validity as evidenced by moderate to strong correlations between both subscales and upper extremity disability, pain intensity, depression, self-efficacy, and key pinch strength (sample 1). The TASD also showed good discriminant, and good known-groups validity. The concise TASD is useful in assessing symptoms and disability related to TMC arthrosis, has a simple scoring system and administration mode (self-administered), and is free.

Radiographic Assessment of the Robert and Lateral Views in Trapeziometacarpal Osteoarthrosis.

To evaluate the effectiveness of the Robert view in assessing trapeziometacarpal arthrosis and to compare the accuracy of the Robert and lateral views in staging trapeziometacarpal (TM) joint arthrosis. Patient demographics were obtained. Four participating raters reviewed 62 randomly selected thumb x-rays of patients presenting with thumb TM joint pain. Lateral and Robert-hyperpronation views were assessed using an analysis of 13 criteria. X-rays of 62 thumbs for 58 patients were evaluated. The average patients' age was 64 (47-87) and 51 (80%) were females. The majority of X-rays evaluated fell into stage 3. Stage 2 was the second most common level of arthritis encountered and the least was stage 1. More osteophytes were encountered in the trapezium than metacarpal on both the Robert and lateral views. The Robert view was superior in detecting osteophytes on the trapezium than the lateral view. Osteophyte size varied from 1.7 to 2 mm. The lateral view displayed 61 cases with dorsal metacarpal subluxation (98%). The Robert view displayed 48 cases (77%) with radial metacarpal subluxation and 9 cases (15%) with ulnar metacarpal subluxation. Thumb metacarpal adduction deformity was encountered on the lateral view in 20 cases (32%) whereas on the Robert view it was encountered in 14 cases (23%). Subchondral sclerosis was encountered on the Robert view in 56 thumbs (90%) while it was seen on the lateral view in 52 thumbs (84%). Pantrapezial arthritis involving the STT joint was encountered equally in 16 cases (26%) on the Robert view and the lateral views. The study found a moderate level of interrater reliability on both the lateral and Robert views. With the exception of osteophytes encountered on the trapezium versus the metacarpal, there were no other statistically significant findings. This study confirms that each of the Robert and lateral views offer unique information and combining both views enhances the ability to assess radiographic disease severity, and should be the recommended set of X-rays for assessing TM osteoarthrosis.

Predictors of missed research appointments in a randomized placebo-controlled trial.

The primary aim of this study was to determine predictors of missed research appointments in a prospective randomized placebo injection-controlled trial with evaluations 1 to 3 and 5 to 8 months after enrollment. This study represents a secondary use of data from 104 patients that were enrolled in a prospective randomized controlled trial of dexamethasone versus lidocaine (placebo) injection for various diagnoses. Patients were enrolled between June 2003 and February 2008. Sixty-three patients (61%) had lateral epicondylosis, 17 patients (16%) had trapeziometacarpal arthrosis, and 24 patients (23%) had de Quervain syndrome. Each patient completed a set of questionnaires at time of enrollment. Bivariable and multivariable analyses were used to determine factors associated with missed research appointments. Fourteen patients (13%) did not return for the first follow-up and 33 patients (32%) did not return for the second follow-up. The best multivariable logistic regression model for missing the first research visit explained 35% of the variability and included younger age, belief that health can be controlled, and no college education. The best model for missing the second research visit explained 17% of the variability and included greater pain intensity, less personal responsibility for health, and diagnosis (trapeziometacarpal arthrosis and de Quervain syndrome). Younger patients with no college education, who believe their health can be controlled, are more likely to miss a research appointment when enrolled in a randomized placebo injection-controlled trial.

Disability in Patients With Trapeziometacarpal Joint Arthrosis: Incidental Versus Presenting Diagnosis

To test the hypothesis that there is no difference in trapeziometacarpal (TMC) joint arthrosis-related symptoms and disability between patients seeking treatment for symptoms of TMC arthrosis and those with incidental TMC joint arthrosis. We compared 64 patients presenting for care of TMC joint arthrosis with 64 with incidental TMC joint arthrosis. For both groups, the diagnosis was based on crepitation on examination. Bivariate and multivariate analyses assessed factors associated with symptoms and disability related to TMC joint arthrosis. In bivariate analysis, patients presenting for care of TMC joint arthrosis had significantly more symptoms and disability from TMC joint arthrosis than those with incidental TMC joint arthrosis. The best multivariate linear regression model for fewer TMC joint arthrosis-related symptoms and disability included patients with incidental TMC joint arthrosis, male sex, no other painful conditions, less catastrophic thinking, and fewer depressive symptoms and explained 74% of the variability. Having incidental TMC joint arthrosis (25%) and more adaptive coping strategies (less catastrophic thinking; 5%) were the most important contributors to fewer symptoms and less disability. Future studies are merited to determine whether training in better coping strategies (eg, less catastrophic thinking and fewer depressive symptoms) can decrease symptoms anddisability in patients with TMC joint arthrosis. Prognostic III.