Treatment Of Carpometacarpal Joint Arthritis Research Articles

The Relationship of Patient Characteristics and Prolonged Pain after Treatment of Carpometacarpal Joint Arthritis of the Thumb.

Background: The carpometacarpal (CMC) joint of the thumb is the second most common site of osteoarthritis in the hand. Clinical severity stage of CMC joint arthritis has not been correlated with the pain level of the patient. Recently, the association of joint pain with patient psychological factor, such as depression or case-specific personality, has been investigated. This study was designed to determine the impact of psychological factors to residual pain after treatment of CMC joint arthritis, using pain catastrophizing scale (PCS) and the Yatabe-Guilford (YG) personality test. Methods: Twenty-six patients (7 males and 19 females) with 26 hands were included. Thirteen patients classified as Eaton stage 3 underwent suspension arthroplasty and 13 patients as Eaton stage 2 underwent conservative treatment using a custom fitted orthosis. Clinical evaluation was assessed using Visual Analogue Scale (VAS) and the quick Disabilities of the Arm, Shoulder and Hand Questionnaire Score (QuickDASH) at initial evaluation, at 1 month and at 3 months after treatment. We compared both groups using the PCS and YG test. Results: The PCS showed significant difference in the VAS scores only at initial evaluation in both surgical and conservative treatment. There was a significant difference in VAS at 3 months between the two groups in both surgical and conservative treatment and in QuickDASH at 3 months in conservative treatment. Conclusions: The YG test has been used mainly in psychiatry. Although this test has not yet been used worldwide, its usefulness has been recognised and applied clinically, especially in Asia. Patient characteristics are strongly associated with residual pain of the CMC joint arthritis of the thumb. The YG test is a useful tool to analyse pain-related patient characteristics and can be utilised to determine the therapeutic modalities and most effective rehabilitation programme for pain control. Level of Evidence: Level III (Therapeutic).

Surgical Treatment of Advanced Carpometacarpal Joint Arthritis: Trapeziectomy with Hematoma Arthroplasty.

Osteoarthritis of the first carpometacarpal joint is common. When nonoperative measures fail, surgery may provide long-term pain relief. There are many surgical options in the management of carpometacarpal joint arthritis. Trapeziectomy with hematoma arthroplasty is technically simple, inexpensive, and has withstood the test of time. It is an excellent option for advanced carpometacarpal joint arthritis with multiple high-quality studies showing equivalent outcomes between this technique and ligament reconstruction tendon interposition techniques. This article reviews trapeziectomy with hematoma arthroplasty for treatment of carpometacarpal joint arthritis, including the indications for the procedure, the authors' preferred technique, and the current literature.

Arthroscopic Partial Trapeziectomy for Thumb Carpometacarpal Joint Osteoarthritis: 5-Year Follow-up.

Osteoarthritis of the thumb carpometacarpal (CMC) joint is the most common type of arthritis of the hand. The goal of the study was to evaluate clinical results and radiographic changes after arthroscopic partial trapeziectomy combined with ligament shrinkage and K-wire fixation to treat thumb CMC joint arthritis. From February 2013 to March 2014, 24 patients with thumb CMC joint arthritis received this arthroscopic procedure. We investigated the preoperative and postoperative Modified Mayo Wrist Score (MMWS); Disabilities of the Arm, Shoulder and Hand (DASH) score; radiographic changes; and associated complications. Sixteen patients completed 5 years of functional score and radiographic follow-up. Comparison of preoperative and postoperative MMWS and DASH scores showed significant improvement after the arthroscopic procedure. Pre-operative and postoperative evaluation of radiographic changes showed significant differences in the CMC joint distance, scaphoid-metacarpal distance, trapezium-metacarpal distance, and metacarpal prominence distance. This arthroscopic procedure is an effective and less invasive method for the treatment of CMC joint arthritis. This procedure can improve clinical function, preserve the mechanical height of the trapezium, and increase CMC joint space. We report our surgical technique and some pitfalls that required attention during the arthroscopic procedure. [Orthopedics. 2022;45(3):e140-e147.].

The Effect of Metacarpophalangeal Joint Hyperextension on Outcomes in the Surgical Treatment of Carpometacarpal Joint Arthritis.

Purpose In the surgical treatment of thumb carpometacarpal (CMC) joint arthritis, the effect of mild preoperative metacarpophalangeal (MCP) hyperextension on postoperative functional outcomes is unknown. We sought to examine outcomes after surgical treatment of CMC arthritis in patients with and without mild preexisting MCP deformity. Methods A retrospective review was conducted to analyze the functional outcomes of patients treated for CMC arthritis at a single institution from March 1998 to May 2009. All patients were treated with one of two standard CMC arthroplasty procedures-either ligament reconstruction tendon interposition (LRTI) or a Weilby procedure-and none had additional procedures to address MCP hyperextension. Pre- and postoperative assessments included pinch and grip strength, degree of MCP hyperextension, and thumb radial and palmar abduction. A t -test was used to assume unequal variances. Results A total of 203 patients were followed for an average of 27.3 months. Patients were divided into two groups: (1) patients without preoperative MCP hyperextension (167 patients) and (2) patients with mild but untreated preoperative MCP hyperextension (≤ 30 degrees; 36 patients). All patients underwent either a Weilby procedure (118 patients) or an LRTI; 85 patients). The main difference between techniques was the use of the abductor pollicis longus tendon as a post to secure the flexor carpi radialis (Weilby) or the use of a bone tunnel in the first metacarpal (LRTI). Analysis of the preoperative data showed no difference in the baseline parameters among both the groups, with the exception of MCP hyperextension. Postoperatively, neither the type of CMC procedure nor the presence of MCP hyperextension demonstrated any significant differences in key pinch, tip pinch, grip strength, and radial or palmar abduction of the thumb between the groups. Conclusion There were no statistically significant differences in improvement of functional outcomes after surgery when comparing patients without preoperative MCP hyperextension to patients with untreated MCP hyperextension of less than 30 degrees. Level of Evidence Level III, retrospective comparative study.