Patient Goals and Motivation for Thumb Carpometacarpal Osteoarthritis Surgery

Background:Knowledge is lacking on patient goals and motivation for carpometacarpal joint osteoarthritis (CMCJ OA) surgery. The objective of this study was to explore patient goals and motivation for surgery, whether patient goals were reflected in self-reports of pain and function, and factors characterizing patients highly motivated for surgery.Methods:This cross-sectional study included 180 patients referred from their general practitioner for CMCJ surgical consultation. Goals for surgery were collected with an open-ended question, categorized with the International Classification of Functioning, Disability and Health coding system, and compared to self-reports of pain and function. Motivation for surgery was rated with a Numeric Rating Scale (NRS, 0-10, 0 = not motivated). Factors characterizing patients highly motivated for surgery (NRS ≥ 8) were explored with multivariate regression analyses.Results:The mean age of the participants was 63 years (SD = 7.6), and 142 (79%) were women. The most common goals for surgery were to reduce pain and improve arm and hand use, but these were not reflected in self-reports of pain and function. Fifty-six (31%) of the patients were characterized as highly motivated for surgery. High motivation for surgery was strongly associated with reporting more activity limitations (odds ratio [OR] = 4.00, P = .008), living alone (OR = 3.18, P = .007), and a young age (OR = 0.94, P = .002).Conclusions:Decisions on CMCJ OA surgery should be based on assessment and discussion of patients’ life situation, hand pain, activity limitations for, and goals and motivation for surgery. According to the european league against rheumatism (EULAR) recommendations, previously received conservative and pharmacological treatment should also be evaluated.     

Comparison of Two Carpometacarpal Stabilizing Splints for Individuals with Thumb Osteoarthritis

Splinting the thumb in carpometacarpal osteoarthritis (CMC OA) is a common practice; however, research evidence is lacking to support the use of one specific splint design. The purpose of the study was to compare the effect of two different splints on hand function, pain, and hand strength in adults with CMC OA. Fifty-six participants were assigned randomly to splint order in a two-phase, four-week crossover trial. Hand function, the primary outcome, was assessed using the Australian Canadian Hand Osteoarthritis Hand Index. Differences between the two splints were not statistically significant for effect on hand function, and grip and pinch strength. However, the custom-made splint showed a greater average reduction in pain scores. Both splints demonstrated modest improvements in hand function. The prefabricated splint was the preferred splint although the custom-made splint decreased pain slightly more. This reinforces the client-centered approach to splinting.

Level of Evidence

2b.     

Soft Tissue Interposition Arthroplasty for Osteoarthritis of the Carpometacarpal Joint of the Thumb

A soft tissue interposition arthroplasty for carpometacarpal osteoarthritis of the thumb is described. Thirty-seven joints in 32 patients were operated on. the results with regard to pain, strength and mobility are recorded. in 34 cases the patients reported considerable improvement after the operation and the majority of the patients could resume their usual work. Only minor complications occurred.     

Rehabilitation Protocol after Suspension Arthroplasty of Thumb Carpometacarpal Joint Osteoarthritis

Study DesignRetrospective case series.IntroductionWhen conservative modalities and therapies fail to control symptoms of thumb carpometacarpal (CMC) joint osteoarthritis, surgery may be indicated.Purpose of the StudyTo present a rehabilitation protocol used in a series of patient cases after suspension arthroplasty and to evaluate outcomes.MethodsTwenty-seven patients with CMC osteoarthritis were treated by the same arthroplasty technique and the same rehabilitation program. Patients were evaluated before and 12th week after surgery, and at the last follow-up using a visual analog scale; the Disability of the Arm, Shoulder, and Hand questionnaire; strength measurements; range of motion evaluations; and radiographic assessment.ResultsAverage follow-up period was 31.5 months. There was a decreasing trend in both subjective scores during follow-ups (p = 0.0001). Thirty-three percent and 30% improvements on radial and palmar abductions, respectively, and 29% improvement on pinch strengths were recorded at the final follow-up. Postoperative grip improvement was not preserved at the last follow-up.ConclusionsThe results demonstrate a high degree of patient satisfaction suggesting the efficacy of this surgical technique and postoperative rehabilitation protocol.Level of EvidenceLevel 4.     

Non-Suspensionplasty by Abductor Pollicis Longus Tendon for First Carpometacarpal Osteoarthritis of the Thumb

Many surgical procedures have been described for treating painful osteoarthritis at the carpometacarpal joint of the thumb. We describe the new nonsuspension abductor pollicis longus (APL) arthroplasty of base of the thumb after excision of trapezium. APL arthroplasty formed neojoint scapho-metacarpo-trapezoid joint. This technique is effective, technically straightforward, and appears to be robust.     

Lessons Learned: Trapeziectomy and Suture Suspension Arthroplasty for Thumb Carpometacarpal Osteoarthritis

In this study, we describe refinements of an accepted technique made by a single surgeon for trapeziectomy and suture suspension arthroplasty for thumb carpometacarpal (CMC) osteoarthritis after 220 cases over 4 years. Results are derived from 77 patients who underwent treatment using this technique comparing postoperative results with preoperative assessment and had sufficient data for inclusion. The surgical technique is described, including tips and modifications to avoid known possible complications. All patients in this study had advanced Eaton stage III or IV osteoarthritis. Grip strength and key pinch showed statistically significant improvement, and the improvement in palmar pinch approached significance. Pain scores were significantly decreased with over 50% of the patients rating their pain at 0 postoperatively. The overall complication rate was very low, and improvements in technique were made to mitigate future occurrence. This surgical technique for the treatment of thumb CMC arthritis achieved pain relief and recreated ligamentous support of the base of the first metacarpal to resist proximal migration after trapeziectomy, providing an increase in grip strength and key pinch with return of range of motion early in the postoperative period. Refinements on this technique through a large volume single surgeon experience provide technical tips for optimizing outcomes.     

Ultrastructure and Innervation of Thumb Carpometacarpal Ligaments in Surgical Patients With Osteoarthritis

Background

The complex configuration of the thumb carpometacarpal (CMC-1) joint relies on musculotendinous and ligamentous support for precise circumduction. Ligament innervation contributes to joint stability and proprioception. Evidence suggests abnormal ligament innervation is associated with osteoarthritis (OA) in large joints; however, little is known about CMC-1 ligament innervation characteristics in patients with OA. We studied the dorsal radial ligament (DRL) and the anterior oblique ligament (AOL), ligaments with a reported divergent presence of mechanoreceptors in nonosteoarthritic joints.

Questions/purposes

This study’s purposes were (1) to examine the ultrastructural architecture of CMC-1 ligaments in surgical patients with OA; (2) to describe innervation, specifically looking at mechanoreceptors, of these ligaments using immunohistochemical techniques and compare the AOL and DRL in terms of innervation; and (3) to determine whether there is a correlation between age and mechanoreceptor density.

Methods

The AOL and DRL were harvested from 11 patients with OA during trapeziectomy (10 women, one man; mean age, 67 years). The 22 ligaments were sectioned in paraffin and analyzed using immunoflourescent triple staining microscopy.

Results

In contrast to the organized collagen bundles of the DRL, the AOL appeared to be composed of disorganized connective tissue with few collagen fibers and little innervation. Mechanoreceptors were identified in CMC-1 ligaments of all patients with OA. The DRL was significantly more innervated than the AOL. There was no significant correlation between innervation of the DRL and AOL and patient age.

Conclusions

The dense collagen structure and rich innervation of the DRL in patients with OA suggest that the DRL has an important proprioceptive and stabilizing role.

Clinical Relevance

Ligament innervation may correlate with proprioceptive and neuromuscular changes in OA pathophysiology and consequently support further investigation of innervation in disease prevention and treatment strategies.     

Reduction in Cylindrical Grasp Strength Is Associated With Early Thumb Carpometacarpal Osteoarthritis

Clinical Orthopaedics and Related Research® - Advanced thumb carpometacarpal (CMC) osteoarthritis (OA) can cause substantial impairment in hand function, from grasping heavy objects to fine...     

韧带重建术治疗拇腕掌关节脱位

作者报告了5例拇腕掌关节脱位的手术治疗结果,其中陈旧性拇腕掌关节脱位3例,新鲜脱位2例,该手术利用了桡测腕屈肌肌腱重建拇腕掌关节周围韧带,取得了满意的临床效果,本文不但详细描述了手术方法,也分析了该术式的解剖学基础及手术适应证,作者认为本术式设计生物力学合理,手术操作简单,是值得推荐的一种手术治疗措施。