Exercise Therapy in Addition to an Orthosis Reduces Pain More Than an Orthosis Alone in Patients With Thumb Base Osteoarthritis: A Propensity Score Matching Study

ObjectiveTo compare the effect of exercises and orthotics with orthotics alone on pain and hand function in patients with first carpometacarpal joint (CMC-1) osteoarthritis (OA) and to predict outcomes on pain and hand function of exercises and orthotics.DesignProspective cohort study with propensity score matching.SettingData collection took place in 13 outpatient clinics for hand surgery and hand therapy in The Netherlands.ParticipantsA consecutive, population-based sample of patients with CMC-1 OA (N=173) was included in this study, of which 84 were matched on baseline demographics and baseline primary outcomes.InterventionsExercises and orthotics versus orthotics alone.Main Outcome MeasuresPrimary outcomes included pain and hand function at 3 months, measured using visual analog scale (VAS, 0-100) and the Michigan Hand Outcomes Questionnaire (MHQ, 0-100).ResultsA larger decrease in VAS pain at rest (11.1 points difference; 95% confidence interval, 1.9-20.3; P=.002) and during physical load (22.7 points difference; 95% confidence interval, 13.6-31.0; P<.001) was found in the exercise + orthotic group compared to the orthotic group. In addition, larger improvement was found for the MHQ subscales pain, work performance, aesthetics, and satisfaction in the exercise + orthotic group. No differences were found on other outcomes. Baseline scores of metacarpophalangeal flexion, presence of scaphotrapeziotrapezoid OA, VAS pain at rest, heavy physical labor, and MHQ total predicted primary outcomes for the total exercise + orthotic group (N=131).ConclusionsNon-surgical treatment of patients with CMC-1 OA should include exercises, since there is a relatively large treatment effect compared to using an orthosis alone. Future research should study exercises and predictors in a more standardized setting to confirm this finding.     

Joint distraction for thumb carpometacarpal osteoarthritis: a feasibility study with 1-year follow-up

Objective: The purpose of this pilot study was to evaluate the feasibility of joint distraction of the first carpometacarpal (CMC1) joint in patients with CMC1 osteoarthritis (OA).

Methods: An external joint distractor was placed over the CMC1 joint by K-wire fixation in the trapezium and the metacarpal. The joint was distracted 3?mm during surgery. The device was then kept in place for 8 weeks. Disabilities of the Arm, Shoulder, and Hand (DASH) score, Michigan Hand Outcome Questionnaire (MHQ), Visual Analogue Scale (VAS), and grip strength were recorded preoperatively and at set postoperative intervals.

Results: Five female patients with an average age of 53 years (range?=?41–61) were included. One year postoperatively, average DASH, MHQ, and VAS scores improved compared to preoperative values; DASH 53 to 27, MHQ 48 to 76, and VAS pain 48 to 14. There were no technical problems associated with the device. One patient had a local pin site infection treated successfully with oral antibiotics.

Conclusions: This study concludes that joint distraction of the osteoarthritic CMC1 joint is technically feasible. In this small, prospective pilot study the majority of the results were favourable during short-term follow-up.     

第五腕掌关节创伤性关节炎患者的关节成型术治疗

目的：总结分析腕掌关节成型术治疗第五腕掌关节（ carpometacarpal,CMC ）创伤性关节炎的疗效。方法2006年1月至2011年1月,利用 Scheker 腕掌关节成型术治疗第五腕掌关节创伤性关节炎患者6例,男5例,女1例;左侧1例,右侧5例;年龄（45±10）（31～55）岁。分别记录术前和术后的临床和影像学结果,检查指标包括握力、掌指关节活动度及第五掌骨高度。并在手术前后采用疼痛视觉模拟评分（ VAS ）来评估主观的疼痛程度。结果6例均随访（17.6±10.4）（9～36）个月。腕掌关节成型术后,植骨融合时间（6.2±0.8）（5～7）周。患侧握力术前为（33.6±12.2） kg,术后握力改善为（44.2±12.7） kg,术前与术后比较差异有统计学意义（ t＝-4.566,P＝0.006）。患侧小指掌指关节活动度术前为（88.5±3.6）°,术后为（87.8±2.6）°,术前与术后比较差异无统计学意义（ t＝1.195,P＝0.286）。患侧第五掌骨高度术前为（53.7±4.0） mm,术后为（52.3±3.6） mm,术前与术后比较差异无统计学意义（ t＝1.754,P＝0.140）。术后疼痛改善, VAS由术前平均2.8,降至术后0.2。结论 Scheker腕掌关节成型术是治疗第五腕掌关节创伤性关节炎的有效方法,可以改善握力,并消除腕尺侧疼痛。     

Dislocation of the Carpometacarpal Joint of the Thumb Associated with Trapezium and Bennett’s Fractures

We report a case of a 30-year-old man with a carpometacarpal joint dislocation of the thumb associated with trapezium and Bennett’s fractures. This combined injury pattern appears to be very rare. Since, to our knowledge a similar case was not found in the literature. The lesion was managed with closed reduction and percutaneous pining, resulting in good functional outcome.     

Traumatic thumb carpometacarpal joint dislocations

Isolated traumatic dislocation of the thumb carpometacarpal joint, also called the trapeziometacarpal joint, is a rare injury. Controversy still exists concerning which ligaments are the true key stabilizers for the joint and therefore need to be damaged to result in dislocation, and optimal treatment strategies for thumb carpometacarpal joint dislocations are the subject of continuing debate. We give a review of the literature concerning traumatic dislocations of the carpometacarpal joint of the thumb and propose a treatment algorithm.     

Adjustable distractor for management of thumb web contracture

Thumb web contracture is a progressive disabling deformity, and prevention or early intervention is advisable. We describe the use in 18 cases of an external adjustable thumb web distractor, with one static and one mobile block on K-wires fixed transversely to the metacarpal shafts. The mobile block can be moved, causing distraction or compression between the two blocks, to maintain or correct thumb web expansion. This inexpensive and effective device can be safely applied to an injured hand, allows movement at the first carpometacarpal joint and hence obtains good functional outcome. The only complication has been minor pin site infection.