Reliability of handgrip strength test in elderly subjects with unilateral thumb carpometacarpal osteoarthritis

BackgroundThe grip strength test is widely used; however, little has been investigated about its reliability when used in elderly with subjects thumb carpometacarpal (CMC) osteoarthritis (OA). The purpose of this study was to examine the test–retest reliability of the grip strength test in elderly subjects with thumb CMC OA.MethodsA total of 78 patients with unilateral thumb CMC OA, 84.6 % female (mean ± SD age 83 ± 5 years), were recruited. Each patient performed three pain free maximal isometric contractions on each hand in two occasions, 1 week apart. Intraclass correlation coefficient (ICC), standard error of measurement (SEM), and 95 % limits of agreement (LOA) were calculated.ResultsTest–retest reliability was excellent for side affected (ICC = 0.947; p = 0.001) and contralateral (ICC = 0.96; p = 0.001) thumb CMC OA.ConclusionsThe present results indicate that maximum handgrip strength can be measured reliably, using the Jamar hand dynamometer, in patients with thumb CMC OA, which enables its use in research and in the clinic to determine the effect of interventions on improving grip.     

钩骨腕掌关节移位重建指骨间关节的解剖学基础研究

目的探讨钩骨腕掌关节移位、修复和重建手的功能性关节的解剖学基础。方法22侧冷冻成人手腕标本,解剖观测钩骨腕掌关节和中节指骨基底关节面的形态、结构特点,测量各关节面的尺桡径、掌背径、关节面凹面的深度及关节面面积。将所得数据进行统计分析,比较钩骨腕掌关节和中节指骨基底关节面在形态、结构特点、面积及各径线长度的相似度。结果钩骨腕掌关节的尺桡径(13.54mm±1.15mm,钩骨腕掌关节尺桡侧缘中点的距离)和示、中、环指中节与拇指远节指骨基底关节面的尺桡径(关节面尺桡侧缘中点的距离)无统计学差异(P0.01,对应t值分别为2.7670、-2.0720、2.1608、1.2189);钩骨腕掌关节的掌背径(10.71mm±0.93mm,钩骨底嵴的两顶点间距离)和环指中节指骨基底关节面的掌背径(关节面掌背侧缘中点的距离)无统计学差异(P0.01,t=1.6170);钩骨腕掌关节的尺侧凹面深度(1.30±0.08)mm、桡侧凹面深度(0.95±0.05)mm、面积(139.89±5.44)mm2和示、中、环、小指中节指骨、拇指远节指骨基底关节面的凹面深度(尺、桡侧关节面掌背缘中点为支点测量深度)及面积有统计学差异(P0.01)。结论钩骨腕掌关节可作为一个新的良好关节供区,用于修复和重建各中节指骨基底关节面。     

Convergent validity and responsiveness of the Canadian Occupational Performance Measure for the evaluation of therapeutic outcomes for patients with carpometacarpal osteoarthritis

Study DesignThis is a longitudinal, observational, multicenter, cohort study.IntroductionThumb carpometacarpal (CMC) osteoarthritis (OA) is associated with more pain and restrictions than other hand OA. The use of patient-identified occupational performance goals to guide hand therapy treatment and to measure clinical outcomes is fundamental for a patient-centered intervention. The COPM enables subjects to identify goals for hand therapy and engage in a subject-specific therapeutic process.Purpose of the StudyThe purpose of this study is to evaluate the convergent validity and responsiveness of the COPM to evaluate the relationship between the patient’s self-perception and satisfaction of performance in everyday living and pain intensity, upper limb function, and manual ability.MethodsEligible participants to multiple hand therapy centers were recruited. Outcomes measures (VAS scale, QuickDASH, MAM-36, and the COPM questionnaire) were measured at the baseline and 3 months after.ResultsOne hundred forty-five (n = 145) consecutive patients for five different hand rehabilitation centers with symptomatic thumb CMC OA were screened for eligibility criteria. COPM-P and COPM-S were the most responsive instruments, with an area under the curve of 0.88 (95% CI 0.79-0.96) and 0.88 (95% CI 0.80-0.96), respectively.ConclusionsAlthough more investigation in this area is necessary to conclude that the COPM is the best option to evaluate the effectiveness of hand therapy interventions for thumb OA. The COPM focuses on function and occupation and, in comparison with others upper limb scales, does not require the use of another complementary scale for addressing both satisfaction and ADL status. COPM is an instrument with a good convergent validity and responsiveness to evaluate the relationship between the patient’s self-perception and satisfaction in thumb CMC OA.     

Multiple volar dislocations of the carpometacarpal joints with an associated fracture of the first metacarpal base

Multiple pometacarpal （CMC） joints volar dislocations of car- are uncommon and have been reported rarely. A 25 years old male presented with injury to his left hand 6 days following a road traffic accident. Clini- cal examination revealed gross swelling of the hand and diffuse tenderness over the carpometacarpal area. His ra- diographs of the hand showed volar dislocation of the second, third and fourth CMC joints in association with anextra-articular fracture of the base of thumb metacarpal. He was treated by open reduction and percutaneous fixation using Kirschner wires. The functional results were excellent at one year follow-up.     

Volar dislocation of second, third, and fourth carpometacarpal joints: a rare and easily missed diagnosis

Volar carpometacarpal dislocation is a rare form of hand injury that can be easily missed without applying a high level of suspicion and performing a meticulous examination. In this case report, we present a rare case of compound volar dislocation of the second, third, and fourth carpometacarpal joints in a 40-year-old male. This was managed by closed reduction and the use of a mini external fixator. The patient regained a good range of motion in 6 weeks with no pain. It is important to diagnose and treat this injury in order to avoid the considerable morbidity associated with this condition.     

Thumb CMC total exchange arthroplasty with the ARPE implant

We present two case reports of successful total exchange arthroplasty at the carpometacarpal joint of the thumb using an ARPE implant. In one patient (62-year-old female), a primary MOJE prosthesis had been implanted two years previous. In the second patient (48-year-old female), a primary ELEKTRA prosthesis had been implanted one year previous. At a follow-up of two and three years respectively, there were no changes in position of both ARPE implants and no signs of loosening. All clinical parameters (DASH score, pain through VAS, grip strength) had improved.