Beneficial Effects of Nonsurgical Treatment for Symptomatic Thumb Carpometacarpal Instability in Clinical Practice: A Cohort Study

Abstract

Objective: To describe outcomes of nonsurgical treatment for symptomatic thumb carpometacarpal joint (CMC-1) instability. Secondary, to evaluate the conversion rate to surgical treatment. Design: Prospective cohort study. Setting: A total of 20 outpatient clinics for hand surgery and hand therapy in the Netherlands. Participants: A consecutive sample of patients with symptomatic CMC-1 instability (NZ431). Intervention: Nonsurgical treatment including exercise therapy and an orthosis. Main Outcome Measures: Pain (visual analog scale [VAS], 0-100) and hand function (Michigan Hand Outcomes Questionnaire [MHQ], 0-100) at baseline, 6 weeks, and 3 months. Conversion to surgery was recorded for all patients with a median follow-up of 2.8 years (range, 0.8-6.7y). Results: VAS scores for pain during the last week, at rest, and during physical load improved with a mean difference at 3 months of 17 (97.5% CI, 9-25), 13 (97.5% CI, 9-18), and 19 (97.5% CI, 12-27), respectively (P<.001). No difference was present at 3 months for MHQ total score, but the subscales activities of daily living, work, pain, and satisfaction improved by 7 (97.5% CI, 1-14), 10 (97.5% CI, 4-16), 5 (97.5% CI, 2-9), and 12 (97.5% CI, 2-22) points, respectively (P<.001-.007). After median follow-up of 2.8 years, only 59 participants (14%) were surgically treated. Both in the subgroups that did and did not convert to surgery, VAS pain scores decreased at 3 months compared with baseline (P<.001-.010), whereas MHQ total score did not improve in both subgroups. However, VAS and MHQ scores remained worse for patients who eventually converted to surgery (P<.001). Conclusions: In this large sample of patients with symptomatic CMC-1 instability, nonsurgical treatment demonstrated clinically relevant improvements in pain and aspects of hand function. Furthermore, after 2.8 years, only 14% of all patients were surgically treated, indicating that nonsurgical treatment is a successful treatment of choice.

Patient reported outcome of silversplints used for osteoarthritis of the hand

“…In a comparative study, silversplints led to equal functional results compared with thermoplastic orthoses, but they were valued more highly on aspects of comfort and cosmetics (21)(22)(23)(24)(25). However, in the current study patients were not asked to value these aspects.…”

Thumb Carpometacarpal Stabilization With a Dorsal Capsule Repair Augmented With an Internal Brace

“…Exercise therapy aims to prevent subluxation by optimizing joint positioning. 12 The use of orthotics can be coupled with exercise therapy to prevent joint subluxation and subsequent inflammation. Wouters et al 12 showed improved VAS pain scores after 3 months of conservative therapy but long term outcomes in nonsurgically managed patients have not been reported.…”

“…Conservative treatment of thumb CMC joint instability can involve exercise therapy and orthotic usage. Exercise therapy aims to prevent subluxation by optimizing joint positioning 12 . The use of orthotics can be coupled with exercise therapy to prevent joint subluxation and subsequent inflammation.…”

Defining trapezial dysplasia – analysis of trapezial inclination in a normal population

“…Similar to the hip joint, a dysplastic TMC joint can still be asymptomatic and does not always necessitate surgical intervention. However, if a TMC joint becomes symptomatic in the presence of a trapezial dysplasia, one could consider a corrective osteotomy to normalize trapezial inclination if the patient does not respond to conservative treatment (Wouters et al., 2020). As such, our results could be of interest in the preoperative planning of a trapezial osteotomy.…”

“…Instability of the trapeziometacarpal (TMC) joint is a cause of thumb base pain in young adults (Eaton and Littler, 1973; Lane and Henley, 2001). The management of these patients remains challenging (Schoenaers et al., 2017; Wouters et al., 2020) due to their higher functional demands. The absence of an osteoarthritic joint also makes them unsuitable candidates for classic surgical procedures like total joint replacement or trapeziectomy.…”