Efficacy of Nonsurgical Interventions for Trapeziometacarpal (Thumb Base) Osteoarthritis: A Systematic Review

Abstract

Objective. To synthesize the literature on the efficacy of existing nonsurgical interventions for trapeziometacarpal (TM) osteoarthritis (TMO). Methods. A medical librarian conducted an electronic search in 16 databases. Two authors independently carried out study selection, data extraction, and risk-of-bias assessment. The Agency for Healthcare Research and Quality guidance was followed to integrate a valid body of evidence from the existing systematic reviews. Intervention effects were estimated based on the Cochrane Collaboration review methodology. Results. We identified 17 systematic reviews, 34 randomized controlled trials, and 6 nonrandomized controlled trials. Most of the studies had unclear or high risk of biases. Evidence of low-to-moderate quality supports the superiority of the following interventions for pain and/or physical function: 1) saline over steroid intraarticular injections confirmed by radiography, 2) saline injections over sham (i.e., pressure) in tender subcutaneous areas, 3) custommade thermoplastic thumb orthosis over no intervention or a control, 4) custom-made thermoplastic hand-based TM joint orthosis over no intervention, 5) radial nerve mobilization over sham ultrasound, and 6) a combination of hand exercises and TM joint and median/radial nerve mobilization over sham ultrasound. Conclusion. This comprehensive systematic review allowed collating evidence-based data on the efficacy of nonsurgical interventions for TMO. Steroid intraarticular injections would not be more effective than saline injections. Rehabilitative interventions (orthosis, exercises, nerve mobilization) would be efficacious. However, these findings must be treated with circumspection due to methodologic limitations in many studies.

A Randomized, Placebo Controlled Clinical Trial to Evaluate the Efficacy and Safety of HFPM-01 in Improving Pain, Stiffness, and Inflammation in Patients Suffering from Knee Osteoarthritis

“…Many experimental results have shown that W. somnifera improved VAS score by improving pain response, antioxidant status and general wellbeing The present data represent that herbs like turmeric, chopchini extract (Bark) and ginger used in HFPM-01 formulation have its promising effect on GI related complications like nausea, hyperacidity, heartburn and constipation etc. [20] The absence of gastric disturbance and improved compliance and quality of life can contribute to the better prognosis of the results in chronic OA patients.…”

Trapeziometacarpal osteoarthritis – a stepwise therapeutic approach

“…Nevertheless, in early stages of TMO or when inflammation is predominant corticos- teroids infiltration, in combination with splinting, can provide long-term pain relief [43]. It remains unclear whether the volume injected into the joint or specific anti-inflammatory effects are responsible for pain reduction, as some studies have revealed that saline injections can provide similar results [9,42].…”

“…Pain can vary from episodic to pain related to a specific activity, sometimes accompanied by a background ache [7,8]. Grasping and pinching is often limited [9]. As the thumb is needed for countless daily activities and represents approximately 40% of overall hand function, limitation of its function can be very disabling [9][10][11].…”

“…Grasping and pinching is often limited [9]. As the thumb is needed for countless daily activities and represents approximately 40% of overall hand function, limitation of its function can be very disabling [9][10][11]. Known risk factors include obesity [5], heavy manual labour [12], female gender and hormonal changes, such as menopause [1].…”

Impact of Thumb Carpometacarpal Joint Osteoarthritis: A Pragmatic Qualitative Study

“…The natural history can result in less symptomatic or stable end‐stage disease (3) or progress to pain and functional limitations interfering with patients’ quality of life (4–6). A range of conservative interventions is available, such as splints and exercise, but evidence for their effectiveness is sparse and of poor quality (7–11).

Outcome measures and treatments tailored to the unique impact of first carpometacarpal (CMC1) joint osteoarthritis (OA) are likely to improve outcomes.

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