Surgical treatment of trapeziometacarpal joint osteoarthritis

Abstract

Trapeziometacarpal joint osteoarthritis is a common cause of radial-sided wrist pain that prevalently affects women. It is diagnosed on the basis of a thorough history, physical examination, and radiographic evaluation. While radiographs are used to determine the stage of disease, treatment is dependent on the severity of the symptoms. Non-surgical treatment frequently consists of activity modification, non-steroidal anti-inflammatory drugs, splinting and corticosteroid injections. After failure of conservative treatment, various surgical options exist depending on the stage of the disease. These options range from ligament reconstruction or osteotomy, for early painful laxity, to trapeziectomy, arthrodesis and arthroplasty for more severe osteoarthritis. This article reviews the literature supporting the various surgical treatment options and analyzes the surgical techniques most frequently used in the different disease stages. 140JOINTS 2013;1(3):138-144 J oints G. taccardo et al. 144 JOINTS 2013;1(3):138-144 J oints G. taccardo et al.

Trapeziectomy With Intermetacarpal Suspension: A Surgical Technique

“…When all techniques have equivalent results, the choice of any particular technique can be based on technical ease, associated risks, and cost. TIMS revisits the basic requirements of CMC OA surgery: (1) trapeziectomy and (2) supporting the thumb metacarpal in a manner that prevents proximal migration, with the ultimate goal of providing pain relief and a stable column to support pinching and gripping 3. Historically, this goal was achieved using a combination of local tissue harvest that sacrifices tendons, the use of temporary Kirschner wires, or the insertion of permanent implants such as suture button fixation devices.…”

“…TIMS revisits the basic requirements of CMC OA surgery: (1) trapeziectomy and (2) supporting the thumb metacarpal in a manner that prevents proximal migration, with the ultimate goal of providing pain relief and a stable column to support pinching and gripping. 3 Historically, this goal was achieved using a combination of local tissue harvest that sacrifices tendons, the use of temporary Kirschner wires, or the insertion of permanent implants such as suture button fixation devices. TIMS, in comparison, relies on suture suspension which functions similarly to Kirschner wires or suture button implants.…”

Surgical treatment of carpometacarpal thumb arthritis with trapeziectomy and intra-tendon (FCR) suspension with one-loop APL: comparative cohort study

“…Osteoarthritis of the trapeziometacarpal joint of the thumb is a painful and debilitating condition of the hand with a reported age-adjusted prevalence of 7% in men and 15% in women [ 1 ]. It typically presents in postmenopausal females, and patients often complain of pain at the base of the thumb during activities which require opposition or pinch grip [ 2 ]. Conservative treatment involves activity modification, non-steroidal anti-inflammatory drugs (NSAIDS), splinting, and corticosteroid injections [ 2 ].…”

“…It typically presents in postmenopausal females, and patients often complain of pain at the base of the thumb during activities which require opposition or pinch grip [ 2 ]. Conservative treatment involves activity modification, non-steroidal anti-inflammatory drugs (NSAIDS), splinting, and corticosteroid injections [ 2 ]. When these fail, surgical treatment should be considered to provide pain relief and restoring thumb motion and strength [ 2 ].…”

“Natural History of Metacarpal Subsidence Following Trapeziectomy with Ligament Reconstruction and Tendon Interposition and Its Relationship to Clinical Outcomes”

“…1 Symptomatic TMJ osteoarthritis is most commonly treated by trapeziectomy with reconstruction of the volar beak ligament and tendon interposition (LRTI) after failure of conservative treatment; alternative methods include simple trapeziectomy, trapeziectomy and hematoma distraction, trapeziometacarpal arthrodesis, and prosthetic arthroplasty. 2…”