Trapeziometacarpal Arthrosis

Introduction Thumb base osteoarthritis (OA) is a prevalent hand OA phenotype, associated with specific risk factors, treatment strategies, and requiring a distinct subset of evaluative approaches. This paper aimed at surveying our clinical evaluative methods and identifying gaps in our ability to capture the thumb’s unique attributes and how they could impact our treatment recommendations. Methods A scoping review was conducted in accordance with the Joanna Briggs Institute methodology to gather relevant published and non-published articles regarding clinical tests currently available to assess the physical presentation of thumb base OA with special consideration of its specific multifactorial parameters namely architecture, ligaments, biomechanics, neuromuscular control, and proprioception. A full search strategy of MEDLINE, CINAHL, EMBASE, Scopus, Google Scholar, and Clinical Trials.gov from their inception through May 2020 was performed. Results Of 1936 citation identified, 54 met the inclusion criteria. Fifty-two clinical physical tests for the evaluation of thumb base OA were extracted, most of which well suited to address research questions regarding efficacy of clinical intervention, however providing limited information regarding the underlying impairments of ligaments, biomechanics, neuromuscular or proprioceptive components. Conclusions The tests and measures specific to the basal thumb OA phenotype, and capable of isolating its multifactorial contributors are scarce. Our limited physical assessment repertoire impedes our ability to describe and answer explicative research questions. Without these we cannot evaluate the effect of conservative management and provide specific treatment recommendations. Further research is needed to develop and validate distinct clinical tools for this debilitating pathology.

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“…Positive test recreates pain at the trapeziometacarpal joint. 46,60 Yes 2…”

Section: Thumb Adduction Testmentioning

confidence: 99%

“…Reproduction of pain at the trapeziometacarpal joint is a positive finding. 49,60 Yes 2…”

Section: Ligamentous Lever Testmentioning

confidence: 99%

Clinical evaluation of thumb base osteoarthritis: A scoping review

et al. 2021

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“…On the other hand, there is often no or little evidence of TMO on conventional radiographs in early stages, whereas functional limitations and pain can be very prominent [5]. Symptoms of TMO usually include pain in the trapeziometarcarpal (TMC) joint, reduced hand strength and decreased mobility of the thumb [7]. Pain can vary from episodic to pain related to a specific activity, sometimes accompanied by a background ache [7,8].…”

Section: Introductionmentioning

confidence: 99%

“…Symptoms of TMO usually include pain in the trapeziometarcarpal (TMC) joint, reduced hand strength and decreased mobility of the thumb [7]. 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].…”

Section: Introductionmentioning

confidence: 99%

Trapeziometacarpal osteoarthritis – a stepwise therapeutic approach

Nuessle¹,

Vögelin²,

Hirsiger³

2021

Swiss Med Wkly

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Osteoarthritis of the trapeziometarcarpal joint, also called rhizarthrosis, is a common finding in the second half of life. It has a higher prevalence in females and is of growing importance in ageing societies. A variety of conservative and surgical treatment options are known, including conservative treatment up to joint replacement. Without treatment, rhizarthrosis can lead to disabling pain and loss of hand function. The goal of this overview of treatment options is to present a stepwise approach that can be initiated by any physician.Treatment of trapeziometacarpal osteoarthritis should be started early with conservative measures such as splinting and physical therapy, which can be supplemented by oral and topical analgesics and local infiltrations subsequently. If all of these interventions do not provide sufficient relief, referral to a hand surgeon should be considered.Surgical strategies vary from arthroscopic debridement over trapeziectomy, with or without tendon interposition and ligament reconstruction, to interposition implants and total joint replacements. The planned intervention should be based on clinical and subjective functional limitations and associated degenerative changes, as well as the patient's expectations and needs.The goal of this paper is to develop a treatment algorithm, leading to higher levels of patient functionality and satisfaction. Below we discuss the current literature and point out key treatment options used in our department. Additional imagingMultilayer imaging can help to evaluate the trapeziometacarpal joint and the neighbouring joints in more detail. To evaluate bone stock and cartilage surfaces, and especially if planning prosthetic implants, computed tomography (CT) enhanced by intra-articular contrast injection can be useful [18]. Magnetic resonance imaging (MRI) allows ligament and soft tissue evaluation. Recent

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“…Prostheses are associated with loosening, subluxation, fracture, and synovitis, potentially requiring revision surgery [5][6][7][8][9][10]. Arthrodesis of the CMC1 joint reduces range of motion and has the associated risk of non-union resulting in revision surgery [11]. For patients with persisting symptoms of CMC1 OA requiring surgical intervention at a relatively young age, other techniques that preserve the joint and are less invasive may be more desirable.…”

Section: Introductionmentioning

confidence: 99%

Can we decrease the duration of basal thumb joint distraction for early osteoarthritis from 8 to 6 weeks? Study protocol for a non-inferiority randomized controlled trial

Ottenhoff

Teunis

Braakenburg

et al. 2021

Trials

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Background To our knowledge, to date, 52 patients with thumb carpometacarpal osteoarthritis (CMC1 OA) were treated with joint distraction. So far, most patients experienced improved physical function and less pain. After 2 years, only 1 patient proceeded to trapeziectomy. This study assesses if we can safely lower the distraction duration from 8 to 6 weeks for CMC1 joint distraction, maintaining the improvement in physical function and pain. Methods This is a monocenter randomized controlled non-inferiority trial that includes patients younger than 65 years of age with ongoing symptoms of CMC1 OA and an established indication for surgery. All patients will be treated with CMC1 joint distraction. The primary outcome is to assess whether 6 weeks of joint distraction is not inferior to 8 weeks in terms of physical function at 1 year after surgery. Secondary outcomes will identify differences between groups at 1 year in pain intensity, patient satisfaction, hand health status, adverse event rates, treatment failure, differences in thumb strength and range of motion, and radiographic changes. Discussion If safe, the duration of basal thumb joint distraction can be reduced to 6 weeks, reducing patient burden. Because this is a relatively new treatment, this trial will provide greater knowledge of potential adverse events. This knowledge allows for more informed decision making for patients considering CMC1 distraction treatment. Future studies can directly compare joint distraction to other treatments of CMC1 joint arthritis like splinting and trapeziectomy. Trial registration Central Committee on Research Involving Human Subjects (CCMO), NL68225.100.18; registered on 9 August 2019. Medical Research Ethics Committees United (MEC-U), R19.003; registered on 9 August 2019. Netherlands Trial Register, NL8016; registered on 15 September 2019.

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Trapeziometacarpal Arthrosis

Cited by 20 publications

References 131 publications

Clinical evaluation of thumb base osteoarthritis: A scoping review

Clinical evaluation of thumb base osteoarthritis: A scoping review

Trapeziometacarpal osteoarthritis – a stepwise therapeutic approach

Can we decrease the duration of basal thumb joint distraction for early osteoarthritis from 8 to 6 weeks? Study protocol for a non-inferiority randomized controlled trial

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