Trapezium Trabecular Morphology in Carpometacarpal Arthritis

Lee, Arthur T.; Williams, Ariel A.; Lee, Jung Hwa; Cheng, Robert C.; Lindsey, Derek P.; Ladd, Amy L.

doi:10.1016/j.jhsa.2012.10.038

Cited by 32 publications

(23 citation statements)

References 43 publications

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“…The statistically significant motions at the CMC joint are generally consistent with previously reported patterns of cartilage damage, which typically starts in the volar quadrants of the CMC joint [16,20]. Given the large change in contact pressure that may result even from very little joint motion [10], a follow-up study of changes in joint space and joint congruence at the CMC joint will be useful to quantify the influence of loading and to determine whether mechanical measures other than kinematics may be statistically and clinically different with sex and age.…”

Section: Discussionsupporting

confidence: 88%

In Vivo Kinematics of the Thumb Carpometacarpal Joint During Three Isometric Functional Tasks

Halilaj

Rainbow

Got

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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Background The thumb carpometacarpal (CMC) joint is often affected by osteoarthritis-a mechanically mediated disease. Pathomechanics of the CMC joint, however, are not thoroughly understood due to a paucity of in vivo data. Questions/purposes We documented normal, in vivo CMC joint kinematics during isometric functional tasks. We hypothesized there would be motion of the CMC joint during these tasks and that this motion would differ with sex and age group. We also sought to determine whether the rotations at the CMC joint were coupled and whether the trapezium moved with respect to the third metacarpal. Methods Forty-six asymptomatic subjects were CT-scanned in a neutral position and during three functional tasks (key pinch, jar grasp, jar twist), in an unloaded and a loaded position. Kinematics of the first metacarpal, third metacarpal, and the trapezium were then computed. Results Significant motion was identified in the CMC joint during all tasks. Sex did not have an effect on CMC joint kinematics. Motion patterns differed with age group, but these differences were not systematic across the tasks. Rotation at the CMC joint was generally coupled and posture of the trapezium relative to the third metacarpal changed significantly with thumb position. Conclusions The healthy CMC joint is relatively stable during key pinch, jar grasp, and jar twist tasks, despite sex and age group. Clinical Relevance Our findings indicate that directionally coupled motion patterns in the CMC joint, which lead to a specific loading profile, are similar in men and women. These patterns, in addition to other, nonkinematic influences, especially in the female population, may contribute to the pathomechanics of the osteoarthritic joint.

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Section: Discussionsupporting

confidence: 88%

In Vivo Kinematics of the Thumb Carpometacarpal Joint During Three Isometric Functional Tasks

Halilaj

Rainbow

Got

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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“…This confirmed our initial hypothesis; clinically, patients with CMC OA often present with limitations such as turning keys in doorknobs or manipulating fine objects [23]. Prior research also has implied that the key pinch position is associated with translation of the trapezium and instability at the CMC joint [15], specific cartilage wear patterns [18,21], and increased mechanical load on the trapezium [19]. This theory supports the notion that the kinematics of the CMC joint during key pinch may be most affected by early weakness and instability.…”

Section: Discussionsupporting

confidence: 77%

Weaker Functional Pinch Strength Is Associated With Early Thumb Carpometacarpal Osteoarthritis

McQuillan

Kenney

Crisco

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background The thumb carpometacarpal (CMC) joint orchestrates pinch in its various positions, and thumb CMC osteoarthritis (OA) is a major source of orthopaedic morbidity. Self-reported pain, weakness, and physical examination may not correspond to radiographic findings when diagnosing early thumb CMC OA. Weakness is a prominent feature of the disease, but little evidence exists to quantify self-reported loss of strength with time, or to compare weakness with that of a nonarthritic population during early disease. Questions/purposes We asked: (1) Is pinch strength in subjects with early thumb CMC OA less than that in asymptomatic control subjects; and (2) weakness in which pinch position (key, tripod, or tip pinch) has the strongest association with early OA diagnosis? Methods For this case-control study, we recruited 23 subjects who were asymptomatic and 91 with early OA for comprehensive history, physical examination, strength measurements, pain surveys, and radiographic evaluation. We used multivariate logistic regression to quantify the association between declining pinch strength and early OA diagnosis after controlling for age, sex, and BMI. This analysis was performed for three different pinch positions (key, tripod, and tip pinch) to evaluate which measurement was most closely associated with diagnosis. Results Pinch strength was less in patients with early thumb CMC OA. Key pinch had the most robust association with OA diagnosis, in which a 20% decrease in key pinch strength from the control subjects' baseline was associated with a 10% increase in the OA diagnosis (95% CI, 3%-16%; p = 0.004). This had a stronger association with OA diagnosis than tip pinch, in which a 20% decrease in strength was associated with a 6% increase in early CMC OA (95% CI, 1.0%-11%; p = 0.031). Tripod pinch also was associated to a lesser extent; a 20% reduction in tripod pinch led to a 5% increase in OA (95% CI, 1.3%-9%; p = 0.048). Conclusions Decreasing pinch strength, especially key pinch, is associated with early CMC arthritis before the development of extensive radiographic disease.

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“…Although increased trapezial tilt is prevalent in radiographic arthritis [13], this may reflect trapezial-trapezoid articulation laxity [42]. In our recent evaluation of 82 trapeziae [64,65,103], we confirm that the trapezium's metacarpal surface is gently comma-shaped (left) or C-shaped (right) with the ulnar-radial axis as vertical reference ( Fig. 4A-B).…”

Section: Osteologysupporting

confidence: 58%

“…We performed a complementary micro-CT study [48] evaluating quadrant [26,108] trabecular characteristics in the trabecular midregion bone of 13 normal and 16 arthritic trapeziae from patients with mean ages of 69 and 61 years, respectively and male-to-female ratios of 4:9 and 10:6, respectively [64]. ANOVA with post hoc Bonferroni/Dunn correction revealed no difference in bone volume fraction between the OA and normal specimens (p = 0.31) although OA trapeziae demonstrated higher trabecular number (p = 0.025) and connectivity (p = 0.018) than non-OA trapeziae.…”

Section: Microscopicmentioning

confidence: 99%

The 2014 ABJS Nicolas Andry Award: The Puzzle of the Thumb: Mobility, Stability, and Demands in Opposition

Ladd

Crisco

Hagert

et al. 2014

Clin Orthop Relat Res

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Trapezium Trabecular Morphology in Carpometacarpal Arthritis

Cited by 32 publications

References 43 publications

In Vivo Kinematics of the Thumb Carpometacarpal Joint During Three Isometric Functional Tasks

In Vivo Kinematics of the Thumb Carpometacarpal Joint During Three Isometric Functional Tasks

Weaker Functional Pinch Strength Is Associated With Early Thumb Carpometacarpal Osteoarthritis

The 2014 ABJS Nicolas Andry Award: The Puzzle of the Thumb: Mobility, Stability, and Demands in Opposition

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