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Mazza DF, Boonsri PS, Arora A, Bayne CO, Szabo RM, Chaudhari AJ, Boutin RD. Relationships between diagnostic imaging of first carpometacarpal osteoarthritis and pain, functional status, and disease progression: A systematic review. Osteoarthritis Cartilage 2024; 32:476-492. [PMID: 38141842 DOI: 10.1016/j.joca.2023.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 10/20/2023] [Accepted: 11/29/2023] [Indexed: 12/25/2023]
Abstract
OBJECTIVE To systematically review the association of pain, function, and progression in first carpometacarpal (CMC) osteoarthritis (OA) with imaging biomarkers and radiography-based staging. DESIGN Database searches in PubMed, Embase, and the Cochrane Library, along with citation searching were conducted in accordance with published guidance. Data on the association of imaging with pain, functional status, and disease progression were extracted and synthesized, along with key information on study methodology such as sample sizes, use of control subjects, study design, number of image raters, and blinding. Methodological quality was assessed using National Heart, Lung, and Blood Institute tools. RESULTS After duplicate removal, a total of 1969 records were screened. Forty-six articles are included in this review, covering a total of 28,202 study participants, 7263 with first CMC OA. Osteophytes were found to be one of the strongest biomarkers for pain across imaging modalities. Radiographic findings alone showed conflicting relationships with pain. However, Kellgren-Lawrence staging showed consistent associations with pain in various studies. Radiographic, sonographic, and MRI findings and staging showed little association to tools evaluating functional status across imaging modalities. The same imaging methods showed limited ability to predict progression of first CMC OA. A major limitation was the heterogeneity in the study base, limiting synthesis of results. CONCLUSION Imaging findings and radiography-based staging systems generally showed strong associations with pain, but not with functional status or disease progression. More research and improved imaging techniques are needed to help physicians better manage patients with first CMC OA.
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Affiliation(s)
- Dario F Mazza
- Department of Radiology, University of California, Davis, CA, USA.
| | | | - Aman Arora
- Department of Radiology, University of California, Davis, CA, USA.
| | - Christopher O Bayne
- Department of Orthopaedic Surgery, University of California, Davis, CA, USA.
| | - Robert M Szabo
- Department of Orthopaedic Surgery, University of California, Davis, CA, USA.
| | | | - Robert D Boutin
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA.
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Kooi K, Nukala V, Smits NAF, Canta O, Ashkani-Esfahani S, Bhashyam AR. Predicting Contralateral Surgery for Trapeziometacarpal Arthrosis Within 5 Years. J Hand Surg Am 2024; 49:354-361. [PMID: 38349285 DOI: 10.1016/j.jhsa.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 12/23/2023] [Accepted: 01/11/2024] [Indexed: 04/05/2024]
Abstract
PURPOSE Symptomatic trapeziometacarpal (TMC) joint arthritis is a common cause of hand pain. It is unknown how many patients ultimately elect to have bilateral surgery for TMC arthritis. In this study, we assessed the frequency and predictive factors for contralateral TMC surgery in patients who underwent prior TMC surgery. METHODS We identified 712 patients who underwent primary surgery for TMC arthritis with a follow-up period of 5 years. We collected demographic, surgical, and follow-up data. Prediction models for contralateral surgery using a training and testing data set were created with multivariable logistic regression and random forest classifier algorithms. RESULTS At the time of initial surgery, 230 patients had bilateral thumb pain (32%), but only 153 patients ultimately had an operation for TMC arthritis on the contralateral side within 5 years (21% of 712 total patients and 67% of 230 patients with bilateral pain). Common predictive factors between both models for contralateral surgery were younger age (odds ratio [OR] = 0.95; 95% confidence interval [CI], 0.93-0.98), bilateral thumb pain (OR = 3.76; 95% CI, 2.52-5.65), and anxiety disorders (OR = 1.84; 95% CI, 1.11-3.03). CONCLUSIONS In our study, we found that the rate of contralateral surgery was 21% in patients who underwent prior TMC surgery. Predictive factors for future contralateral surgery included younger age, bilateral thumb pain, and anxiety disorder at the time of initial surgery. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic II.
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Affiliation(s)
- Kevin Kooi
- Department of Orthopaedic Surgery, Hand and Arm Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Plastic, Reconstructive, and Hand Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Musculoskeletal Health Program, Amsterdam Movement Sciences, Amsterdam, the Netherlands.
| | - Varun Nukala
- Department of Orthopaedic Surgery, the Foot and Ankle Research and Innovation Lab, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Nienke A F Smits
- Department of Orthopaedic Surgery, Hand and Arm Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Olga Canta
- Department of Orthopaedic Surgery, Hand and Arm Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Soheil Ashkani-Esfahani
- Department of Orthopaedic Surgery, the Foot and Ankle Research and Innovation Lab, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Abhiram R Bhashyam
- Department of Orthopaedic Surgery, Hand and Arm Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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Inaba N, Oki S, Nagura T, Sato K, Jinzaki M, Iwamoto T, Nakamura M. In-vivo kinematics of the trapeziometacarpal joint in dynamic pinch motion using four-dimensional computed tomography imaging. Skeletal Radiol 2024; 53:129-140. [PMID: 37306769 DOI: 10.1007/s00256-023-04387-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/03/2023] [Accepted: 06/04/2023] [Indexed: 06/13/2023]
Abstract
OBJECTIVE CT imaging precisely and quantitatively analyzes the kinematics of the carpal bones to evaluate the etiology of related osteoarthritis. Previous studies have investigated the kinematics of the trapeziometacarpal joint using static CT scans of various postures including the pinch position. This study analyzed the in-vivo kinematics of the trapeziometacarpal joint during dynamic pinch motion in young healthy volunteers using four-dimensional CT. MATERIALS AND METHODS Twelve healthy young volunteers participated in this study. Each participant held the pinch meter between their thumb and index finger and pinched it with maximum force for a period of 6 s. This series of movement was recorded using a four-dimensional CT. The surface data of the trapezium and first metacarpal of all frames were reconstructed, and bone movement at the trapeziometacarpal joint was calculated using sequential three-dimensional registration. The instantaneous pinch force of each frame was measured using a pointer on a pinch meter that was reconstructed from the CT data. RESULTS The first metacarpal was abducted (15.9 ± 8.3°) and flexed (12.2 ± 7.1°) relative to the trapezium, and significantly translated to the volar (0.8 ± 0.6 mm) and ulnar directions (0.9 ± 0.8 mm) with maximum pinch force. This movement consistently increased with the pinch force. CONCLUSION This study successfully employed 4D-CT to precisely demonstrate changes in rotation and translation at the trapeziometacarpal joint during pinch motion for various instantaneous forces.
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Affiliation(s)
- Naoto Inaba
- Department of Orthopedic Surgery, Keio University School of Medicine, Shinanomachi 35, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Satoshi Oki
- Department of Orthopedic Surgery, Keio University School of Medicine, Shinanomachi 35, Shinjuku-Ku, Tokyo, 160-8582, Japan.
| | - Takeo Nagura
- Department of Orthopedic Surgery, Keio University School of Medicine, Shinanomachi 35, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Kazuki Sato
- Institute for Integrated Sports Medicine, Keio University School of Medicine, Shinanomachi 35, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Masahiro Jinzaki
- Department of Diagnostic Radiology, Keio University School of Medicine, Shinanomachi 35, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Takuji Iwamoto
- Department of Orthopedic Surgery, Keio University School of Medicine, Shinanomachi 35, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Masaya Nakamura
- Department of Orthopedic Surgery, Keio University School of Medicine, Shinanomachi 35, Shinjuku-Ku, Tokyo, 160-8582, Japan
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Imbergamo CM, Durant NF, Giladi AM, Means KR. Patient Perspectives on Cognitive Behavioral Therapy for Thumb, Hand, or Wrist Pain and Function: A Survey of 98 Patients. J Hand Surg Am 2024; 49:28-34. [PMID: 37702644 DOI: 10.1016/j.jhsa.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 07/19/2023] [Accepted: 08/02/2023] [Indexed: 09/14/2023]
Abstract
PURPOSE Cognitive behavioral therapy (CBT) is an established option to improve pain and function for many orthopedic conditions. Our purpose was to obtain patient perspectives regarding CBT for thumb, hand, or wrist pain and function. METHODS Between March and April 2022, we distributed an electronic survey via email to patients in our institution's health system with a diagnosis of arthritic or non-specific thumb, hand, or wrist pain. The survey included the opening statement "Cognitive Behavioral Therapy (CBT) is a non-medication option to help manage pain and improve function" and up to 13 questions pertaining to patients' experiences and perceptions regarding CBT. The survey was anonymous and did not collect protected health information. We used descriptive statistics for the findings. RESULTS We distributed the survey to 327 patients, yielding a 30% response rate (98/327). Of the respondents, 17 reported already using CBT to specifically help with pain/function. Of these, 15 felt it was helpful and agreed it could help others. Of the subset that used CBT for arthritis, all felt it was helpful. Of the 75 respondents with no CBT experience, 42 indicated "I've never heard of it," 28 responded "I never had it recommended as an option," and 16 marked "I don't know enough about it." Small subsets noted potential personal barriers to CBT implementation, such as cost, time involved, or perceived lack of potential efficacy for themselves. CONCLUSIONS A small proportion of patients from our institution with thumb, hand, or wrist pain are utilizing CBT, and the majority finds it helpful. CLINICAL RELEVANCE While some patients are already substantially benefiting from CBT to improve their thumb, hand, or wrist pain or function, there is a notable opportunity for providers to increase awareness and recommendations for this option.
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Affiliation(s)
- Casey M Imbergamo
- Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD; MedStar Orthopaedic Institute, MedStar Union Memorial Hospital, Baltimore, MD
| | - Natasha F Durant
- Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD; MedStar National Rehabilitation Hospital, Washington, DC
| | - Aviram M Giladi
- Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD
| | - Kenneth R Means
- Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD.
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Colonna S, Borghi C. Rhizarthrosis Part I: A Literature Review. Cureus 2024; 16:e52932. [PMID: 38406032 PMCID: PMC10893956 DOI: 10.7759/cureus.52932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2024] [Indexed: 02/27/2024] Open
Abstract
Rhizarthrosis (RA), or trapeziometacarpal osteoarthritis, is an arthritic degenerative process that affects the first joint of the thumb. The objective of this work is to provide therapists with an overview of the fundamental issues related to the therapeutic management of trapeziometacarpal joint instability. Prevalent in females, especially post-menopause, and linked to age, RA involves ligament and muscle structures, with causes ranging from hormonal influences to mechanical factors. Understanding the biomechanics, stability, and factors contributing to RA is crucial for effective intervention. This study explores the role of ligaments, muscles, and anatomical variants in thumb joint degeneration, emphasizing the importance of stability and congruence. RA manifests as pain at the base of the thumb, limiting grip strength and hindering everyday tasks. Pain initially occurs during specific movements but can progress to constant discomfort, affecting sleep. Chronic RA leads to joint stiffness, deformities like the "Z thumb," and muscle atrophy, impacting daily functions. Clinical evaluation involves pain assessment, joint mobility examination, and palpation. Diagnostic tests like the grind test and lever test aid in confirming RA. Radiographic examination reveals joint space degeneration and osteophytes and helps classify RA stages using the Eaton-Littler classification. Conservative treatment aims to alleviate pain, reduce joint stress, and enhance function. Orthoses help stabilize the joint. Therapeutic exercises, emphasizing muscle strength and dynamic stability, prove beneficial. Manual therapies like neurodynamic, Kaltenborn, Mulligan, and Maitland techniques target pain reduction and improve joint mechanics. The studies on conservative approaches provide evidence that a multimodal intervention consisting of joint mobilization, neural mobilization, and exercise is beneficial in reducing pain in patients with RA. When conservative therapy fails, surgical intervention is indicated.
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Affiliation(s)
- Saverio Colonna
- Osteopathic Spine Center Education (OSCE), Spine Center, Bologna, ITA
| | - Corrado Borghi
- Osteopathic Spine Center Education (OSCE), Spine Center, Bologna, ITA
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Maniglio L, Maniglio M, Aregger F, Schweizer A. Is increased trapezial slope a cause of early trapeziometacarpal osteoarthritis? Hand Surg Rehabil 2023; 42:464-469. [PMID: 37776974 DOI: 10.1016/j.hansur.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 09/12/2023] [Accepted: 09/12/2023] [Indexed: 10/02/2023]
Abstract
OBJECTIVES Thumb carpometacarpal joint osteoarthritis is one of the most common forms of osteoarthritis in the hand. The underlying causes are multifactorial. We investigated whether increased trapezial slope could be a causal factor. MATERIAL AND METHODS We measured trapezial slope and 1st metacarpal slope in 37 patients with early thumb carpometacarpal joint osteoarthritis and compared results with 41 patients without osteoarthritis, using computer-supported 3D-analysis based on CT scans. RESULTS There was a significant intergroup difference in trapezial slope (111° in patients with osteoarthritis, and 107° in patients without) and in 1st metacarpal slope (17° versus 14°). CONCLUSION Steeper trapezial slope seemed to be a risk factor for thumb carpometacarpal joint osteoarthritis. Therefore, correction of trapezial slope by trapezium osteotomy could be a valuable surgical approach in early thumb carpometacarpal joint osteoarthritis.
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Affiliation(s)
- Lara Maniglio
- Department of Orthopedics, Hand Surgery Division, Balgrist University Hospital Zurich, Forchstrasse 340, 8008 Zürich, Switzerland; Department of General Surgery, Hospital Grabs, Spitalstrasse 44, 9472 Grabs, Switzerland
| | - Mauro Maniglio
- Department of Plastic and Hand Surgery, CHUV - Centre Hospitalier Universitaire Vaudois, Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Fabian Aregger
- Department of Orthopedics and Traumatology, Inselspital, Universitiy Hospital Bern, 3010 Bern, Switzerland
| | - Andreas Schweizer
- Department of Orthopedics, Hand Surgery Division, Balgrist University Hospital Zurich, Forchstrasse 340, 8008 Zürich, Switzerland.
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Fouasson-Chailloux A, Morel X, Jager T, Duysens C, Falcone A, Pomares G. Joint capsule innervation does not explain the difference in symptoms between scaphotrapezial and trapeziometacarpal osteoarthritis. Hand Surg Rehabil 2023; 42:470-474. [PMID: 37567415 DOI: 10.1016/j.hansur.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/03/2023] [Accepted: 08/05/2023] [Indexed: 08/13/2023]
Abstract
OBJECTIVES Peritrapezial osteoarthritis (OA) includes scaphotrapezial and trapeziometacarpal OA. In clinical practice, scaphotrapezial OA seems better tolerated than trapeziometacarpal OA, with fewer complaints and better tolerance. The difference in pain could be linked to a difference in joint capsule innervation, perhaps with fewer nerve fibers in the scaphotrapezial than the trapeziometacarpal joint. MATERIALS AND METHODS We performed a histologic evaluation of these two joints to compare their respective innervation in 17 cadaveric specimens with peritrapezial OA. Radiographic scoring confirmed the presence of peritrapezial OA. Mean Kellgren-Lawrence score was 2.2 ± 1.1 in the trapeziometacarpal joint and 1.5 ± 0.7 in the scaphotrapezial joint (p = 0.08). RESULTS There was no difference between scaphotrapezial and trapeziometacarpal joints in number of neurofilaments: 5.2 ± 3.9 and 4.4 ± 4.5, respectively (p = 0.20). A significant difference was found in S100 staining (myelinated structures), with a higher rate in the scaphotrapezial joint: 11.8 ± 7.5 vs 6.6 ± 5.2 (p = 0.005). CONCLUSION The present study suggests that lower tolerance of trapeziometacarpal OA is not due to a difference in joint capsule innervation. On the contrary, we found a higher rate of myelinated tissues in the scaphotrapezial joint. These results suggested other pain pathways to explain clinical observations.
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Affiliation(s)
- Alban Fouasson-Chailloux
- Institut Européen de la Main, Hôpital Kirchberg, 2540 Luxembourg, Luxembourg; Medical Training Center, Hôpital Kirchberg, 2540 Luxembourg, Luxembourg; Service de Médecine Physique et Réadaptation Locomotrice et Respiratoire, CHU Nantes, Nantes Université, 44093 Nantes, France; Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, ONIRIS, Nantes Université, Nantes, France.
| | - Xavier Morel
- Institut Européen de la Main, Hôpital Kirchberg, 2540 Luxembourg, Luxembourg
| | - Thomas Jager
- Institut Européen de la Main, Hôpital Kirchberg, 2540 Luxembourg, Luxembourg; Medical Training Center, Hôpital Kirchberg, 2540 Luxembourg, Luxembourg
| | - Christophe Duysens
- Institut Européen de la Main, Hôpital Kirchberg, 2540 Luxembourg, Luxembourg
| | - Andrea Falcone
- Institut Européen de la Main, Hôpital Kirchberg, 2540 Luxembourg, Luxembourg
| | - Germain Pomares
- Institut Européen de la Main, Hôpital Kirchberg, 2540 Luxembourg, Luxembourg; Medical Training Center, Hôpital Kirchberg, 2540 Luxembourg, Luxembourg
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Chen K, Shun Y, Xiang W. Differences between trapeziometacarpal arthrodesis and trapeziectomy with ligament reconstruction for the treatment of trapeziometacarpal osteoarthritis: a systematic review and meta-analysis. Acta Orthop Belg 2023; 89:551-561. [PMID: 37935242 DOI: 10.52628/89.3.11618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
The optimal management of trapeziometacarpal (TMC) osteoarthritis remains controversial. This meta-analysis assessed the subjective and objective outcomes of trapeziometacarpal arthrodesis (TMA) versus trapeziec-tomy with ligament reconstruction (LRTI). The PubMed, Cochrane Library, Embase, Web of science data-bases were searched from inception to June 30, 2022. Keywords included "trapeziometacarpal osteoarthrosis", "trapeziometacarpal arthrodesis" and "trapeziectomy with ligament reconstruction". Randomized controlled trials (RCTs) and controlled clinical trials (CCTs) including patients treated for TMC osteoarthritis were included. The subjective outcomes visual analogue scale (VAS) , Patient-Rated Wrist and Hand Evaluation (PRWHE), Disabilities of arm, shoulder and hand (DASH) scores, Kapanji scores, objective outcomes total interphalangeal (IP) and metacarpophalangeal (MCP) joint motion, palmar abduction, grip strength, tip, key pinch strength and complications were extracted. The methodological quality of each was assessed in- dependently. Meta-analysis was performed for comparative trials. From the 5 included studies (2 RCTs, 3 CCTs), 208 cases were divided into TMA group (n = 107) and LRTI group (n =101) groups. Compared with the TMA group, PRWHE, tip pinch strength and palmar abduction was better in the LRTI group. There was no statistical difference in DASH score, VAS, kapandji score, grip strength, key pinch strength, total IP joint motion, total MCP joint motion and complications. The LRTI group had more obvious advantages in term of PRWHE, tip pinch strength and palmar abduction. Moreover, there was no statistical difference in DASH score, VAS, kapandji score, grip strength, key pinch strength, total IP joint and total MCP joint motion and complications. Therefore, we concluded LRTI was more recommendable for more management of TMC osteoarthritis. Certainly, high-quality studies are required in long-term follow-up.
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Hamasaki T, Choinière M, Harris PG, Bureau NJ, Gaudreault N, Patenaude N. Biopsychosocial factors associated with pain severity and hand disability in trapeziometacarpal osteoarthritis and non-surgical management. J Hand Ther 2023; 36:647-657. [PMID: 36918308 DOI: 10.1016/j.jht.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 10/06/2022] [Accepted: 10/09/2022] [Indexed: 03/16/2023]
Abstract
BACKGROUND Trapeziometacarpal osteoarthritis (TMO) is one of the most prevalent and painful forms of hand osteoarthritis. PURPOSE This study aimed at (1) describing the TMO pain experience, (2) identifying biopsychosocial factors associated with pain intensity and disability, and 3) documenting the use of non-surgical management modalities. STUDY DESIGN Cross-sectional. METHODS Participants who presented for care for TMO were recruited from 15 healthcare institutions. They completed a questionnaire addressing sociodemographic, pain, disability, psychological well-being, quality of life (QoL), productivity, and treatment modalities employed. Multivariable regression analyses identified biopsychosocial factors associated with pain intensity and magnitude of disability. RESULTS Among our 228 participants aged 62.6 years, 78.1% were women. More than 80% of the participants reported average pain of moderate to severe intensity in the last 7 days. Nearly 30 % of them scored clinically significant levels of anxiodepressive symptoms. The participants' norm-based physical QoL score on the SF-12v2 was 41/100. Among the 79 employed respondents, 13 reported having missed complete or part of workdays in the previous month and 18 reported being at risk of losing their job due to TMO. Factors independently associated with more intense pain included higher pain frequency and greater disability, accounting for 59.0% of the variance. The mean DASH score was 46.1 of 100, and the factors associated with greater magnitude of disability were higher pain intensity, greater levels of depression, female sex, and lower level of education, explaining 60.1% of the variance. Acetaminophen, oral non-steroid anti-inflammatory drugs, cortisone injections, orthoses, hand massage/exercises, and heat/cold application were the most frequently employed modalities. Most participants never used assistive devices, ergonomic techniques, and psychosocial services. CONCLUSIONS Patients with TMO can experience severe pain, disability, disturbed emotional well-being, limited QoL and reduced productivity. As disability is associated with TMO pain, and depressive symptoms with disability, reducing such modifiable factors should be one of the clinicians' priorities.
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Affiliation(s)
- Tokiko Hamasaki
- Centre hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada; Research Center of the CHUM, Montreal, Quebec, Canada; Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada.
| | - Manon Choinière
- Research Center of the CHUM, Montreal, Quebec, Canada; Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Patrick G Harris
- Centre hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada; Research Center of the CHUM, Montreal, Quebec, Canada; Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Nathalie J Bureau
- Centre hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada; Research Center of the CHUM, Montreal, Quebec, Canada; Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Nathaly Gaudreault
- Faculty of Medecine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada; Research Center of the CHUS, Sherbrooke, Quebec, Canada
| | - Nicolas Patenaude
- Faculty of Medecine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada; Centre hospitalier universitaire de Sherbrooke (CHUS), Sherbrooke, Quebec, Canada
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Morton AM, Moore DC, Ladd AL, Weiss APC, Molino J, Crisco JJ. Dorsal Subluxation of the First Metacarpal During Thumb Flexion is an Indicator of Carpometacarpal Osteoarthritis Progression. Clin Orthop Relat Res 2023; 481:1224-1237. [PMID: 36877171 PMCID: PMC10194679 DOI: 10.1097/corr.0000000000002575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 01/06/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND Measurable changes in patients with progression of thumb carpometacarpal (CMC) osteoarthritis (OA) include joint space narrowing, osteophyte formation, subluxation, and adjacent-tissue changes. Subluxation, an indication of mechanical instability, is postulated as an early biomechanical indicator of progressing CMC OA. Various radiographic views and hand postures have been proposed to best assess CMC subluxation, but 3D measurements derived from CT images serve as the optimal metric. However, we do not know which thumb pose yields subluxation that most indicates OA progression. QUESTIONS/PURPOSES Using osteophyte volume as a quantitative measure of OA progression, we asked: (1) Does dorsal subluxation vary by thumb pose, time, and disease severity in patients with thumb CMC OA? (2) In which thumb pose(s) does dorsal subluxation most differentiate patients with stable CMC OA from those with progressing CMC OA? (3) In those poses, what values of dorsal subluxation indicate a high likelihood of CMC OA progression? METHODS Between 2011 and 2014, 743 patients were seen at our institutions for trapeziometacarpal pain. We considered individuals who were between the ages of 45 and 75 years, had tenderness to palpation or a positive grind test result, and had modified Eaton Stage 0 or 1 radiographic thumb CMC OA as potentially eligible for enrollment. Based on these criteria, 109 patients were eligible. Of the eligible patients, 19 were excluded because of a lack of interest in study participation, and another four were lost before the minimum study follow-up or had incomplete datasets, leaving 86 (43 female patients with a mean age of 53 ± 6 years and 43 male patients with a mean age of 60 ± 7 years) patients for analysis. Twenty-five asymptomatic participants (controls) aged 45 to 75 years were also prospectively recruited to participate in this study. Inclusion criteria for controls included an absence of thumb pain and no evidence of CMC OA during clinical examination. Of the 25 recruited controls, three were lost to follow-up, leaving 22 for analysis (13 female patients with a mean age of 55 ± 7 years and nine male patients with a mean age of 58 ± 9 years). Over the 6-year study period, CT images were acquired of patients and controls in 11 thumb poses: neutral, adduction, abduction, flexion, extension, grasp, jar, pinch, grasp loaded, jar loaded, and pinch loaded. CT images were acquired at enrollment (Year 0) and Years 1.5, 3, 4.5, and 6 for patients and at Years 0 and 6 for controls. From the CT images, bone models of the first metacarpal (MC1) and trapezium were segmented, and coordinate systems were calculated from their CMC articular surfaces. The volar-dorsal location of the MC1 relative to the trapezium was computed and normalized for bone size. Patients were categorized into stable OA and progressing OA subgroups based on trapezial osteophyte volume. MC1 volar-dorsal location was analyzed by thumb pose, time, and disease severity using linear mixed-effects models. Data are reported as the mean and 95% confidence interval. Differences in volar-dorsal location at enrollment and rate of migration during the study were analyzed for each thumb pose by group (control, stable OA, and progressing OA). A receiver operating characteristic curve analysis of MC1 location was used to identify thumb poses that differentiated patients whose OA was stable from those whose OA was progressing. The Youden J statistic was used to determine optimized cutoff values of subluxation from those poses to be tested as indicators of OA progression. Sensitivity, specificity, negative predictive values, and positive predictive values were calculated to assess the performance of pose-specific cutoff values of MC1 locations as indicators of progressing OA. RESULTS In flexion, the MC1 locations were volar to the joint center in patients with stable OA (mean -6.2% [95% CI -8.8% to -3.6%]) and controls (mean -6.1% [95% CI -8.9% to -3.2%]), while patients with progressing OA exhibited dorsal subluxation (mean 5.0% [95% CI 1.3% to 8.6%]; p < 0.001). The pose associated with the most rapid MC1 dorsal subluxation in the progressing OA group was thumb flexion (mean 3.2% [95% CI 2.5% to 3.9%] increase per year). In contrast, the MC1 migrated dorsally much slower in the stable OA group (p < 0.001), at only a mean of 0.1% (95% CI -0.4% to 0.6%) per year. A cutoff value of 1.5% for the volar MC1 position during flexion at enrollment (C-statistic: 0.70) was a moderate indicator of OA progression, with a high positive predictive value (0.80) but low negative predictive value (0.54). Positive and negative predictive values of subluxation rate in flexion (2.1% per year) were high (0.81 and 0.81, respectively). The metric that most indicated a high likelihood of OA progression (sensitivity 0.96, negative predictive value 0.89) was a dual cutoff that combined the subluxation rate in flexion (2.1% per year) with that of loaded pinch (1.2% per year). CONCLUSION In the thumb flexion pose, only the progressing OA group exhibited MC1 dorsal subluxation. The MC1 location cutoff value for progression in flexion was 1.5% volar to the trapezium , which suggests that dorsal subluxation of any amount in this pose indicates a high likelihood of thumb CMC OA progression. However, volar MC1 location in flexion alone was not sufficient to rule out progression. The availability of longitudinal data improved our ability to identify patients whose disease will likely remain stable. In patients whose MC1 location during flexion changed < 2.1% per year and whose MC1 location during pinch loading changed < 1.2% per year, the confidence that their disease would remain stable throughout the 6-year study period was very high. These cutoff rates were a lower limit, and any patients whose dorsal subluxation advanced faster than 2% to 1% per year in their respective hand poses, were highly likely to experience progressive disease. CLINICAL RELEVANCE Our findings suggest that in patients with early signs of CMC OA, nonoperative interventions aimed to reduce further dorsal subluxation or operative treatments that spare the trapezium and limit subluxation may be effective. It remains to be determined whether our subluxation metrics can be rigorously computed from more widely available technologies, such as plain radiography or ultrasound.
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Affiliation(s)
- Amy M. Morton
- Bioengineering Laboratory, Department of Orthopaedics, The Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI, USA
| | - Douglas C. Moore
- Bioengineering Laboratory, Department of Orthopaedics, The Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI, USA
| | - Amy L. Ladd
- Robert A. Chase Hand & Upper Limb Center, Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Arnold-Peter C. Weiss
- Department of Orthopaedics, The Warren Alpert Medical School of Brown University/University Orthopedics, Providence, RI, USA
| | - Janine Molino
- Department of Orthopaedics, The Warren Alpert Medical School of Brown University/University Orthopedics, Providence, RI, USA
| | - Joseph J. Crisco
- Bioengineering Laboratory, Department of Orthopaedics, The Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI, USA
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11
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Eyiis E, Mathijssen NMC, Kok P, Sluijter J, Kraan GA. Three-dimensional printed customized versus conventional plaster brace for trapeziometacarpal osteoarthritis: a randomized controlled crossover trial. J Hand Surg Eur Vol 2023; 48:412-418. [PMID: 36650951 DOI: 10.1177/17531934221146864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
We investigated the non-operative management of trapeziometacarpal osteoarthritis with a three-dimensional (3-D) printed patient-customized brace compared with a conventional plaster brace. Fifty-two patients with symptomatic trapeziometacarpal osteoarthritis were enrolled in a 9-week crossover study, which was designed as a randomized controlled trial of two periods of 4-week brace therapies. The primary outcome was patient satisfaction measured with the Dutch version of the Quebec User Evaluation of Satisfaction with Assistive Technology questionnaire survey. Secondary outcomes included pain, patient-reported function, functional hand strength measured by pinch and grip strength, and compliance assessed through a daily log of self-reported brace usage. The 3-D printed patient-customized brace had higher patient satisfaction and compliance than the conventional plaster brace. Patients preferred the 3-D printed customized brace (93%) rather than the conventional plaster brace (7%). This suggests that the 3-D printed patient-customized brace is effective in the non-operative management of trapeziometacarpal osteoarthritis.Level of evidence: I.
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Affiliation(s)
- Esra Eyiis
- Department of Orthopaedics, Reinier de Graaf Hospital, Delft, The Netherlands
| | - Nina M C Mathijssen
- Department of Orthopaedics, Reinier de Graaf Hospital, Delft, The Netherlands.,Reinier Haga Orthopedic Center, Zoetermeer, The Netherlands
| | - Petra Kok
- Department of Rheumatology, Reinier de Graaf Hospital, Delft, The Netherlands
| | - Judith Sluijter
- Department of Orthopaedics, Reinier de Graaf Hospital, Delft, The Netherlands
| | - Gerald A Kraan
- Department of Orthopaedics, Reinier de Graaf Hospital, Delft, The Netherlands.,Reinier Haga Orthopedic Center, Zoetermeer, The Netherlands
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12
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Abstract
BACKGROUND Many surgical procedures have been described for the treatment of thumb carpometacarpal (CMC) joint osteoarthritis, with significant variation. To date, none has proven to be superior. The purpose of this study was to report long-term follow-up results of suture suspension arthroplasty (SSA). METHODS The SSA technique uses a single incision, trapeziectomy, and an intra-articular suture suspension sling anchored into the insertions of the flexor carpi radialis (FCR) and abductor pollicis longus (APL), which serves to stabilize the base of the thumb metacarpal, correct subluxation deformity, and maintain arthroplasty space. Ninety of 153 SSA reconstructions (59% recall) were evaluated at long-term follow-up (mean, 12.6 years). Data were analyzed for functional outcomes, including preoperative and postoperative grip and pinch strength, radiographs, complications, and postoperative Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) scores. RESULTS The mean age at date of surgery was 61.7 ± 7.6 years (82% women). Significant improvement was noted in grip strength (preoperative mean, 25.0 kg; postoperative mean, 28.0 kg; P < .0001), key pinch (preoperative, 4.2 kg; postoperative, 5.1 kg; P < .0001), and tip pinch (preoperative, 2.9 kg; postoperative, 3.6 kg; P < .0001). Radiographic subsidence averaged 35% (0-90). Postoperative QuickDASH scores (mean, 6.6; range, 0-50) revealed good to excellent pain relief and function. One revision was performed, and postoperative FCR rupture occurred in 3 reconstructions. CONCLUSIONS The SSA technique for thumb CMC arthritis reconstruction yields good to excellent long-term clinical outcomes. Potential advantages of the SSA include short operative time, a single incision, minimal cost, and no need for tendon harvesting, pin fixation, or implantable hardware.
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13
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Binvignat M, Pires G, Tchitchek N, Costantino F, Courties A, Klatzmann D, Butte AJ, Combe B, Dougados M, Richette P, Mariotti-Ferrandiz E, Berenbaum F, Sellam J. Identification of Symptom Phenotypes of Hand Osteoarthritis Using Hierarchical Clustering: Results From the DIGICOD Cohort. Arthritis Care Res (Hoboken) 2022. [PMID: 36263851 DOI: 10.1002/acr.25047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 09/20/2022] [Accepted: 10/18/2022] [Indexed: 01/27/2023]
Abstract
OBJECTIVE We aimed to delineate phenotypes in hand osteoarthritis (HOA) based on cardinal symptoms (pain, functional limitation, stiffness, and aesthetic discomfort). METHODS With data from the Digital Cohort Design (DIGICOD), we performed a hierarchical agglomerative clustering analysis based on Australian/Canadian Osteoarthritis Hand Index (AUSCAN) subscores for pain, physical function, stiffness, and visual analog scale for aesthetic discomfort. Kruskal-Wallis and post hoc analyses were used to assess differences between clusters. RESULTS Among 389 patients, we identified 5 clusters: cluster 1 (n = 88) and cluster 2 (n = 91) featured low and mild symptoms; cluster 3 (n = 80) featured isolated aesthetic discomfort; cluster 4 (n = 42) featured a high level of pain, stiffness, and functional limitation; and cluster 5 (n = 88) had the same features as cluster 4 but with high aesthetic discomfort. For clusters 4 and 5, AUSCAN pain score was >41 of 100, representing only one-third of our patients. Aesthetic discomfort (clusters 3 and 5) was significantly associated with erosive HOA and a higher number of nodes. The highly symptomatic cluster 5 was associated but not significantly with metabolic syndrome, and body mass index and C-reactive protein level did not differ among clusters. Symptom intensity was significantly associated with joint destruction as well as with physical and psychological burden. Patients' main expectations differed among clusters, and function improvement was the most frequent expectation overall. CONCLUSION The identification of distinct clinical clusters based on HOA cardinal symptoms suggests previously undescribed subtypes of this condition, warranting further study of biological characteristics of such clusters, and opening a path toward phenotype-based personalized medicine in HOA.
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Affiliation(s)
- Marie Binvignat
- Department of Rheumatology, Saint-Antoine Hospital, Centre de Recherche Saint-Antoine, Paris Inserm UMRS 938, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Paris, France, Immunology, Immunopathology, Immunotherapy I3 Lab, Inserm URMS 959, Pitié-Salpêtrière Hospital, Paris, France, and Bakar Computational Health Science Institute, University of California, San Francisco
| | - Gabriel Pires
- Immunology, Immunopathology, Immunotherapy I3 Lab, Inserm URMS 959, Pitié-Salpêtrière Hospital, Paris, France
| | - Nicolas Tchitchek
- Immunology, Immunopathology, Immunotherapy I3 Lab, Inserm URMS 959, Pitié-Salpêtrière Hospital, Paris, France
| | - Félicie Costantino
- Department of Rheumatology, Ambroise Paré Hospital, UMR 1173 INSERM, Université de Versailles Saint-Quentin, Assistance Publique-Hôpitaux de Paris, Boulogne, France
| | - Alice Courties
- Department of Rheumatology, Saint-Antoine Hospital, Centre de Recherche Saint-Antoine, Paris Inserm UMRS 938, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - David Klatzmann
- Immunology, Immunopathology, Immunotherapy I3 Lab, Inserm URMS 959, Pitié-Salpêtrière Hospital and Biotherapy (CIC-BTi) and Inflammation Immunopathology-Biotherapy Department (i2B), Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Atul J Butte
- Bakar Computational Health Science Institute, University of California, San Francisco
| | - Bernard Combe
- Department of Rheumatology, Université de Montpellier, Montpellier, France
| | - Maxime Dougados
- Department of Rheumatology, Cochin Hospital, Inserm UMR 1153, Université de Paris, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Pascal Richette
- Department of Rheumatology, Lariboisière Hospital, INSERM U1132, Université de Paris, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | - Francis Berenbaum
- Department of Rheumatology, Saint-Antoine Hospital, Centre de Recherche Saint-Antoine, Paris Inserm UMRS 938, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jérémie Sellam
- Department of Rheumatology, Saint-Antoine Hospital, Centre de Recherche Saint-Antoine, Paris Inserm UMRS 938, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Paris, France
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14
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Loos NL, Hoogendam L, Souer JS, Slijper HP, Andrinopoulou ER, Coppieters MW, Selles RW. Machine Learning Can be Used to Predict Function but Not Pain After Surgery for Thumb Carpometacarpal Osteoarthritis. Clin Orthop Relat Res 2022; 480:1271-1284. [PMID: 35042837 PMCID: PMC9191288 DOI: 10.1097/corr.0000000000002105] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 12/13/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Surgery for thumb carpometacarpal osteoarthritis is offered to patients who do not benefit from nonoperative treatment. Although surgery is generally successful in reducing symptoms, not all patients benefit. Predicting clinical improvement after surgery could provide decision support and enhance preoperative patient selection. QUESTIONS/PURPOSES This study aimed to develop and validate prediction models for clinically important improvement in (1) pain and (2) hand function 12 months after surgery for thumb carpometacarpal osteoarthritis. METHODS Between November 2011 and June 2020, 2653 patients were surgically treated for thumb carpometacarpal osteoarthritis. Patient-reported outcome measures were used to preoperatively assess pain, hand function, and satisfaction with hand function, as well as the general mental health of patients and mindset toward their condition. Patient characteristics, medical history, patient-reported symptom severity, and patient-reported mindset were considered as possible predictors. Patients who had incomplete Michigan Hand outcomes Questionnaires at baseline or 12 months postsurgery were excluded, as these scores were used to determine clinical improvement. The Michigan Hand outcomes Questionnaire provides subscores for pain and hand function. Scores range from 0 to 100, with higher scores indicating less pain and better hand function. An improvement of at least the minimum clinically important difference (MCID) of 14.4 for the pain score and 11.7 for the function score were considered "clinically relevant." These values were derived from previous reports that provided triangulated estimates of two anchor-based and one distribution-based MCID. Data collection resulted in a dataset of 1489 patients for the pain model and 1469 patients for the hand function model. The data were split into training (60%), validation (20%), and test (20%) dataset. The training dataset was used to select the predictive variables and to train our models. The performance of all models was evaluated in the validation dataset, after which one model was selected for further evaluation. Performance of this final model was evaluated on the test dataset. We trained the models using logistic regression, random forest, and gradient boosting machines and compared their performance. We chose these algorithms because of their relative simplicity, which makes them easier to implement and interpret. Model performance was assessed using discriminative ability and qualitative visual inspection of calibration curves. Discrimination was measured using area under the curve (AUC) and is a measure of how well the model can differentiate between the outcomes (improvement or no improvement), with an AUC of 0.5 being equal to chance. Calibration is a measure of the agreement between the predicted probabilities and the observed frequencies and was assessed by visual inspection of calibration curves. We selected the model with the most promising performance for clinical implementation (that is, good model performance and a low number of predictors) for further evaluation in the test dataset. RESULTS For pain, the random forest model showed the most promising results based on discrimination, calibration, and number of predictors in the validation dataset. In the test dataset, this pain model had a poor AUC (0.59) and poor calibration. For function, the gradient boosting machine showed the most promising results in the validation dataset. This model had a good AUC (0.74) and good calibration in the test dataset. The baseline Michigan Hand outcomes Questionnaire hand function score was the only predictor in the model. For the hand function model, we made a web application that can be accessed via https://analyse.equipezorgbedrijven.nl/shiny/cmc1-prediction-model-Eng/. CONCLUSION We developed a promising model that may allow clinicians to predict the chance of functional improvement in an individual patient undergoing surgery for thumb carpometacarpal osteoarthritis, which would thereby help in the decision-making process. However, caution is warranted because our model has not been externally validated. Unfortunately, the performance of the prediction model for pain is insufficient for application in clinical practice. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Nina L. Loos
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, Rotterdam, the Netherlands
- Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, the Netherlands
| | - Lisa Hoogendam
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, Rotterdam, the Netherlands
- Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, the Netherlands
- Hand and Wrist Center, Xpert Clinics, the Netherlands
| | | | - Harm P. Slijper
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, Rotterdam, the Netherlands
- Hand and Wrist Center, Xpert Clinics, the Netherlands
| | - Eleni-Rosalina Andrinopoulou
- Department of Biostatistics, Erasmus MC, Rotterdam, the Netherlands
- Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands
| | - Michel W. Coppieters
- Menzies Health Institute Queensland, Griffith University, Brisbane and Gold Coast, Australia
- Amsterdam Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Ruud W. Selles
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, Rotterdam, the Netherlands
- Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, the Netherlands
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15
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Kerkhof F, Kenney D, Ogle M, Shelby T, Ladd A. The biomechanics of osteoarthritis in the hand: Implications and prospects for hand therapy. J Hand Ther 2022; 35:367-376. [PMID: 36509610 DOI: 10.1016/j.jht.2022.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The unique anatomy of the human hand makes it possible to carefully manipulate tools, powerfully grasp objects, and even throw items with precision. These apparent contradictory functions of the hand, high mobility for manual dexterity vs high stability during forceful grasping, imply that daily activities impose a high strain on a relatively instable joint. This makes the hand susceptible to joint disorders such as osteoarthritis. Both systemic (eg, genetics, hormones) and mechanical factors (eg, joint loading) are important in the development of osteoarthritis, but the precise pathomechanism remains largely unknown. This paper focuses on the biomechanical factors in the disease process and how hand therapists can use this knowledge to improve treatment and research. CONCLUSION Multiple factors are involved in the onset and development of osteoarthritis in the hand. Comprehension of the biomechanics helps clinicians establish best practices for orthotics intervention, exercise, and joint protection programs even in de absence of clear evidence-based guidelines. The effect and reach of hand therapy for OA patients can be expanded substantially when intervention parameters are optimized and barriers to early referrals, access reimbursement, and adherence are addressed. Close and early collaboration between hand therapists and primary care, women's health, rheumatology, and hand surgery providers upon diagnosis, and with hand surgeons pre and postoperatively, combined with advances in the supporting science and strategies to enhance adherence, appear to be a promising way forward.
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Affiliation(s)
- Faes Kerkhof
- Chase Hand and Upper Limb Center, Stanford University, Palo Alto, CA, USA.
| | - Deborah Kenney
- Chase Hand and Upper Limb Center, Stanford University, Palo Alto, CA, USA
| | - Miranda Ogle
- Chase Hand and Upper Limb Center, Stanford University, Palo Alto, CA, USA
| | - Tara Shelby
- Chase Hand and Upper Limb Center, Stanford University, Palo Alto, CA, USA
| | - Amy Ladd
- Chase Hand and Upper Limb Center, Stanford University, Palo Alto, CA, USA
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16
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Killip SC, MacDermid JC, Wouters RM, Sinden KE, Gewurtz RE, Selles RW, Packham TL. Rasch analysis of the brief Michigan Hand Questionnaire in patients with thumb osteoarthritis. BMC Musculoskelet Disord 2022; 23:551. [PMID: 35676667 PMCID: PMC9175463 DOI: 10.1186/s12891-022-05478-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 05/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The brief Michigan Hand Questionnaire (brief MHQ) is a 12-item self-reported measure of hand function for patients with hand disorders which has been validated using Classical Test Theory. Rasch analysis can provide more detailed psychometric information. The purpose of this Rasch analysis is to assess the psychometric properties of the brief MHQ for patients with thumb osteoarthritis, and to make recommendations for improvements to the questionnaire if needed. METHODS: The Michigan Hand Questionnaire and demographic data were collected from 923 thumb osteoarthritis patients treated in specialized clinics for hand surgery and therapy in the Netherlands. Rasch analysis was performed on the 12 items of the brief MHQ using RUMM 2030 to assess the fit of the brief MHQ to the Rasch model. To determine fit, analysis of fit summary statistics, individual person fit and individual item fit were assessed. Threshold distributions were assessed to identify if any items required rescoring. The Person Separation Index was calculated to measure reliability of the questionnaire. Differential item functioning was assessed to identify item bias, and Principal Component Analysis was performed to identify unidimensionality and local dependence. RESULTS The brief MHQ showed misfit (χ2 = 1312.5, p < 0.0001) with 6 items having disordered thresholds and 9 items requiring rescoring. After deleting 3 of the rescored items due to significant item fit residuals, the brief MHQ had an acceptable reliability (Cronbach's alpha = 0.79). Misfit to the model (χ2 = 49.6, p = 0.0001), multidimensionality (10.2% of t-tests were significant), and item bias from non-uniform differential item functioning for 7 items across many person variables were still found. CONCLUSION Although no satisfactory solutions were found to correct the misfit to the Rasch model, it is recommended that the response options of the brief MHQ be rescored, and that items 6, 9 and 10 be removed. The lack of unidimensionality indicates that the items do not represent the singular construct of hand disability and that totalling the scores of the brief MHQ does not provide a valid measure of hand disability for people with thumb osteoarthritis. The 37-item Michigan Hand Questionnaire may provide a better assessment of hand disability for patients with thumb osteoarthritis.
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Affiliation(s)
- Shannon C Killip
- School of Rehabilitation Science, McMaster University, 1400 Main Street West IAHS 403, Hamilton, ON, L8S 4L8, Canada.
| | - Joy C MacDermid
- School of Rehabilitation Science, McMaster University, 1400 Main Street West IAHS 403, Hamilton, ON, L8S 4L8, Canada.,Physical Therapy and Surgery, Western University, London, ON, Canada.,Clinical Research Lab, Hand and Upper Limb Centre, St. Joseph's Health Centre, London, ON, Canada
| | - Robbert M Wouters
- Departments of Rehabilitation Medicine and Plastic, Reconstructive and Hand Surgery, Erasmus MC Rotterdam, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.,Center for Hand Therapy, Handtherapie Nederland, Eindhoven, The Netherlands
| | - Kathryn E Sinden
- School of Kinesiology, Lakehead University, 955 Oliver Rd, Thunder Bay, Thunder Bay, ON, P7B 5E1, Canada
| | - Rebecca E Gewurtz
- School of Rehabilitation Science, McMaster University, 1400 Main Street West IAHS 403, Hamilton, ON, L8S 4L8, Canada
| | - Ruud W Selles
- Departments of Rehabilitation Medicine and Plastic, Reconstructive and Hand Surgery, Erasmus MC Rotterdam, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Tara L Packham
- School of Rehabilitation Science, McMaster University, 1400 Main Street West IAHS 403, Hamilton, ON, L8S 4L8, Canada
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Ratneswaran A, Rockel JS, Antflek D, Matelski JJ, Shestopaloff K, Kapoor M, Baltzer H. Investigating Molecular Signatures Underlying Trapeziometacarpal Osteoarthritis Through the Evaluation of Systemic Cytokine Expression. Front Immunol 2022; 12:794792. [PMID: 35126358 PMCID: PMC8814933 DOI: 10.3389/fimmu.2021.794792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 12/31/2021] [Indexed: 11/13/2022] Open
Abstract
PurposeNon-operative management of trapeziometacarpal osteoarthritis (TMOA) demonstrates only short-term symptomatic alleviation, and no approved disease modifying drugs exist to treat this condition. A key issue in these patients is that radiographic disease severity can be discordant with patient reported pain, illustrating the need to identify molecular mediators of disease. This study characterizes the biochemical profile of TMOA patients to elucidate molecular mechanisms driving TMOA progression.MethodsPlasma from patients with symptomatic TMOA undergoing surgical (n=39) or non-surgical management (n=44) with 1-year post-surgical follow-up were compared using a targeted panel of 27 cytokines. Radiographic (Eaton-Littler), anthropometric, longitudinal pain (VAS, TASD, quick DASH) and functional (key pinch, grip strength) data were used to evaluate relationships between structure, pain, and systemic cytokine expression. Principal Component Analysis was used to identify clusters of patients.ResultsPatients undergoing surgery had greater BMI as well as higher baseline quick DASH, TASD scores. Systemically, these patients could only be distinguished by differing levels of Interleukin-7 (IL-7), with an adjusted odds ratio of 0.22 for surgery for those with increased levels of this cytokine. Interestingly, PCA analysis of all patients (regardless of surgical status) identified a subset of patients with an “inflammatory” phenotype, as defined by a unique molecular signature consisting of thirteen cytokines.ConclusionOverall, this study demonstrated that circulating cytokines are capable of distinguishing TMOA disease severity, and identified IL-7 as a target capable of differentiating disease severity with higher levels associated with a decreased likelihood of TMOA needing surgical intervention. It also identified a cluster of patients who segregate based on a molecular signature of select cytokines.
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Affiliation(s)
- Anusha Ratneswaran
- Hand Program, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada
- Division of Orthopedics, Osteoarthritis Research Program, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
| | - Jason S. Rockel
- Division of Orthopedics, Osteoarthritis Research Program, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
| | - Daniel Antflek
- Hand Program, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
| | - John J. Matelski
- Biostatistics Research Unit, University Health Network, Toronto, ON, Canada
| | - Konstantin Shestopaloff
- Division of Orthopedics, Osteoarthritis Research Program, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
| | - Mohit Kapoor
- Division of Orthopedics, Osteoarthritis Research Program, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
- Department of Surgery and Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Heather Baltzer
- Hand Program, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
- Division of Plastic and Reconstructive Surgery, University of Toronto, Toronto, ON, Canada
- *Correspondence: Heather Baltzer,
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SAHEB RICARDOLUCCACABARITE, VAZ BRENOALVESDESOUSA, SOEIRA THABATAPASQUINI, SHIMAOKA FILIPEJUN, HERRERO CARLOSFERNANDOPEREIRADASILVA, MAZZER NILTON. SURGICAL TREATMENT FOR RHIZARTHROSIS: A SYSTEMATIC REVIEW OF THE LAST 10 YEARS. Acta Ortop Bras 2022; 30:e246704. [PMID: 35431632 PMCID: PMC8979356 DOI: 10.1590/1413-785220223001e246704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 03/16/2021] [Indexed: 11/21/2022]
Abstract
Introduction Comparison of different surgical techniques to treat patients with rhizarthrosis or carpometacarpal osteoarthritis of the thumb. Materials and Methods A systematic review was conducted using three electronic databases. Randomized, controlled trials in patients who underwent surgery for the treatment of rhizarthrosis were included. The literature review followed the PRISMA protocol. Results A total of 15 articles involving a total population of 958 patients were selected. Seven different surgical techniques were compared. Conclusions We conclude that no procedure is superior to another in terms of pain, physical function, overall patient assessment, range of motion, or strength. Outcome measurements should be standardized to enable better comparison between surgical techniques. Level of evidence II, Systematic Review.
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Qin MM, Qin CD, Johnson DJ, Kalainov DM. Risk of Infection in Thumb Carpometacarpal Surgery After Corticosteroid Injection. J Hand Surg Am 2021; 46:765-771.e2. [PMID: 34078549 DOI: 10.1016/j.jhsa.2021.04.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 02/02/2021] [Accepted: 04/07/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to determine whether patients who had an intra-articular corticosteroid injection into the thumb carpometacarpal (CMC) joint for the treatment of arthritis within the 3 months before CMC joint arthroplasty or arthrodesis were at increased risk for wound complication/infection and/or repeat surgery for wound complication/infection in comparison with patients who did not receive an injection within 6 months or who received an injection between 3 and 6 months before surgery. METHODS We identified 5,046 patients in the Humana claims database who underwent surgery for CMC joint arthritis. The patients were stratified into 3 groups: (1) no thumb injection within 6 months of CMC joint surgery, (2) thumb injection between 3 and 6 months before CMC joint surgery, and (3) thumb injection within 3 months before CMC joint surgery. The primary outcome was wound complication/infection within 90 days after surgery. The secondary outcome was repeat surgery for wound complication/infection within 90 days after surgery. Multivariable logistic regression was performed to assess the associations between the timing of injection and wound complication/infection and repeat surgery for wound complication/infection. RESULTS The rates of wound complication/infection within 90 days after surgery were similar among the 3 study groups. However, patients who received an intra-articular corticosteroid injection within 3 months before surgery had a 2.2 times greater likelihood of repeat surgery for a wound complication/infection compared with patients who did not have an injection within 6 months before surgery. CONCLUSIONS Patients who receive an intra-articular corticosteroid injection within the 3 months before surgery for CMC joint arthritis may be at increased risk of repeat surgery to treat a wound complication/infection in the 90-day postoperative period. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic II.
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Affiliation(s)
- Mia M Qin
- Department of Orthopedic Surgery, Northwestern University.
| | - Charles D Qin
- Department of Orthopedic Surgery, University of Chicago, Chicago, IL
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Gutiérrez Espinoza H, Araya-Quintanilla F, Olguín-Huerta C, Valenzuela-Fuenzalida J, Jorquera-Aguilera R, Gutiérrez-Monclus R, Castillo-Alcayaga J, Retamal-Pérez P. Effectiveness of manual therapy in patients with thumb carpometacarpal osteoarthritis: a systematic review and meta-analysis. Physiother Theory Pract 2021; 38:2368-2377. [PMID: 34074220 DOI: 10.1080/09593985.2021.1926026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: The effectiveness of Manual Therapy (MT) in thumb carpometacarpal osteoarthritis (OA) is unclear.Objective: This study aimed to determine the effectiveness of MT for functional outcomes in patients with thumb carpometacarpal OA. Design: Systematic review and meta-analysis of randomized clinical trials. Methods: An electronic search was performed in the Medline, Central, Embase, PEDro, Lilacs, Cinahl, SPORTDiscus, and Web of Science databases. The eligibility criteria for selecting studies included randomized clinical trials that compared MT versus other interventions in functional outcomes, such as thumb and/or hand function questionnaires, pinch and/or grip strength, thumb and/or hand range of motion, and pain intensity or pressure pain threshold in patients with thumb carpometacarpal OA. Results: Five clinical trials met the eligibility criteria; for the quantitative synthesis, four studies were included. The mean difference (MD) for grip strength was 0.87kg (95% CI = 0.29-1.44, p = .003), for pinch strength was 0.10kg (95% CI = -0.01-0.20, p = .06), and for the pressure pain threshold was 0.64kg/cm2 (95% CI = 0.07-1.20, p = .03). All differences were in favor of the MT group. Conclusions: In the short-term, there was moderate to high evidence, with statistically significant differences in the functional outcomes, in favor of MT versus sham interventions in patients with thumb carpometacarpal OA. However, these differences are not clinically important.
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Affiliation(s)
| | | | - Cristian Olguín-Huerta
- Rehabilitation in Health Research Center (CIRES), Universidad De Las Américas, Santiago, Chile
| | | | | | | | - Jaime Castillo-Alcayaga
- Rehabilitation in Health Research Center (CIRES), Universidad De Las Américas, Santiago, Chile
| | - Patricio Retamal-Pérez
- Rehabilitation in Health Research Center (CIRES), Universidad De Las Américas, Santiago, Chile
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Hamasaki T, Harris PG, Bureau NJ, Gaudreault N, Ziegler D, Choinière M. Efficacy of Surgical Interventions for Trapeziometacarpal (Thumb Base) Osteoarthritis: A Systematic Review. Journal of Hand Surgery Global Online 2021; 3:139-148. [PMID: 35415551 PMCID: PMC8991854 DOI: 10.1016/j.jhsg.2021.02.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 02/16/2021] [Indexed: 11/01/2022] Open
Abstract
Purpose Methods Results Conclusions Type of study/level of evidence
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22
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Wouters RM, Porsius JT, van der Oest MJW, Slijper HP, Souer JS, Selles RW, MacDermid JC; Hand-Wrist Study Group. Psychological Characteristics, Female Sex, and Opioid Use Predict Acute Postoperative Pain in Patients Surgically Treated for Thumb Base Osteoarthritis: A Cohort Study. Plast Reconstr Surg 2020; 146:1307-16. [PMID: 33234961 DOI: 10.1097/PRS.0000000000007337] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND It is unclear which factors predict acute postoperative pain in patients surgically treated for thumb base osteoarthritis. The authors investigated the influence of type of surgery, preoperative sociodemographics, preoperative patient-reported outcome measures, psychological characteristics, and postoperative opioid use on acute postoperative pain 24 hours postoperatively following surgery for thumb carpometacarpal osteoarthritis. In addition, preoperative and acute postoperative pain were compared. METHODS In this prospective cohort study, 215 patients surgically treated for thumb carpometacarpal osteoarthritis were included. Data were collected in 16 clinics for hand surgery and therapy in The Netherlands. Hierarchical regression was used to identify whether type of surgery, preoperative sociodemographics, preoperative patient-reported outcome measures, psychological characteristics (including treatment credibility and expectations, illness perception, pain catastrophizing, anxiety, and depression), and postoperative opioid use predicted acute postoperative pain 24 hours postoperatively, measured using the Numeric Pain Rating Scale (range, 0 to 10). RESULTS Female sex, opioid use, higher preoperative satisfaction with hand, and higher self-reported consequences and coherence predicted greater postoperative pain, with 31 percent explained variance in the final model including psychological factors. Mean postoperative Numeric Pain Rating Scale score was lower (5.1 ± 2.4) than preoperative pain, measured using visual analogue scales (during the past week, 6.7 ± 1.7; physical load, 7.5 ± 1.7) and the Michigan Hand Outcomes Questionnaire (6.4 ± 1.4; p < 0.001). CONCLUSIONS Psychological factors, female sex, and opioid use enhance the prediction of acute postoperative pain beyond surgery type, preoperative sociodemographics, and patient-reported outcome measures. Female sex and opioid use were the strongest predictors, even after controlling for psychological factors. Future studies may investigate sex-based approaches and patient education for reducing acute postoperative pain. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, II.
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Caggiari G, Polese F, Rosetti C, Ciurlia E, Brusoni M, Leone A, Pisanu F, Manunta AF, Doria C, Manca M. Suspension arthroplasty in the treatment of thumb carpometacarpal osteoarthritis. Orthop Rev (Pavia) 2020; 12:8514. [PMID: 33569157 PMCID: PMC7868953 DOI: 10.4081/or.2020.8514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 10/14/2020] [Indexed: 11/22/2022] Open
Abstract
Literature presents several examples of surgical techniques for the treatment of carpometacarpal osteoarthritis. In our study we used a modified Ceruso's suspended arthroplasty technique. In this study, 53 patients from 2011 to 2017 underwent arthroplasty with trapezius excision and suture suspension between abductor pollicis longus and flexor carpi radialis. The average age at surgery was 69, the participants were 43 women and 10 men. The average total operation time was 59 minutes. The modified CMC suspension arthroplasty technique provides excellent results compared with those in the literature.
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Affiliation(s)
| | | | | | | | - Matteo Brusoni
- Orthopaedic Department, Versilia Hospital, Lido di Camaiore
| | - Andrea Leone
- Orthopaedic Department, Parma University Hospital Parma, Italy
| | | | | | - Carlo Doria
- Orthopaedic Department, Parma University Hospital Parma, Italy
| | - Mario Manca
- Orthopaedic Department, Versilia Hospital, Lido di Camaiore
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Cantero-Téllez R, Villafañe JH, Valdes K, García-Orza S, Bishop MD, Medina-Porqueres I. Effects of High-Intensity Laser Therapy on Pain Sensitivity and Motor Performance in Patients with Thumb Carpometacarpal Joint Osteoarthritis: A Randomized Controlled Trial. Pain Med 2020; 21:2357-2365. [PMID: 31807782 DOI: 10.1093/pm/pnz297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To examine the effects of high-intensity laser therapy (HILT) on pain sensitivity and motor performance in patients with thumb carpometacarpal (CMC) osteoarthritis (OA). DESIGN Prospective, triple-blinded, randomized, placebo-controlled trial. SETTING Private practice, Malaga, Spain. SUBJECTS Forty-three patients (mean ± SD age = 71 ± 12 years) with a diagnosis of thumb CMC OA grade 1-2 were randomized to the control group (N = 21) or experimental group (N = 22). METHODS The experimental group (ExpG) received high-intensity laser therapy (HILT), and the control group (ConG) received a placebo treatment. The outcome measures were pain intensity (visual analog scale) and key pinch strength measurements (dynamometer). All outcome measures were collected at baseline, immediately following the intervention, at four weeks, and at 12 weeks following the intervention. RESULTS Analysis of variance revealed a group × time interaction (F = 40.8, P < 0.001) for pain intensity, with those patients receiving LT experiencing a greater reduction in pain compared with those receiving placebo therapy at the end of the intervention (P < 0.001), as well as at 12 weeks after the intervention. Although mean values in the ExpG were higher than in the ConG for key pinch at assessment, these differences were not statistically significant. CONCLUSIONS HILT effectively diminishes pain intensity when used as an isolated treatment for patients with thumb CMC OA, but the effect of treatment decreases after 12 weeks.
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Affiliation(s)
- Raquel Cantero-Téllez
- Department of Physical Therapy, Faculty of Health Sciences, University of Malaga, Malaga, Spain
| | | | - Kirstin Valdes
- Departament of Ocupational Therapy, Gannon University, Ruskin, FL, USA
| | | | - Mark D Bishop
- Department of Physical Therapy, University of Florida, Gainesville, Florida, USA
| | - Ivan Medina-Porqueres
- Department of Physical Therapy, Faculty of Health Sciences, University of Malaga, Malaga, Spain
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Buhler M, Chapple CM, Stebbings S, Adams J, Gwynne-Jones D, Baxter GD. Splinting for thumb carpometacarpal osteoarthritis: protocol for a feasibility randomized controlled trial. Physical Therapy Reviews 2020. [DOI: 10.1080/10833196.2020.1763662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- M. Buhler
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - C. M. Chapple
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - S. Stebbings
- Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - J. Adams
- School of Health Sciences, University of Southampton, Southampton, UK
| | - D. Gwynne-Jones
- Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - G. D. Baxter
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
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Affiliation(s)
- Suzanne C Wilkens
- Hand and Upper Extremity Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Michael M Meghpara
- Hand and Upper Extremity Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - David Ring
- Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Austin, Texas
| | - J Henk Coert
- Department of Plastic Surgery and Hand Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jesse B Jupiter
- Hand and Upper Extremity Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Neal C Chen
- Hand and Upper Extremity Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Ayhan FF, Sunar İ, Umay E, Keskİn D, Altan L, DİnÇer F, DuruÖz T, Karalezlİ N, Kuran B, Tuncer T. The Turkish League Against Rheumatism Recommendations for the Management of Hand Osteoarthritis Under Guidance of the Current Literature and 2018 European League Against Rheumatism Recommendations. Arch Rheumatol 2020; 35:309-320. [PMID: 33458653 PMCID: PMC7788652 DOI: 10.46497/archrheumatol.2020.7693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 09/14/2019] [Indexed: 01/17/2023] Open
Abstract
Objectives
This study aims to explore the accordance to the 2018 European League Against Rheumatism (EULAR) recommendations for the management of hand osteoarthritis (OA) among the Turkish League Against Rheumatism (TLAR) expert panel and composition of TLAR recommendations for the management of hand OA under guidance of the current literature. Materials and methods
The TLAR convener designated an expert panel of 10 physicians experienced in hand OA for this process. The 2018 EULAR recommendations for the management of hand OA and the systematic review of the literature were sent to the expert panel via e-mails. The e-mail process which included Delphi round surveys was completed. The EULAR standard operational procedure Appraisal of Guidelines for Research and Evaluation II was followed. The level of agreement was calculated for each item and presented as mean, standard deviations, minimum and maximum and comparisons of 2018 EULAR recommendations were performed. Results
Five overarching principles and 10 recommendations were discussed. Revisions were held for the sixth, seventh, and ninth recommendations with lowest level of agreements. These recommendations were revised in accordance with suggestions from the experts and re-voted. The revised forms were approved despite the lack of statistically significant difference between these forms (p=0.400, p=0.451, p=0.496, respectively). Except for the ninth recommendation about surgery (p=0.008), no significant difference in level of agreements was observed between the EULAR and TLAR hand OA recommendations. The 11th recommendation about paraffin bath was added. Conclusion The optimal treatment of hand OA consists of personalized non-pharmacological (self-management, exercise, splint), pharmacological (topical non-steroidal anti-inflammatory drugs as the first choice), and interventional procedures (only for refractory cases) based on shared decision between the patient and physician. TLAR hand OA recommendations were created mainly based on the most recent literature and the last EULAR hand OA management recommendations, which are widely approved among the TLAR experts.
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Affiliation(s)
- Fikriye Figen Ayhan
- Department of Physical Medicine and Rehabilitation, Uşak University, School of Medicine, Uşak, Turkey
| | - İsmihan Sunar
- Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Ankara University, School of Medicine, Ankara, Turkey
| | - Ebru Umay
- Department of Physical Therapy and Rehabilitation, Health Sciences University, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Dilek Keskİn
- Department of Physical Medicine and Rehabilitation, Kırıkkale University, School of Medicine, Kırıkkale, Turkey
| | - Lale Altan
- Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Uludağ University, School of Medicine, Bursa, Turkey
| | - Fitnat DİnÇer
- Department of Physical Medicine and Rehabilitation, Hacettepe University, School of Medicine, Ankara, Turkey
| | - Tuncay DuruÖz
- Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Marmara University, School of Medicine, İstanbul, Turkey
| | - Nazım Karalezlİ
- Department of Orthopedics, Division of Hand Surgery, Muğla Sıtkı Koçman University, School of Medicine, Muğla, Turkey
| | - Banu Kuran
- Department of Physical Medicine and Rehabilitation, Health Sciences University, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
| | - Tiraje Tuncer
- Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Akdeniz University, School of Medicine, Antalya, Turkey
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Bühler M, Chapple CM, Stebbings S, Pōtiki-Bryant K, David Baxter G. Impact of Thumb Carpometacarpal Joint Osteoarthritis: A Pragmatic Qualitative Study. Arthritis Care Res (Hoboken) 2019; 73:336-346. [PMID: 31841264 DOI: 10.1002/acr.24124] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 11/11/2019] [Accepted: 12/10/2019] [Indexed: 11/05/2022]
Abstract
OBJECTIVE First carpometacarpal (CMC1) joint osteoarthritis (OA) is typically understood as part of the disease entity of hand OA. However, CMC1 joint OA often occurs in isolation or is a primary source of symptoms. The aim of the current study was to explore the experiences of New Zealanders with CMC1 joint OA to better understand the unique impact of this condition, ascertain outcomes of importance, and identify treatment targets. METHODS In this pragmatic qualitative study, patients who either reported a history suggestive of CMC1 joint OA or had been diagnosed by a physician were recruited from health and community settings in 2 centers on the South Island of New Zealand. Thirty participants (11 men and 19 women, mean ± SD age 65.4 ± 11.36 years) took part in individual face-to-face interviews and kept diaries. The interviews were audio recorded, and along with the diaries, transcribed. Data were analyzed by thematic analysis using a primarily inductive approach. The Health Impact Model was employed to help with interpretation of the results. RESULTS Five interrelated levels of health impact were identified: symptom status, functional limitations, restrictions in social activities and roles, negative thoughts and feelings, and an altered sense of self. Constant pain and pain at night were key symptoms that were associated with impact at the other levels. CONCLUSION Constant pain, pain at night, functional capacity, medication burden, emotional impact, and sense of self are important outcomes and treatment targets in people with CMC1 joint OA.
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Affiliation(s)
| | | | - Simon Stebbings
- University of Otago and Dunedin Hospital Dunedin, Dunedin, Otago, New Zealand
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Wouters RM, Vranceanu AM, Slijper HP, Vermeulen GM, van der Oest MJW, Selles RW, Porsius JT. Patients With Thumb-base Osteoarthritis Scheduled for Surgery Have More Symptoms, Worse Psychological Profile, and Higher Expectations Than Nonsurgical Counterparts: A Large Cohort Analysis. Clin Orthop Relat Res 2019; 477:2735-2746. [PMID: 31764344 PMCID: PMC6907312 DOI: 10.1097/corr.0000000000000897] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 06/25/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Psychological characteristics, such as depression, anxiety or negative illness perception are highly prevalent in patients with several types of OA. It is unclear whether there are differences in the clinical and psychological characteristics of patients with thumb carpometacarpal (CMC-1) osteoarthritis (OA) scheduled for nonsurgical treatment and those with surgical treatment. QUESTIONS/PURPOSES (1) What are the differences in baseline sociodemographic characteristics and clinical characteristics (including pain, hand function, and health-related quality of life) between patients with thumb CMC-1 OA scheduled for surgery and those treated nonoperatively? (2) What are the differences in psychological characteristics between patients scheduled for surgery and those treated nonsurgically, for treatment credibility, expectations, illness perception, pain catastrophizing, and anxiety and depression? (3) What is the relative contribution of baseline sociodemographic, clinical, and psychological characteristics to the probability of being scheduled for surgery? METHODS This was a cross-sectional study using observational data. Patients with CMC-1 OA completed outcome measures before undergoing either nonsurgical or surgical treatment. Between September 2017 and June 2018, 1273 patients were screened for eligibility. In total, 584 participants were included: 208 in the surgery group and 376 in the nonsurgery group. Baseline sociodemographic, clinical, and psychological characteristics were compared between groups, and a hierarchical logistic regression analysis was used to investigate the relative contribution of psychological characteristics to being scheduled for surgery, over and above clinical and sociodemographic variables. Baseline measures included pain, hand function, satisfaction with the patient's hand, health-related quality of life, treatment credibility and expectations, illness perception, pain catastrophizing, and anxiety and depression. RESULTS Patients in the surgery group had longer symptom duration, more often a second opinion, higher pain, treatment credibility and expectations and worse hand function, satisfaction, HRQoL, illness perception and pain catastrophizing compared with the non-surgery group (effect sizes ranged from 0.20 to 1.20; p values ranged from < 0.001 to 0.044). After adjusting for sociodemographic, clinical, and psychological factors, we found that the following increased the probability of being scheduled for surgery: longer symptom duration (standardized odds ratio [SOR], 1.86; p = 0.004), second-opinion visit (SOR, 3.81; p = 0.027), lower satisfaction with the hand (SOR, 0.65; p = 0.004), higher treatment expectations (SOR, 5.04; p < 0.001), shorter perceived timeline (SOR, 0.70; p = 0.011), worse personal control (SOR, 0.57; p < 0.001) and emotional response (SOR, 1.40; p = 0.040). The hierarchical logistic regression analysis including sociodemographic, clinical, and psychological factors provided the highest area under the curve (sociodemographics alone: 0.663 [95% confidence interval 0.618 to 0.709]; sociodemographics and clinical: 0.750 [95% CI 0.708 to 0.791]; sociodemographics, clinical and psychological: 0.900 [95% CI 0.875 to 0.925]). CONCLUSIONS Patients scheduled to undergo surgery for CMC-1 OA have a worse psychological profile than those scheduled for nonsurgical treatment. Our findings suggest that psychological characteristics should be considered during shared decision-making, and they might indicate if psychological interventions, training in coping strategies, and patient education are needed. Future studies should prospectively investigate the influence of psychological characteristics on the outcomes of patients with CMC-1 OA. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Robbert M Wouters
- R. M. Wouters, Center for Hand Therapy, Handtherapie Nederland, Utrecht, the Netherlands R. M. Wouters, H. P. Slijper, M. J. W. van der Oest, R. W. Selles, J. T. Porsius, Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands R. M. Wouters, H. P. Slijper, M. J. W. van der Oest, R. W. Selles, J. T. Porsius, Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands A.-M. Vranceanu, J. T. Porsius, Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA H. P. Slijper, G. M. Vermeulen, M. J. W. van der Oest, J. T. Porsius, Hand and Wrist Center, Xpert Clinic, Eindhoven, the Netherlands
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Cantero-Téllez R, Villafañe JH, Valdes K, Berjano P. Effect of immobilization of metacarpophalangeal joint in thumb carpometacarpal osteoarthritis on pain and function. A quasi-experimental trial. J Hand Ther 2019; 31:68-73. [PMID: 28237072 DOI: 10.1016/j.jht.2016.11.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 11/10/2016] [Accepted: 11/11/2016] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN A quasi-experimental trial. INTRODUCTION Orthoses are effective to decrease pain and improve function in patients with carpometacarpal osteoarthritis (CMC OA). However, current research does not support one design of an orthosis as more effective and/or more favorable than another. PURPOSE OF THE STUDY The aim of this study was to compare the effectiveness of 2 different static orthosis on pain and functional abilities on CMC OA. METHODS Eighty-four patients, 91.7% females (mean ± standard deviation age, 60.1 ± 9.6 years), with thumb CMC OA were randomized into 1 of 2 groups. For group A, a Ballena orthotic was constructed, and for group B, a Colditz orthotic was constructed. Both static orthoses were worn for 3 months. The outcome measures included pain with activity measured with the visual analog scale and functional abilities assessed with the Disabilities of the Arm, Shoulder and Hand. RESULTS Both orthoses improved pain level and functional abilities (F[1.0] = 413.327 and F[1.0] = 211.742; both P < .001). There was no statistically significant difference between 2 groups regarding to pain recovery and functional improvement (F[1.0] = 0.075 and F[1.0] = 7.248; both P > .05). DISCUSSION The main purpose was to compare the effect of 2 different thermoplastic thumb orthoses. Previous studies support the use of CMC orthoses to decrease hand pain and improve hand function, but different orthoses have been described and in most cases, orthotic interventions were accompanied by other medical treatments. CONCLUSIONS A clinically significant reduction in pain intensity and improvement in functional abilities was achieved with both orthoses in patients with thumb CMC OA. LEVEL OF EVIDENCE 2. TRIAL REGISTRATION ClinicalTrials.gov registration number: NCT02780999.
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Affiliation(s)
- Raquel Cantero-Téllez
- Physical Therapy Section, Faculty of Health Sciences, University of Malaga, Tecan Hand Rehabilitation Center, Málaga, Spain
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Tsehaie J, Spekreijse KR, Wouters RM, Feitz R, Hovius SE, Slijper HP, Selles RW. Predicting Outcome After Hand Orthosis and Hand Therapy for Thumb Carpometacarpal Osteoarthritis: A Prospective Study. Arch Phys Med Rehabil 2019; 100:844-850. [DOI: 10.1016/j.apmr.2018.08.192] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 08/30/2018] [Accepted: 08/31/2018] [Indexed: 10/28/2022]
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Buhler M, Chapple CM, Stebbings S, Sangelaji B, Baxter GD. Effectiveness of splinting for pain and function in people with thumb carpometacarpal osteoarthritis: a systematic review with meta-analysis. Osteoarthritis Cartilage 2019; 27:547-59. [PMID: 30317000 DOI: 10.1016/j.joca.2018.09.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 09/21/2018] [Accepted: 09/26/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To examine the effectiveness of splinting for reducing pain and improving function and health-related quality of life (HR-QoL) in people with thumb carpometacarpal osteoarthritis (CMC OA). DESIGN The Cochrane Library, MEDLINE, Embase, CINAHL, ISI Web of Science, Scopus and Google Scholar, 3 trial registries and 4 conference proceedings were systematically searched for randomised and non-randomised controlled trials up to March 17th, 2018. Two reviewers independently applied the inclusion criteria to select potential studies and assess risk of methodologic bias using the Cochrane Collaboration's Risk of Bias Tool. Studies were pooled using the inverse variance method to calculate standardised mean difference (SMD). Sensitivity analyses were conducted and the quality of evidence for each outcome was judged following the Grades of Recommendation Assessment, Development and Evaluation (GRADE) approach. RESULTS Twelve studies were retrieved (n = 1353), 4 comparing a splint to control and 8 to another splint. In the medium-term (3-12 months), low quality evidence showed that splints cause a moderate to large reduction in pain (SMD 0.7 [95% confidence interval (CI) 1.04, 0.35], P < 0.0001) and small to moderate improvement in function (SMD 0.42 [95% CI 0.77, 0.08], P = 0.02). No significant effect was found at short-term or for different types of splints. No studies reported HR-QoL. CONCLUSIONS Splinting demonstrated a moderate to large effect for pain and small to moderate effect for function in the medium-term but not in the short term. Quality of the evidence is low. Major challenges are the lack of diagnostic criteria and of a gold-standard outcome measure for thumb CMC OA.
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Weiss AC, Kamal RN, Paci GM, Weiss BA, Shah KN. Suture Suspension Arthroplasty for the Treatment of Thumb Carpometacarpal Arthritis. J Hand Surg Am 2019; 44:296-303. [PMID: 30947824 DOI: 10.1016/j.jhsa.2019.02.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 11/26/2018] [Accepted: 02/01/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE Most studies have demonstrated little difference in the outcome of the various techniques proposed for the surgical treatment of thumb carpometacarpal (CMC) arthritis. However, the difficulty and time required to perform each technique vary widely. In addition, the introduction of recent implants has increased the cost of the overall procedure. We hypothesize that using a simple, yet stable, suture suspension technique without tendon interposition or ligament reconstruction yields similar results to conventional approaches with less operative time. METHODS Three hundred twenty consecutive patients underwent thumb CMC arthroplasty by trapezial excision and metacarpal suspension using #2 high-strength orthopedic suture locked weave alone passed from the distal most abductor pollicis longus and flexor carpi radialis insertions without K-wire fixation or tendon transfer. Average duration of preoperative symptoms was 17.8 months. Patient radiographs were graded for arthritis severity and a visual analog scale (VAS) pain score (scale 0-10) obtained. Postoperative clinical and radiological follow-up averaged 5.4 years (minimum, 24 months). RESULTS The average age at surgery was 57.3 years and there were 221 women (243 procedures) and 65 men (77 procedures). Average total operative time was 23.4 minutes. The dominant hand was involved in 52% of patients. All had prior treatment including orthoses and nonsteroidal anti-inflammatory drugs with 312 having had at least 1 steroid injection. Five patients had stage 1, 134 had stage 2, 164 had stage 3, and 17 had stage 4 disease on radiographs. Average trapezial space height on final follow-up radiographs was 0.8 cm. Two patients had complete trapezial space collapse and required a revision procedure. The average VAS score was 0.6 with pain eliminated in 269 thumbs, minimal in 49, and unchanged/worse in 2. All patients that were employed at the time of surgery returned to work at an average of 2.3 months (range, 3-16 weeks). CONCLUSIONS Suture suspension thumb CMC arthroplasty provides comparable clinical results and several advantages over many current techniques that are described in the literature. The advantages include shortened operative time, inherent stability of the thumb metacarpal height, and no necessity for K-wire fixation, tendon transfers, or implants. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Wouters RM, Tsehaie J, Slijper HP, Hovius SER, Feitz R, Selles RW. Exercise Therapy in Addition to an Orthosis Reduces Pain More Than an Orthosis Alone in Patients With Thumb Base Osteoarthritis: A Propensity Score Matching Study. Arch Phys Med Rehabil 2018; 100:1050-1060. [PMID: 30543802 DOI: 10.1016/j.apmr.2018.11.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 09/04/2018] [Accepted: 11/09/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To compare the effect of exercises and orthotics with orthotics alone on pain and hand function in patients with first carpometacarpal joint (CMC-1) osteoarthritis (OA) and to predict outcomes on pain and hand function of exercises and orthotics. DESIGN Prospective cohort study with propensity score matching. SETTING Data collection took place in 13 outpatient clinics for hand surgery and hand therapy in The Netherlands. PARTICIPANTS A consecutive, population-based sample of patients with CMC-1 OA (N=173) was included in this study, of which 84 were matched on baseline demographics and baseline primary outcomes. INTERVENTIONS Exercises and orthotics versus orthotics alone. MAIN OUTCOME MEASURES Primary outcomes included pain and hand function at 3 months, measured using visual analog scale (VAS, 0-100) and the Michigan Hand Outcomes Questionnaire (MHQ, 0-100). RESULTS A larger decrease in VAS pain at rest (11.1 points difference; 95% confidence interval, 1.9-20.3; P=.002) and during physical load (22.7 points difference; 95% confidence interval, 13.6-31.0; P<.001) was found in the exercise + orthotic group compared to the orthotic group. In addition, larger improvement was found for the MHQ subscales pain, work performance, aesthetics, and satisfaction in the exercise + orthotic group. No differences were found on other outcomes. Baseline scores of metacarpophalangeal flexion, presence of scaphotrapeziotrapezoid OA, VAS pain at rest, heavy physical labor, and MHQ total predicted primary outcomes for the total exercise + orthotic group (N=131). CONCLUSIONS Non-surgical treatment of patients with CMC-1 OA should include exercises, since there is a relatively large treatment effect compared to using an orthosis alone. Future research should study exercises and predictors in a more standardized setting to confirm this finding.
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Affiliation(s)
- Robbert M Wouters
- Center for Hand Therapy, Handtherapie Nederland, Utrecht, The Netherlands; Department of Plastic, Reconstructive and Hand Surgery, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Rehabilitation Medicine, Erasmus Medical Center, Rotterdam, The Netherlands.
| | - Jonathan Tsehaie
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Rehabilitation Medicine, Erasmus Medical Center, Rotterdam, The Netherlands; Hand and Wrist Center, Xpert Clinic, Hilversum, The Netherlands
| | - Harm P Slijper
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Rehabilitation Medicine, Erasmus Medical Center, Rotterdam, The Netherlands; Hand and Wrist Center, Xpert Clinic, Hilversum, The Netherlands
| | - Steven E R Hovius
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus Medical Center, Rotterdam, The Netherlands; Hand and Wrist Center, Xpert Clinic, Hilversum, The Netherlands
| | - Reinier Feitz
- Hand and Wrist Center, Xpert Clinic, Hilversum, The Netherlands
| | | | - Ruud W Selles
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Rehabilitation Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
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Abstract
Introduction First carpometacarpal joint osteoarthritis is a common degenerative condition. The thumb has been reported to account for up to 50% of hand function and is functionally and biomechanically unique in the hand. To this end, it would seem appropriate that exercise programs for first carpometacarpal joint osteoarthritis would be specifically tailored to the thumb. However, this is not widely reflected in the literature. This review aimed to critically evaluate studies presenting primary evidence to determine whether a joint-specific exercise program is effective for patients with osteoarthritis in the first carpometacarpal joint. Methods Six electronic databases were searched for papers presenting primary data relating to home exercise programs that were specific to osteoarthritis in the first carpometacarpal joint. Methodological quality of included papers was evaluated using the Structured Effectiveness for Evaluation of Studies tool and levels of evidence were established based on National Health and Medical Research Council (NHMRC) guidelines. Qualitative analysis of the combined body of literature was performed and a recommendation generated and then graded according to NHMRC guidelines. Results Searching identified three relevant papers. Overall, methodological quality was moderate, with limitations primarily related to lack of power. Findings from the body of literature demonstrated considerable variation, but evidence to support specific thumb strengthening exercises was found. This provided an NHMRC Grade D level of recommendation. Conclusions It is recommended that future studies consider optimal frequency of strengthening exercises and the potential role of adductor pollicis release and passive carpometacarpal joint mobilization in home exercise programs for first carpometacarpal osteoarthritis.
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Affiliation(s)
- Anna Scott
- Occupational Therapy, Gold Coast Hospital and Health Service, Queensland, Australia
- Student in MSc Hand Therapy, College of Health and Social Care, University of Derby, Derby, UK
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Kroon FPB, van Beest S, Ermurat S, Kortekaas MC, Bloem JL, Reijnierse M, Rosendaal FR, Kloppenburg M. In thumb base osteoarthritis structural damage is more strongly associated with pain than synovitis. Osteoarthritis Cartilage 2018; 26:1196-1202. [PMID: 29709499 DOI: 10.1016/j.joca.2018.04.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 03/15/2018] [Accepted: 04/11/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Osteoarthritis in thumb base joints (first carpometacarpal (CMC-1), scaphotrapeziotrapezoid (STT)) is prevalent and disabling, yet focussed studies are scarce. Our aim was to investigate associations between ultrasonographic and magnetic resonance imaging (MRI) inflammatory features, radiographic osteophytes, and thumb base pain in hand osteoarthritis patients. DESIGN Cross-sectional analyses were performed in cohorts with MRI (n = 202) and ultrasound measurements (n = 87). Pain upon thumb base palpation was assessed. Radiographs were scored for CMC-1/STT osteophytes. Synovial thickening, effusion and power Doppler signal in CMC-1 joints were assessed with ultrasound. MRIs were scored for synovitis and bone marrow lesions (BMLs) in CMC-1 and STT joints using OMERACT-TOMS. Associations between ultrasound/MRI features, osteophytes, and thumb base pain were assessed. Interaction between MRI features and osteophytes was explored. RESULTS In 289 patients (mean age 60.2, 83% women) 139/376 thumb bases were painful. Osteophyte presence was associated with pain (MRI cohort: odds ratio (OR) 5.1 (2.7-9.8)). Ultrasound features were present in 25-33% of CMC-1 joints, though no associations were seen with pain. MRI-synovitis and BMLs grade ≥2 were scored in 25% and 43% of thumb bases, and positively associated with pain (OR 3.6 (95% CI 1.7-7.6) and 3.0 (1.6-5.5)). Associations attenuated after adjustment for osteophyte presence. Combined presence of osteophytes and MRI-synovitis had an additive effect. CONCLUSIONS Ultrasonographic and MRI inflammatory features were often present in the thumb base. Osteophytes were more strongly associated with thumb base pain than inflammatory features, in contrast to findings in finger OA studies, supporting thumb base osteoarthritis as a distinct phenotype.
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Affiliation(s)
- F P B Kroon
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
| | - S van Beest
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - S Ermurat
- Department of Rheumatology, Uludag University Medical Faculty, Bursa, Turkey
| | - M C Kortekaas
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - J L Bloem
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - M Reijnierse
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - F R Rosendaal
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - M Kloppenburg
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
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Magnusson K, Turkiewicz A, Timpka S, Englund M. Prediction of midlife hand osteoarthritis in young men. Osteoarthritis Cartilage 2018; 26:1027-32. [PMID: 29792926 DOI: 10.1016/j.joca.2018.05.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 05/03/2018] [Accepted: 05/07/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Improved prediction modeling in osteoarthritis (OA) may encourage risk reduction through calculation of individual and population lifetime risks. There are currently no prediction models for hand OA. Thus, we aimed to 1) develop a prediction model for hand OA in men and 2) to contrast its discriminative performance to a prediction model for lung cancer and chronic obstructive pulmonary disease (COPD). METHODS We included 40,118 men aged 18 years undergoing mandatory conscription in Sweden 1969-70. Incident hand OA and lung cancer/COPD were obtained from diagnostic codes in the Swedish National Patient Register 1987-2010, i.e., until subjects were 59 years of age. We studied the strongest candidate predictors from five domains; socioeconomic, local biomechanical, systemic, lifestyle-related and general health factors, using logistic regression with backward elimination of candidate predictors with P > 0.2 to determine final models. To avoid overfitting we used bootstrapping. RESULTS The strongest predictors for hand OA were body mass index (BMI), elbow flexor strength, systolic blood pressure, lower education and sleep problems. We observed excellent agreement between observed and predicted values, yet the discrimination was moderate (Area Under the Curve [AUC] = 0.62, 95% CI = 0.58-0.64). The discrimination in the prediction model for lung cancer/COPD was good (AUC = 0.74, 95% CI = 0.72-0.76). CONCLUSION This prediction model for hand OA was capable of discriminating between persons with and without hand OA to a similar extent that has been previously reported for knee OA. Still, prediction of OA is more challenging than for chronic pulmonary disease.
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Valdes K, Naughton N, Algar L. Linking ICF components to outcome measures for orthotic intervention for CMC OA: A systematic review. J Hand Ther 2017; 29:396-404. [PMID: 27662802 DOI: 10.1016/j.jht.2016.06.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Revised: 03/24/2016] [Accepted: 06/06/2016] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Systematic review. INTRODUCTION/PURPOSE The purpose of this study was to systematically review outcome measures used for assessment of orthotic intervention in the conservative management of thumb carpometacarpal osteoarthritis to determine if they characterize International Classification of Functioning, Disability, and Health (ICF) components. The determinants of patient satisfaction regarding the orthotic intervention were also extracted from the studies. METHODS A comprehensive literature search was conducted. Outcome measures in the included studies were linked to the ICF. Determinants of patient satisfaction regarding the orthotic intervention were also extracted. RESULTS Nine studies met inclusion criteria. Eight (47.1%) outcomes were linked to body structures and functions, 8 (47.1%) to activity limitations and participation restrictions, and 1 (5.9%) outcome fell into the nondefinable quality of life category. Four studies assessed patient satisfaction. DISCUSSION/CONCLUSIONS This systematic review on orthotic intervention for thumb carpometacarpal osteoarthritis found opportunities related to assessment and outcome measures when present studies are linked to the ICF. LEVEL OF EVIDENCE 2a.
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Affiliation(s)
- K Valdes
- Department of Occupational Therapy, Gannon University, Ruskin, FL, USA; Hand Works Therapy, Venice, FL, USA.
| | | | - Lori Algar
- Orthopaedic Specialty Group PC, Fairfield, CT, USA
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Abstract
The thumb carpometacarpal joint (CMCJ1) is born to have good freedom of motion. However, the excellent mobility at this joint also predisposes attenuation of capsuloligamentous structures, joint incongruity, instability, and osteoarthritis. The prevalence of radiographic CMCJ1 arthritis is high. There is no single ideal surgery for all stages of CMCJ1 arthritis, and for all kinds of patients. The arthroscopic approach seems to provide a better alternative with rewarding preliminary results. It includes arthroscopic synovectomy/debridement/thermal shrinkage, arthroscopic partial trapeziectomy and suture button suspensionplasty, and arthroscopic CMCJ1 excision/suture button suspensionplasty/K-wire fixation.
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Affiliation(s)
- Clara Wing-Yee Wong
- Division of Hand and Microsurgery, Department of Orthopaedic and Traumatology, Prince of Wales Hospital, Chinese University of Hong Kong, 16/F, The Club Lusitano, 16 Ice House Street, Central, Hong Kong SAR.
| | - Pak-Cheong Ho
- Division of Hand and Microsurgery, Department of Orthopaedic and Traumatology, Prince of Wales Hospital, Chinese University of Hong Kong, 5F, Lui Che Woo Clinical Sciences Building, 30-32 Ngan Shing Street, Shatin, NT, Hong Kong SAR
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de Almeida PHT, MacDermid J, Pontes TB, Dos Santos-Couto-Paz CC, Matheus JPC. Differences in orthotic design for thumb osteoarthritis and its impact on functional outcomes: A scoping review. Prosthet Orthot Int 2017; 41:323-335. [PMID: 27613587 DOI: 10.1177/0309364616661255] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Orthoses are a well-known intervention for the treatment of thumb osteoarthritis; however, there is a multitude of orthotic designs and not enough evidence to support the efficacy of specific models. OBJECTIVE To examine the influence of different orthoses on pain, hand strength, and hand function of patients with thumb osteoarthritis. STUDY DESIGN Literature review. METHODS A scoping literature review of 14 publications reporting orthotic interventions for patients with thumb osteoarthritis was conducted. Functional outcomes and measures were extracted and analyzed. RESULTS In total, 12 studies reported improvements in pain and hand strength after the use of thumb orthoses. Comparisons between different orthotic designs were inconclusive. CONCLUSION The use of orthoses can decrease pain and improve hand function of patients with thumb osteoarthritis; however, the effectiveness of different orthoses still needs support through adequate evidence. Clinical relevance Multiple orthoses for thumb osteoarthritis are available. Although current studies support their use to improve pain and hand function, there is no evidence to support the efficacy of specific orthotic designs. Improved functional outcomes can be achieved through the use of short orthoses, providing thumb stabilization without immobilizing adjacent joints.
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Katzel EB, Bielicka D, Shakir S, Fowler J, Buterbaugh GA, Imbriglia JE. Midcarpal and Scaphotrapeziotrapezoid Arthritis in Patients with Carpometacarpal Arthritis. Plast Reconstr Surg 2016; 137:1793-8. [PMID: 26890509 DOI: 10.1097/PRS.0000000000002160] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Carpometacarpal arthroplasty provides well-documented pain relief with preservation of thenar function in basal joint arthritis treatment. Nevertheless, some patients continue to have pain following surgery. The authors hypothesize that unrecognized midcarpal (capitolunate) arthritis is a contributor to persistent pain after carpometacarpal arthroplasty. The prevalence of midcarpal arthritis in patients with basal joint arthritis is unknown. This article establishes the radiographic prevalence of midcarpal arthritis in patients with carpometacarpal arthritis. METHODS Patients with basal joint arthritis were identified from a search using International Classification of Diseases, Ninth Revision code 716.94. Hand radiographs were reviewed and graded using the Eaton classification and Sodha classification for carpometacarpal arthritis. Scaphotrapeziotrapezoid arthritis and midcarpal arthritis were graded using the Sodha classification for arthritis as follows: grade 1, no or nearly no arthrosis; grade 2, definite arthrosis but not severe; and grade 3, severe arthrosis. RESULTS Eight hundred ninety-six radiographs were reviewed. The prevalence of scaphotrapeziotrapezoid arthritis in this population was 64 percent. The prevalence of midcarpal arthritis in this population was 23.5 percent. The prevalence of midcarpal arthritis in patients with radiologic evidence of carpometacarpal arthritis was 25.4 percent. The prevalence of severe midcarpal arthritis was 7 percent. CONCLUSIONS The prevalence of midcarpal arthritis in patients with basal joint arthritis is 24 percent. The presence of two locations of arthritis may explain persistent hand and wrist pain in this population despite carpometacarpal arthroplasty. Clinically, these data will allow hand surgeons to better educate patients with basal joint arthritis regarding the possibility of incomplete pain relief following carpometacarpal arthroplasty.
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Dourthe B, D'Agostino P, Stockmans F, Kerkhof F, Vereecke E. In vivo contact biomechanics in the trapeziometacarpal joint using finite deformation biphasic theory and mathematical modelling. Med Eng Phys 2015; 38:108-14. [PMID: 26654104 DOI: 10.1016/j.medengphy.2015.11.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 09/11/2015] [Accepted: 11/03/2015] [Indexed: 11/16/2022]
Abstract
The assessment of the contact biomechanics in the trapeziometacarpal (TMC) joint during functional tasks represents a relevant way to obtain a better understanding of the onset of osteoarthritis (OA). CT scans of the hand region of 20 female volunteers were taken in relaxed neutral, lateral key pinch and power grasp configuration. 3D models of the first metacarpal (MC1) and the trapezium were created. The articular area of each bone was quantified and a mathematical model was developed in Matlab to evaluate the projected contact area and stress distribution of each bone. The articular areas of the MC1 and the trapezium presented no significant difference. A slightly smaller projected contact area was calculated for the trapezium compared to the MC1. Similar amounts of stress were reported in the neutral and lateral pinch configurations. The highest stress levels were observed during power grasp. Very consistent results for high stress location on the volar/radial articular sub-region were found in the neutral and power grasp configurations. More variation was reported during lateral pinch. The mathematical model presented in this paper offers the possibility to predict contact patterns within the TMC joint based on in vivo CT images.
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Affiliation(s)
- Benjamin Dourthe
- KU Leuven, Department of Development & Regeneration @ Kulak, Etienne Sabbelaan 53, 8500 Kortrijk, Belgium.
| | - Priscilla D'Agostino
- KU Leuven, Department of Development & Regeneration @ Kulak, Etienne Sabbelaan 53, 8500 Kortrijk, Belgium
| | - Filip Stockmans
- KU Leuven, Department of Development & Regeneration @ Kulak, Etienne Sabbelaan 53, 8500 Kortrijk, Belgium; AZ Groeninge, Campus Loofstraat, Loofstraat 43, 8500 Kortrijk, Belgium
| | - Faes Kerkhof
- KU Leuven, Department of Development & Regeneration @ Kulak, Etienne Sabbelaan 53, 8500 Kortrijk, Belgium
| | - Evie Vereecke
- KU Leuven, Department of Development & Regeneration @ Kulak, Etienne Sabbelaan 53, 8500 Kortrijk, Belgium
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Thomas MJ, Roddy E, Rathod T, Marshall M, Moore A, Menz HB, Peat G. Clinical diagnosis of symptomatic midfoot osteoarthritis: cross-sectional findings from the Clinical Assessment Study of the Foot. Osteoarthritis Cartilage 2015; 23:2094-2101. [PMID: 26093213 PMCID: PMC4672469 DOI: 10.1016/j.joca.2015.06.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Revised: 05/29/2015] [Accepted: 06/09/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To derive a multivariable diagnostic model for symptomatic midfoot osteoarthritis (OA). METHODS Information on potential risk factors and clinical manifestations of symptomatic midfoot OA was collected using a health survey and standardised clinical examination of a population-based sample of 274 adults aged ≥50 years with midfoot pain. Following univariable analysis, random intercept multi-level logistic regression modelling that accounted for clustered data was used to identify the presence of midfoot OA independently scored on plain radiographs (dorso-plantar and lateral views), and defined as a score of ≥2 for osteophytes or joint space narrowing in at least one of four joints (first and second cuneometatarsal, navicular-first cuneiform and talonavicular joints). Model performance was summarised using the calibration slope and area under the curve (AUC). Internal validation and sensitivity analyses explored model over-fitting and certain assumptions. RESULTS Compared to persons with midfoot pain only, symptomatic midfoot OA was associated with measures of static foot posture and range-of-motion at subtalar and ankle joints. Arch Index was the only retained clinical variable in a model containing age, gender and body mass index. The final model was poorly calibrated (calibration slope, 0.64, 95% CI: 0.39, 0.89) and discrimination was fair-to-poor (AUC, 0.64, 95% CI: 0.58, 0.70). Final model sensitivity and specificity were 29.9% (95% CI: 22.7, 38.0) and 87.5% (95% CI: 82.9, 91.3), respectively. Bootstrapping revealed the model to be over-optimistic and performance was not improved using continuous predictors. CONCLUSIONS Brief clinical assessments provided only marginal information for identifying the presence of radiographic midfoot OA among community-dwelling persons with midfoot pain.
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Affiliation(s)
- M J Thomas
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, United Kingdom.
| | - E Roddy
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, United Kingdom.
| | - T Rathod
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, United Kingdom.
| | - M Marshall
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, United Kingdom.
| | - A Moore
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, United Kingdom.
| | - H B Menz
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, United Kingdom; Lower Extremity and Gait Studies Program, School of Allied Health, La Trobe University, Bundoora, Victoria, 3086, Australia.
| | - G Peat
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, United Kingdom.
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Abstract
In the hand therapy clinic, smartphones can be used as an educational resource, to view a photo or video of a home exercise program, or as a method of electronically documenting progress related to healing from an injury. Smartphone applications may also serve as appropriate therapy interventions to address deficits often presenting with common hand injuries. For individuals with trapeziometacarpal arthrosis, gaming can encourage radial abduction range of motion and neuromuscular control required for joint stability. People with distal radius fractures may benefit from smartphone applications for range of motion and proprioceptive training. These treatments may assist with addressing client-centered goals and be motivating in the current technology driven times.
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Bertozzi L, Valdes K, Vanti C, Negrini S, Pillastrini P, Villafañe JH. Investigation of the effect of conservative interventions in thumb carpometacarpal osteoarthritis: systematic review and meta-analysis. Disabil Rehabil 2015; 37:2025-43. [DOI: 10.3109/09638288.2014.996299] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Dumont C, Lerzer S, Vafa MA, Tezval M, Dechent P, Stürmer KM, Lotz J. Osteoarthritis of the carpometacarpal joint of the thumb: a new MR imaging technique for the standardized detection of relevant ligamental lesions. Skeletal Radiol 2014; 43:1411-20. [PMID: 25081633 DOI: 10.1007/s00256-014-1955-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Revised: 05/25/2014] [Accepted: 06/25/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess ligament lesions and subluxations of the carpometacarpal joints of the thumbs (CMC I) of asymptomatic volunteers and of patients with CMC I osteoarthritis using advanced magnetic resonance imaging (MRI). MATERIALS AND METHODS A total of 20 CMC I joints of 14 asymptomatic volunteers (6× both sides) and 28 CMC I joints of 22 patients (6× both sides) with symptomatic and X-ray-diagnosed osteoarthritis of CMC I joints were studied. During extension, flexion, abduction and adduction of the thumb, the anterior oblique (AOL), intermetacarpal (IML), posterior oblique (POL) and dorsal radial (DRL) ligaments were evaluated using 3-T MRI on two standard planes, and translation of metacarpal I (MC I) was assessed. RESULTS The MRI demonstrated that ligament lesions of the AOL and IML are frequent. Isolated rupture of the AOL was found in 6 of 28 (21%), combined rupture of the AOL + IML in 5 of 28 (18%) and isolated IML rupture in 4 of 28 (14%) joints. The patients had a significantly increased dorsal translation of MC I during extension with a median of 6.4 mm vs. 5.4 mm in asymptomatic volunteers (p < 0.05). CONCLUSION MRIs of CMC I in two standardized planes frequently show combined ligament ruptures. The dorsal subluxation of MC I, which is increased in patients, correlates with OA severity based on X-ray and can be quantified by MRI. For joint-preserving surgical procedures and for prosthesis implantation of the CMC I, we recommend performing an MRI in two planes of the thumb-extension and abduction-to evaluate the ligaments and dorsal subluxation of MC I.
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Affiliation(s)
- Clemens Dumont
- Department of Trauma Surgery, Plastic and Reconstructive Surgery, University Medical Center Göttingen, Goettingen, Germany,
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Visser AW, Bøyesen P, Haugen IK, Schoones JW, van der Heijde DM, Rosendaal FR, Kloppenburg M. Radiographic scoring methods in hand osteoarthritis--a systematic literature search and descriptive review. Osteoarthritis Cartilage 2014; 22:1710-23. [PMID: 25278080 DOI: 10.1016/j.joca.2014.05.026] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 04/18/2014] [Accepted: 05/30/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE This systematic literature review aimed to evaluate the use of conventional radiography (CR) in hand osteoarthritis (OA) and to assess the metric properties of the different radiographic scoring methods. DESIGN Medical literature databases up to November 2013 were systematically reviewed for studies reporting on radiographic scoring of structural damage in hand OA. The use and metric properties of the scoring methods, including discrimination (reliability, sensitivity to change), feasibility and validity, were evaluated. RESULTS Of the 48 included studies, 10 provided data on reliability, 11 on sensitivity to change, four on feasibility and 36 on validity of radiographic scoring methods. Thirteen different scoring methods have been used in studies evaluating radiographic hand OA. The number of examined joints differed extensively and the obtained scores were analyzed in various ways. The reliability of the assessed radiographic scoring methods was good for all evaluated scoring methods, for both cross-sectional and longitudinal radiographic scoring. The responsiveness to change was similar for all evaluated scoring methods. There were no major differences in feasibility between the evaluated scoring methods, although the evidence was limited. There was limited knowledge about the validity of radiographic OA findings compared with clinical nodules and deformities, whereas there was better evidence for an association between radiographic findings and symptoms and hand function. CONCLUSIONS Several radiographic scoring methods are used in hand OA literature. To enhance comparability across studies in hand OA, consensus has to be reached on a preferred scoring method, the examined joints and the used presentation of data.
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Affiliation(s)
- A W Visser
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
| | - P Bøyesen
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - I K Haugen
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - J W Schoones
- Walaeus Library, Leiden University Medical Center, Leiden, The Netherlands
| | - D M van der Heijde
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - F R Rosendaal
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - M Kloppenburg
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands; Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
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O'Brien VH, McGaha JL. Current practice patterns in conservative thumb CMC joint care: survey results. J Hand Ther 2014; 27:14-22. [PMID: 24238930 DOI: 10.1016/j.jht.2013.09.001] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Revised: 09/02/2013] [Accepted: 09/03/2013] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Cross-sectional descriptive survey INTRODUCTION Best practice for conservative clinical care pathways is not well outlined in the literature for patients with thumb carpometacarpal joint (CMCJ) pain. This self-report survey investigated the current practice patterns of assessments and conservative interventions for the painful thumb CMCJ among hand therapists. METHODS An online survey was distributed to members of the American Society of Hand Therapists (ASHT). Questions were included about evaluation measures and intervention techniques used for this population. A descriptive analysis was completed of the results. RESULTS A total of 23.5% of the ASHT membership responded to the survey. Results were categorized using the International Classification of Functioning and Disability domains as a framework. The survey results report varying use of evaluation measures, therapeutic interventions, including orthotic fabrication, joint protection and patient education all therapeutic interventional techniques, and modalities. CONCLUSION Therapists use a comprehensive array of evaluation measures and interventions for body functions and structures in the care of thumb CMC pain. In contrast, more consistent use is needed of psychometrically-sound functional outcome measures that show change in activities and participation. This survey highlights areas to employ current evidence, as well as, future research should address environmental factors and personal factors for this population LEVEL OF EVIDENCE Not applicable.
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Affiliation(s)
- Virginia H O'Brien
- University of Minnesota Medical Center, Fairview, Fairview Hand Center, Minneapolis, MN, USA.
| | - Jamie L McGaha
- Washington University School of Medicine, Program in OT, St. Louis, MO, USA
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Moriatis Wolf J, Turkiewicz A, Atroshi I, Englund M. Prevalence of doctor-diagnosed thumb carpometacarpal joint osteoarthritis: an analysis of Swedish health care. Arthritis Care Res (Hoboken) 2014; 66:961-5. [PMID: 24339432 DOI: 10.1002/acr.22250] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Revised: 09/26/2013] [Accepted: 11/26/2013] [Indexed: 11/06/2022]
Abstract
OBJECTIVE While the prevalence of radiographic thumb carpometacarpal (CMC1) osteoarthritis (OA) is well-described, little is known about clinically symptomatic disease presenting to physicians for care. We sought to determine the prevalence of doctor-diagnosed CMC1 OA. METHODS Using health care data from Skåne in southern Sweden (population 1.24 million), we identified all adults ages >20 years who consulted a physician at least once and received a diagnosis for CMC1 OA (International Classification of Diseases, Tenth Revision, code M18). Data from the 15-year period 1998–2012 were analyzed. Using cross-referencing with the Swedish population register to exclude subjects who were deceased or had relocated, we obtained point estimates of the proportion of the population consulting for CMC1 OA. RESULTS The prevalence of doctor-diagnosed CMC1 OA in adults was estimated at 1.4% (2.2% in women and 0.62% in men). The mean±SD age in the prevalent CMC1 cohort (n=11,111) was 67.7±11.4 years; 78.5% of diagnoses were in women. Prevalence peaked in women ages 70–74 years with an estimate of 5.3% and in men ages 80–84 years with an estimate of 1.7%. Age at initial diagnosis also differed, with women presenting between ages 60–69 years and men presenting between ages 70–79 years. CONCLUSION The clinically important prevalence of CMC1 OA is 3 to 4 times higher in women than men. By the end of2012, more than 1 in 20 elderly women had consulted a physician for CMC1 OA over the last 15 years. The high prevalence of this subset of hand OA is a concern in an aging population.
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Zhou G, Wang J, Zhao M, Xie TX, Tanaka N, Sano D, Patel AA, Ward AM, Sandulache VC, Jasser SA, Skinner HD, Fitzgerald AL, Osman AA, Wei Y, Xia X, Songyang Z, Mills GB, Hung MC, Caulin C, Liang J, Myers JN. Gain-of-function mutant p53 promotes cell growth and cancer cell metabolism via inhibition of AMPK activation. Mol Cell 2014; 54:960-974. [PMID: 24857548 DOI: 10.1016/j.molcel.2014.04.024] [Citation(s) in RCA: 178] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Revised: 02/18/2014] [Accepted: 04/07/2014] [Indexed: 12/25/2022]
Abstract
Many mutant p53 proteins (mutp53s) exert oncogenic gain-of-function (GOF) properties, but the mechanisms mediating these functions remain poorly defined. We show here that GOF mutp53s inhibit AMP-activated protein kinase (AMPK) signaling in head and neck cancer cells. Conversely, downregulation of GOF mutp53s enhances AMPK activation under energy stress, decreasing the activity of the anabolic factors acetyl-CoA carboxylase and ribosomal protein S6 and inhibiting aerobic glycolytic potential and invasive cell growth. Under conditions of energy stress, GOF mutp53s, but not wild-type p53, preferentially bind to the AMPKα subunit and inhibit AMPK activation. Given the importance of AMPK as an energy sensor and tumor suppressor that inhibits anabolic metabolism, our findings reveal that direct inhibition of AMPK activation is an important mechanism through which mutp53s can gain oncogenic function.
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Affiliation(s)
- Ge Zhou
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
| | - Jiping Wang
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Mei Zhao
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Tong-Xin Xie
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Noriaki Tanaka
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Daisuke Sano
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Ameeta A Patel
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Alexandra M Ward
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Vlad C Sandulache
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Samar A Jasser
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Heath D Skinner
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Alison Lea Fitzgerald
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Abdullah A Osman
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Yongkun Wei
- Department of Molecular and Cellular Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Xuefeng Xia
- Department of Cancer Biology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; Center for Diabetes Research, Methodist Hospital Research Institute, Houston, TX 77030, USA
| | - Zhou Songyang
- Verna and Marrs McLean Department of Biochemistry and Molecular Biology, Baylor College of Medicine, Houston, TX 77030, USA; School of Life Sciences, Sun Yat-sen University, Guangzhou 510275, China
| | - Gordon B Mills
- Department of Systems Biology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Mien-Chie Hung
- Department of Molecular and Cellular Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; Graduated Institute of Cancer Biology and Center for Molecular Medicine, China Medical University, Taichung 404, Taiwan
| | - Carlos Caulin
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; Department of Genetics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Jiyong Liang
- Department of Systems Biology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Jeffrey N Myers
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; Department of Cancer Biology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
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