Update on Thumb Basal Joint Arthritis Surgery

Magnetic Resonance Imaging of Thumb Carpometacarpal Arthroplasty: Preoperative Evaluation and Postoperative Imaging

In this review we discuss the magnetic resonance imaging (MRI) appearance of thumb carpometacarpal (CMC) arthroplasty, both the preoperative evaluation and particularly the postoperative MRI of different surgical options for patients with advanced degenerative disease of the basal joint of the thumb. The first CMC joint is one of the most frequently involved articulations in the hand and wrist in the setting of degenerative osteoarthrosis and certainly a pain generator and important cause of disability due to its significant impact on hand function. It is the most common joint for which surgery is sought in the wrist. Radiologists interpreting imaging studies of patients with first CMC joint arthroplasty must be familiar with the normal and abnormal preoperative appearance of the thumb basal joint. Moreover, knowledge of the normal postoperative MRI findings, as well as the appearance of patterns of failure and complications, is of paramount importance.

Selective Denervation for the Thumb Carpometacarpal Joint: Clinical Outcome and Comparison Based on Eaton Stage

PURPOSE

Various operative treatment options for advanced thumb carpometacarpal (CMC) joint arthritis have been presented without a definite surgical guideline. Selective denervation is a less invasive method for thumb CMC arthritis. However, it is unclear whether the clinical outcome varies with the stage of thumb CMC arthritis. This study aimed to evaluate the effectiveness of selective denervation on CMC arthritis for pain relief and functional outcome and to determine whether selective denervation depends on the stage of thumb CMC arthritis.

METHODS

We evaluated 29 thumbs of 28 patients with thumb CMC arthritis treated with selective denervation. The disease stage was determined with the classification system described by Eaton. The denervation was performed in the articular branches of the palmar cutaneous branch of the median nerve, lateral antebrachial cutaneous nerve, and superficial branch of radial nerve. The clinical outcomes were evaluated using the visual analog scale (VAS) and Disabilities of the Arm, Shoulder, and Hand (DASH) scores, along with evaluation of the improvement in both postoperative range of motion and strength recovery.

RESULTS

The mean duration of follow-up was 24 months (range, 18-48 months). The average VAS and DASH scores decreased from 6.1 to 1.3 and from 54.3 to 24.1, respectively. The range of motion during palmar abduction and opposition of the metacarpophalangeal joint improved with an increase in mean value from 44.1 to 53.7 degrees, and the Kapandji score increased from 7.2 to 9.2, respectively. The grip and key pinch strengths increased from mean preoperative values of 14.3 and 3.1 kg to 27.1 and 6.2 kg, respectively, as measured at the 12-month follow-up. The rate of change in the VAS and DASH scores was significantly higher in stages I to III than in stage IV ( P = 0.01, P < 0.01, respectively).

CONCLUSION

The selective denervation for thumb CMC arthritis was effective in pain relief and functional recovery with several advantages, including less invasive procedure, quick recovery time, and regaining of strength. The clinical outcomes were more effective in the early-stage group (Eaton stages I and II) compared with the advance-stage group (Eaton stages III and IV).

Liparthroplasty for Thumb Carpometacarpal Joint Osteoarthritis: A Case Series with Median 5 Years of Follow-Up

Liparthroplasty has recently been discussed as a promising bridging therapy after failed conservative treatment options to postpone arthroplasty surgery of the thumb carpometacarpal joint as long as possible. The current study investigates the sustainability of this method in seven stage II and twenty-four stage III osteoarthritis patients (twenty-seven female and four male cases). Data were evaluated preinterventionally, six months postinterventionally, and two years postinterventionally, as well as a final follow-up assessment after median 5.1 years. We found a significant reduction of all postinterventional disabilities of the arm, shoulder, and hand (dash) scores and pain levels compared to the ones prior to liparthroplasty. Moreover, we even detected a reduction in both parameters within the postinterventional course, so that the DASH scores of our final investigation were significantly lower than the values after six months. Furthermore, 12 of our 31 cases demanded a surgical conversion due to recurrence of symptoms. A binary regression analysis found smokers to have 11 times higher odds for therapy failure, leading to surgical conversion. Seventeen out of nineteen patients in our final assessment stated that they were pleased with liparthroplasty. Due to favorable mid-term outcomes of 61% of the 31 initially treated patients, we recommend liparthroplasty as a reliable bridging therapy for preserving joint integrity as long as possible, especially in non-smoking patients.