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Immobilization and Hand Therapy After Carpometacarpal Arthroplasty: A Systematic Review. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2022; 4:255-262. [PMID: 36157304 PMCID: PMC9492801 DOI: 10.1016/j.jhsg.2022.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 05/25/2022] [Indexed: 11/20/2022] Open
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Siegel P, Jackson D, Baugh C. Practice patterns following carpometacarpal (CMC) arthroplasty. J Hand Ther 2022; 35:67-73. [PMID: 33279365 DOI: 10.1016/j.jht.2020.10.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 10/13/2020] [Accepted: 10/21/2020] [Indexed: 02/09/2023]
Abstract
STUDY DESIGN Descriptive Survey. INTRODUCTION Therapy following thumb carpometacarpal (CMC) arthroplasty is a complex issue as there are multiple surgical procedures and postoperative rehabilitative programs. PURPOSE OF THE STUDY To gather information from therapy practitioners on practice patterns following thumb carpometacarpal (CMC) joint arthroplasty. METHODS A web-based survey was sent to 3221 occupational and physical therapists in a single stage via online technology. RESULTS Six-hundred and one (601) therapists responded to the survey. Key findings included: Most therapists (45.5%) indicated that the therapy program they use was developed in collaboration with the referring surgeon. In addition, most patients received a plaster splint or long thumb spica orthosis following surgery, but time frames for use varied widely. Fifty-five percent of respondents waited until after 22 days postsurgery to initiate active flexion/extension of the wrist, while 19.5% initiated wrist flexion/extension between eight and 14 days postsurgery. Ten percent of respondents initiated active thumb flexion/extension within the first postoperative week, while 55% of respondents did not initiate thumb motion until 22 or more days following surgery. Few respondents (5.7%) indicated that they used a published evidence-based treatment program to guide therapy following thumb CMC arthroplasty surgery. CONCLUSION This study demonstrates that multiple therapy programs exist and rehabilitation following thumb CMC arthroplasty predominantly utilizes clinical expertise.
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Affiliation(s)
- Patricia Siegel
- University of New Mexico, Occupational Therapy Graduate Program, Albuquerque, NM, USA.
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Comparison of 2 Postoperative Therapy Regimens After Trapeziectomy Due to Osteoarthritis: A Randomized, Controlled Trial. J Hand Surg Am 2022; 47:120-129.e4. [PMID: 34649742 DOI: 10.1016/j.jhsa.2021.08.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 06/17/2021] [Accepted: 08/18/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The main aim of the present study was to evaluate whether early mobilization after trapeziectomy in the first carpometacarpal joint is noninferior to a postoperative regimen comprising the use of a rigid orthosis and mobilization after 6 weeks, with regards to patient-reported activity performance and the effect of surgery in patients with first carpometacarpal osteoarthritis. METHODS In this prospective, randomized, controlled noninferiority trial, participants were assessed at baseline (before group allocation) and at 3, 6, and 12 months after surgery. The primary outcomes were activity performance, measured using the Canadian Occupational Performance Measure (1-10, where 1 = unable to perform), and the patient-reported effect of surgery on a 6-point scale ranging from "much worse" to "completely recovered." A change of 2.0 points in the Canadian Occupational Performance Measure was used as a noninferiority margin. Secondary outcomes included hand function (patient-reported in the Measure of Activity Performance of the Hand questionnaire), pain on a numeric rating scale, grip and pinch strengths, and joint mobility. We performed both intention-to-treat and per-protocol analyses. RESULTS Of the 59 participants (88% women) with a mean age of 65 years, 55 (93%) completed all assessments. We found no differences between the groups in primary or secondary outcomes at any time point, except for more decreased pain at rest in the intervention group (n = 28) compared with the control group (n = 27) after 12 months. The per-protocol analyses did not change these results. Fifteen participants experienced 1 or more adverse events during the first 3 months, but the types and frequencies of adverse events were similar between the 2 groups. CONCLUSIONS A postoperative regimen with early mobilization after trapeziectomy is as safe and effective as a postoperative regimen with longer immobilization in patients with first carpometacarpal osteoarthritis. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic II.
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Efremova L, Igeta Y, Fabacher T, Hidalgo Diaz JJ, Gouzou S, Liverneaux P, Facca S. Immobilization protocols following trapeziectomy for osteoarthritis of the thumb: 2 weeks versus 4 weeks. HAND SURGERY & REHABILITATION 2021; 41:73-77. [PMID: 34781000 DOI: 10.1016/j.hansur.2021.10.318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 10/05/2021] [Accepted: 10/31/2021] [Indexed: 11/26/2022]
Abstract
We compared the clinical outcomes of post-trapeziectomy protocols according to their duration. The main hypothesis was that there would be no significant difference in postoperative function whether immobilization duration was 2 or 4 weeks. The secondary hypotheses were that there would be no significant difference in postoperative pain, motion, or strength. 40 trapeziectomies were reviewed. Two weeks' postoperative commissural immobilization was systematic. Patients were then divided in two groups. For the first 20 patients (group I), immobilization stopped at 2 weeks. For the next 20 patients (group II) it was replaced by a splint for further 2 weeks. We compared mean pre- and post-operative (10-20 weeks) function (QuickDASH score), pain (visual analog scale - VAS), thumb opposition (Kapandji score) and strength (palmar pinch test) between the two groups. There was no significant difference between groups in postoperative values or in pre- to post-operative progression. The main hypothesis was confirmed: there was no significant difference in the postoperative function whether the immobilization was for 2 or 4 weeks. The secondary hypotheses regarding postoperative pain, motion and strength were also confirmed.
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Affiliation(s)
- L Efremova
- Department of Hand Surgery, SOS Hand, Hautepierre 2, Strasbourg University Hospital, University of Strasbourg, 1 Avenue Molière, 67000 Strasbourg, France
| | - Y Igeta
- Jutendo University, 2 Chome-1-1 Hongo, Bunkyo City, Tokyo 113-8421, Japan
| | - T Fabacher
- Department of Public Health, Methodology and Biostatistics Sector, University Hospital of Strasbourg, 1 Rue David Richard, 67000 Strasbourg, France
| | - J J Hidalgo Diaz
- Department of Hand Surgery, SOS Hand, Hautepierre 2, Strasbourg University Hospital, University of Strasbourg, 1 Avenue Molière, 67000 Strasbourg, France
| | - S Gouzou
- Department of Hand Surgery, SOS Hand, Hautepierre 2, Strasbourg University Hospital, University of Strasbourg, 1 Avenue Molière, 67000 Strasbourg, France
| | - P Liverneaux
- Department of Hand Surgery, SOS Hand, Hautepierre 2, Strasbourg University Hospital, University of Strasbourg, 1 Avenue Molière, 67000 Strasbourg, France; Icube Laboratory, UMR 7357, CNRS, 2-4 Rue Boussingault, 67000 Strasbourg, France
| | - S Facca
- Department of Hand Surgery, SOS Hand, Hautepierre 2, Strasbourg University Hospital, University of Strasbourg, 1 Avenue Molière, 67000 Strasbourg, France; Icube Laboratory, UMR 7357, CNRS, 2-4 Rue Boussingault, 67000 Strasbourg, France.
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Tsehaie J, Wouters RM, Feitz R, Slijper HP, Hovius SER, Selles RW. Shorter vs Longer Immobilization After Surgery for Thumb Carpometacarpal Osteoarthritis: A Propensity Score-Matched Study. Arch Phys Med Rehabil 2019; 100:2022-2031.e1. [PMID: 31026460 DOI: 10.1016/j.apmr.2019.02.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 01/24/2019] [Accepted: 02/01/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To investigate if shorter immobilization is noninferior to longer immobilization after Weilby procedure for thumb carpometacarpal osteoarthritis DESIGN: Prospective cohort study with propensity score matching. SETTING Data collection took place in 16 outpatient clinics for hand surgery and hand therapy. PARTICIPANTS A total of 131 participants with shorter immobilization and 131 participants with longer immobilization (N=262). INTERVENTION Shorter immobilization (3-5 days plaster cast followed by a thumb spica orthosis including wrist until 4 weeks postoperatively) was compared with longer immobilization (10-14 days plaster cast followed by a thumb spica orthosis including wrist until 6 weeks postoperatively) after Weilby procedure for first carpometacarpal joint osteoarthritis. Propensity score matching was used to control for confounders. MAIN OUTCOME MEASURES Outcomes were pain measured with a visual analog scale and hand function measured with the Michigan Hand Outcomes Questionnaire at 3 and 12 months. Secondary outcomes were complications, range of motion, grip and pinch strength, satisfaction with treatment, and return to work. RESULTS No significant differences were found in visual analog scale pain (effect size, 0.03; 95% confidence interval [CI], -0.21 to 0.27) or the Michigan Hand Outcomes Questionnaire (effect size, 0.01; 95% CI, -0.23 to 0.25) between the groups at 3 months or at 12 months. Furthermore, no differences were found in complication rate or in other secondary outcomes. CONCLUSIONS In conclusion, shorter immobilization of 3-5 days of a plaster cast after Weilby procedure is equal to longer immobilization for outcomes on pain, hand function, and our secondary outcomes. These results indicate that shorter immobilization is safe and can be recommended, since discomfort of longer immobilization may be prevented and patients may be able to recover sooner, which may lead to reduced loss of productivity. Future studies need to investigate effectiveness of early active and more progressive hand therapy following first carpometacarpal joint arthroplasty.
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Affiliation(s)
- Jonathan Tsehaie
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus Medical Center, Rotterdam, the Netherlands; Hand and Wrist Center, Xpert Clinic, Rotterdam, the Netherlands; Department of Rehabilitation Medicine, Erasmus Medical Center, Rotterdam, the Netherlands.
| | - Robbert M Wouters
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus Medical Center, Rotterdam, the Netherlands; Department of Rehabilitation Medicine, Erasmus Medical Center, Rotterdam, the Netherlands; Center for Hand Therapy, Handtherapie Nederland, Utrecht, the Netherlands
| | - Reinier Feitz
- Hand and Wrist Center, Xpert Clinic, Rotterdam, the Netherlands
| | - Harm P Slijper
- Hand and Wrist Center, Xpert Clinic, Rotterdam, 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, Rotterdam, 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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Hutchinson DT, Sueoka S, Wang AA, Tyser AR, Papi-Baker K, Kazmers NH. A Prospective, Randomized Trial of Mobilization Protocols Following Ligament Reconstruction and Tendon Interposition. J Bone Joint Surg Am 2018; 100:1275-1280. [PMID: 30063589 DOI: 10.2106/jbjs.17.01157] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate the hypothesis that an increased duration of immobilization following trapeziectomy with ligament reconstruction and tendon interposition (LRTI) leads to improved patient-reported outcomes compared with an early mobilization protocol. METHODS At 2 institutions, we prospectively randomized 223 patients (238 thumbs) undergoing LRTI to receive 1 of 2 postoperative rehabilitation protocols. The immobilization protocol consisted of use of a postoperative forearm-based thumb-spica splint for 7 days followed by a forearm-based thumb-spica cast for 5 weeks and then by a custom forearm-based thermoplastic thumb-spica splint for an additional 6 weeks. An active range of motion (ROM) was started 6 weeks postoperatively. The early mobilization protocol consisted of the same postoperative splint for 7 days followed by use of a forearm-based thermoplastic thumb-spica splint for 3 weeks and then by a hand-based thumb-spica splint for 4 weeks. An active ROM was started 4 weeks postoperatively. The outcome measures included the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire; pinch and grip strength; 9-hole peg test (NHP); visual analog scale (VAS) for pain; VAS for patient satisfaction; and wrist and thumb ROM. These were measured preoperatively and at 6, 12, 26, 52, and 104 weeks postoperatively. Differences in continuous and categorical variables were assessed with use of Tukey multiple comparisons following 1-way analysis of variance and Fisher exact tests, respectively. RESULTS A minimum follow-up of 1 year (mean, 1.7 years) was achieved for 71% (169) of the 238 randomized thumbs (157 of the 223 patients): 74 patients (80 thumbs) treated with the immobilization protocol and 83 patients (89 thumbs) treated with the early mobilization protocol. DASH scores, VAS pain scores, VAS patient satisfaction scores, and strength all improved similarly with no significant differences between groups at any time point. Wrist and thumb ROM and NHP outcomes were significantly worse for the immobilization group at 6 weeks postoperatively, with no differences observed between groups at 12 weeks and beyond. CONCLUSIONS A conservative immobilization protocol does not improve functional outcomes, satisfaction, strength, or ROM following LRTI compared with an early mobilization protocol. LEVEL OF EVIDENCE Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
| | - Stephanie Sueoka
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah
| | - Angela A Wang
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah
| | - Andrew R Tyser
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah
| | | | - Nikolas H Kazmers
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah
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Anwar R, Cohen A, Nicholl JE. The gap after trapeziectomy: a prospective study. ACTA ACUST UNITED AC 2006; 31:566-8. [PMID: 16920237 DOI: 10.1016/j.jhsb.2006.06.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2005] [Revised: 06/04/2006] [Accepted: 06/15/2006] [Indexed: 11/16/2022]
Abstract
Thirteen patients with basal joint arthritis of the thumb were treated by simple trapeziectomy. All patients underwent radiological assessment pre-operatively and at 2, 4 and 12 weeks after surgery. Special standardised views were taken to assess changes in the 'trapezial gap'. Collapse of this was noticed up to 4 weeks following surgery but no significant change occurred thereafter. In respect of this collapse, prolonging immobilisation after 4 weeks is probably unnecessary.
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Affiliation(s)
- R Anwar
- Kent & Sussex Hospital, Tunbridge Wells, Kent, UK.
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Demir E, Wittemann M, Germann G, Sauerbier M. Treatment of Idiopathic Postmenopausal Osteoarthrosis of the Trapeziometacarpal Joint With the Epping Resection Arthroplasty Technique. Ann Plast Surg 2005; 54:147-52. [PMID: 15655464 DOI: 10.1097/01.sap.0000143607.46558.7a] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Surgical treatment of idiopathic postmenopausal osteoarthrosis of the trapeziometacarpal joint with the Epping resection arthroplasty was performed in 57 cases in 49 women. Data show good pain relief (between 58% and 76%), very good subjective results with 89% patient satisfaction and Disability of Arm, Shoulder, Hand (DASH) scores in the lower third of the scale after 35 months' follow-up. Good functional results with respect to radial abduction (51 degrees) and palmar flexion (45 degrees), as well as improvement in strength measurements, could be achieved. Some patients (13%) reported remaining problems with occasional pain during performance of activities of daily life and work. A significant proximal metacarpal migration (31%) without correlation to objective or subjective outcome was found. The Epping procedure has proven to be a valuable alternative procedure to treat idiopathic postmenopausal trapeziometacarpal arthrosis after a midterm follow-up period. Still, careful patient selection is important and sufficient preoperative information necessary.
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Affiliation(s)
- Erhan Demir
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Plastic and Hand Surgery of the University of Heidelberg, Ludwigshafen, Germany
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