Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Symposium: Thumb Carpometacarpal Arthritis 16 articles

Articles

Surgical Treatment of Trapeziometacarpal Joint Arthritis: A Historical Perspective

Vincent R. Hentz MD

The trapeziometacarpal (TMC) joint’s unique anatomy and biomechanics render it susceptible to degeneration. For 60 years, treatment of the painful joint has been surgical when nonoperative modalities have failed. Dozens of different operations have been proposed, including total or subtotal resection of the trapezium or resection and implant arthroplasty. Proponents initially report high levels of patient satisfaction, but longer-term reports sometimes fail to support initial good results. To date, no one procedure has been shown to be superior to another.

A Systematic Review of Postoperative Hand Therapy Management of Basal Joint Arthritis

Terri Wolfe ORT/LCHT, Jennifer Y. Chu MD, Tammy Woods MD, John D. Lubahn MD

There are a variety of postoperative immobilization and therapy options for patients with basal joint arthritis. Although prior systematic reviews have compared surgical procedures used to treat basal joint arthritis, none to our knowledge compares therapy protocols for this condition, which are considered an important part of the treatment.

Intra- and Interobserver Reliability of the Eaton Classification for Trapeziometacarpal Arthritis: A Systematic Review

Aaron J. Berger MD, PhD, Arash Momeni MD, Amy L. Ladd MD

Trapeziometacarpal, or thumb carpometacarpal (CMC), arthritis is a common problem with a variety of treatment options. Although widely used, the Eaton radiographic staging system for CMC arthritis is of questionable clinical utility, as disease severity does not predictably correlate with symptoms or treatment recommendations. A possible reason for this is that the classification itself may not be reliable, but the literature on this has not, to our knowledge, been systematically reviewed.

Ultrastructure and Innervation of Thumb Carpometacarpal Ligaments in Surgical Patients With Osteoarthritis

Nathalie Mobargha MD, Cassie Ludwig BS, Amy L. Ladd MD, Elisabet Hagert MD, PhD

The complex configuration of the thumb carpometacarpal (CMC-1) joint relies on musculotendinous and ligamentous support for precise circumduction. Ligament innervation contributes to joint stability and proprioception. Evidence suggests abnormal ligament innervation is associated with osteoarthritis (OA) in large joints; however, little is known about CMC-1 ligament innervation characteristics in patients with OA. We studied the dorsal radial ligament (DRL) and the anterior oblique ligament (AOL), ligaments with a reported divergent presence of mechanoreceptors in nonosteoarthritic joints.

In Vivo Pilot Study Evaluating the Thumb Carpometacarpal Joint During Circumduction

Akira Goto MD, Shuai Leng PhD, Kazuomi Sugamoto MD, William P. Cooney MD, Sanjeev Kakar MD, Kristin Zhao PhD

Analysis of arthrokinematics may have clinical use in the diagnosis of dynamic instability of the thumb and wrist. Recent technological advances allow noninvasive, high-resolution imaging of skeletal (thumb and carpal bones) structures during motion.

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

Eni Halilaj BA, Michael J. Rainbow PhD, Christopher Got MD, Joel B. Schwartz BS, Douglas C. Moore MS, Arnold-Peter C. Weiss MD, Amy L. Ladd MD, Joseph J. Crisco PhD

The thumb carpometacarpal (CMC) joint is often affected by osteoarthritis—a mechanically mediated disease. Pathomechanics of the CMC joint, however, are not thoroughly understood due to a paucity of in vivo data.

Review of the Molecular Development of the Thumb: Digit Primera

Kerby C. Oberg MD, PhD

The thumb, or digit 1, is not a typical digit. In addition to its unusual mobility and function, its formation is also unusual. It is the last digit to form and the most commonly targeted when limb development is disrupted. The thumb domain is defined by the overlapping expression of HOXA13, TBX5, GLI3R, and HOXD13 and, importantly, by an absence of other distal HOXD transcription factors. This brief review, combining developmental biology and clinical genetics, discusses the current understanding of how the thumb domain is established.

Functional Task Kinematics of the Thumb Carpometacarpal Joint

Kali R. Luker MD, Arnel Aguinaldo ATC, MA, Deborah Kenney OTR, Katelyn Cahill-Rowley MS, Amy L. Ladd MD

Abnormal biomechanical loading has been identified as an associated risk factor of osteoarthritis in the wrist and hand. Empirical data to date are insufficient to describe the role of altered biomechanics in thumb carpometacarpal (CMC) arthritis.

Relationship of Relaxin Hormone and Thumb Carpometacarpal Joint Arthritis

Jennifer Moriatis Wolf MD, Danielle L. Scher MD, Eric W. Etchill MPH, Frank Scott MD, Allison E. Williams PhD, Steven Delaronde MPH, MSW, Karen B. King PhD

The female predominance in thumb carpometacarpal (CMC) joint arthritis has led to speculation that reproductive hormones or hypermobility are responsible. Evidence shows that patients with pathologic laxity have a higher rate of thumb CMC arthritis. Relaxin hormone increases laxity in the pelvic ligaments through upregulation of matrix metalloproteases (MMPs). It is thus a hormone of interest in the development of thumb CMC arthritis.

Degenerative Change at the Pseudarthrosis After Trapeziectomy at 6-year Followup

Hatem M. Salem MRCS, Tim R. C. Davis FRCS

Simple trapeziectomy has a well-documented history of success for the management of osteoarthritis at the trapeziometacarpal joint. There is concern, however, that late-onset failure can occur as a result of the development of degenerative disease at the scaphoid-metacarpal pseudarthrosis.

Does Arthroscopic Débridement With or Without Interposition Material Address Carpometacarpal Arthritis?

Julie E. Adams MD

Thumb carpometacarpal (CMC) joint arthritis is a common problem in clinical practice with a variety of treatment options. Arthroscopic procedures can preserve all or part of the trapezium in the setting of treatment of basilar joint arthritis, and such procedures (even without stabilization or ligament reconstruction) have high reported success rates. However, little is documented about the limitations of these procedures in terms of patient selection, the optimal type of interposition, if any, and rehabilitation.

Trapeziometacarpal Joint Stability: The Evolving Importance of the Dorsal Ligaments

James D. Lin MD, MS, John W. Karl MD, MPH, Robert J. Strauch MD

Trapeziometacarpal (TMC) arthritis of the thumb is a common source of hand pain and disability. TMC ligamentous instability may play a role in TMC degeneration. However, the relative importance of the TMC ligaments in the etiology of degeneration and the use of surgery to treat instability in early-stage arthritis are unclear.

The Role of Arthroscopy in Trapeziometacarpal Arthritis

David Joseph Slutsky MD

Trapeziometacarpal (TM) arthroscopy should be viewed as a useful minimally invasive adjunctive technique rather than the operation itself since it allows one to visualize the joint surface under high-power magnification with minimal disruption of the important ligamentous complex. Relatively few articles describe the arthroscopic treatment of TM osteoarthritis (OA) and the arthroscopic anatomy of the TM joint. There is lingering confusion as to whether soft tissue interposition and K-wire fixation of the joint are needed and whether the outcomes of arthroscopic procedures compare to the more standard open techniques for TM arthroplasty.