Thumb Carpometacarpal Joint Pathoanatomy—A Computed Tomography-Based Study

Abstract Background Thumb carpometacarpal joint (CMCJ) osteoarthritis is common and can lead to significant morbidity making it a condition frequently treated by hand surgeons when initial conservative measures fail. The surrounding ligamentous structures are complex and important to maintain thumb CMCJ stability. Objectives The aim of this study was to review the normal and arthritic anatomy of the thumb CMCJ, focusing on morphology and position of osteophytes and the gap between metacarpal bases, and the effect of these on intermetacarpal ligament integrity. This may be the sole ligament suspending the first metacarpal following trapeziectomy and could determine the need for further stabilization during surgery, avoiding potential future failures. Methods Computed tomography (CT) scans of a normal cohort and those with arthritic changes who had undergone trapeziectomy following the scan were identified. The three-dimensional reconstructions were examined for osteophyte position on the saddle and the intermetacarpal distance. Results A total of 55 patients, 30 normal and 25 arthritic, were identified and studied. The most common anatomic position for osteophytes was the intermetacarpal ulnar aspect of the trapezium. The intermetacarpal distance increased by an average of 2.1 mm in the presence of the arthritic process. Conclusions The findings point to an increase in the intermetacarpal distance, and hence lengthening of the ligament with potential damage, possibly secondary to osteophyte formation and wear. Further prospective research is required to determine whether using preoperative CT scanning to define osteophyte position and measure the intermetacarpal distance would predict probable damage to the ligament, hence providing an indication for stabilization and reconstruction in trapeziectomy surgery. Level of Evidence This is a Level III, retrospective cohort study.

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Results of 115 Rubis II reverse thumb carpometacarpal joint prostheses with a mean follow-up of 10 years

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193416687508 ◽

2017 ◽

Vol 42 (6) ◽

pp. 592-598 ◽

Cited By ~ 15

Author(s):

M. Dehl ◽

M. Chelli ◽

S. Lippmann ◽

S. Benaissa ◽

V. Rotari ◽

...

Keyword(s):

Clinical Results ◽

Carpometacarpal Joint ◽

Level Of Evidence ◽

Thumb Carpometacarpal Joint ◽

The Mean ◽

Thumb Carpometacarpal ◽

Joint Prostheses ◽

Clinical And Radiological Results

The aim of this study was to assess the clinical and radiological results of the Rubis II thumb carpometacarpal joint reverse prosthesis, at a mean follow-up of 10 years. Between 1997 and 2008, 253 prostheses were implanted in 199 patients; 115 were reviewed. The survival after a mean of 10 years was 89%. At the last follow-up, 70% of prostheses were painless; the others reported moderate or intermittent pain. The satisfaction rate was 98%. The mean opposition was 9 on the Kapandji scale; the mean QuickDASH score was 30. Wrist, key and tip pinch strengths were comparable with the non-operated side. Of the 115 implants, one was radiologically loose (1%) and 15 had suffered dislocations (13%), 12 of which were caused by an injury. Eleven thumbs had revision surgery. This study confirms that the good clinical results of the Rubis II prosthesis are maintained in the medium and long term, and represents a useful alternative to trapeziectomy for selected patients. Level of evidence: IV

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Quantitative analysis of in-vivo thumb carpometacarpal joint kinematics using four-dimensional computed tomography

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193418789828 ◽

2018 ◽

Vol 43 (10) ◽

pp. 1088-1097 ◽

Cited By ~ 5

Author(s):

Kemble K. Wang ◽

Xin Zhang ◽

David McCombe ◽

David C. Ackland ◽

Eugene T. Ek ◽

...

Keyword(s):

Computed Tomography ◽

Proximal Phalanx ◽

Joint Kinematics ◽

Helical Axis ◽

Carpometacarpal Joint ◽

Thumb Carpometacarpal Joint ◽

Instantaneous Axis Of Rotation ◽

Axis Of Rotation ◽

Thumb Carpometacarpal

The purpose of this study was to define the normal thumb carpometacarpal joint kinematics in-vivo during opposition and abduction using four-dimensional computed-tomography in four volunteers. Movement of the metacarpal relative to the trapezium was quantified using both Euler and helical axis representations. Articular surface contact patterns were also analysed. The overall axis of rotation for the movement of opposition and abduction passes through the trapezium and the base of the proximal phalanx, respectively. An abrupt change in instantaneous axis of rotation at terminal opposition was found. Ligament modelling shows dorsoradial ligament becomes tauter towards terminal opposition, whereas anterior oblique ligament becomes more slack. These results support the existence of the ‘screw-home’ pivot at terminal opposition and the importance of the dorsoradial ligament for stability in this position. The normal reference set in this study can help establish a diagnostic tool for subtle carpometacarpal instability, or for evaluating efficacy of surgery.

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Volume of the Thumb Carpometacarpal Joint

Journal of Wrist Surgery ◽

10.1055/s-0039-1693043 ◽

2019 ◽

Vol 09 (01) ◽

pp. 019-021

Author(s):

Kevin F. Lutsky ◽

Fred Liss ◽

Jack Graham ◽

Pedro K. Beredjiklian

Keyword(s):

Fluid Injection ◽

Diagnostic Study ◽

Limited Capacity ◽

Carpometacarpal Joint ◽

Maximum Volume ◽

Level Of Evidence ◽

Thumb Carpometacarpal Joint ◽

Level Ii ◽

The Mean ◽

Thumb Carpometacarpal

Background The volume of the carpometacarpal joint of the thumb (TCMC) and its capacity to accommodate fluid injection is unknown. Questions/Purpose The purpose of the present study is to assess the volume of the TCMC. Methods Forty-two thumbs undergoing surgical treatment for symptomatic TCMCJ osteoarthritis (OA) were evaluated. Prior to the start of the surgical procedure saline was injected into the TCMC until resistance was felt and no further saline could be injected. The maximum volume (MaxVol) of injectate was measured and recorded. Results Mean MaxVol among all patients was 0.9 cc (range: 0.2–3.0 cc). There were 15 patients with 1 cc or more injected, the rest were less than 1 cc. The mean MaxVol for Eaton 2 thumbs was 1.5 cc, for Eaton 3 thumbs 0.9 cc, and for Eaton 4 thumbs 0.7 cc, with negative correlation between Eaton stage and MaxVol. Conclusion TCMC has limited capacity for injected fluid. Level of Evidence This is a Level II, diagnostic study.

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Simple trapeziectomy versus trapeziectomy with flexor carpi radialis suspension: a 17-year follow-up of a randomized blind trial

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193420952966 ◽

2020 ◽

pp. 175319342095296

Author(s):

Adrian Brennan ◽

Julia Blackburn ◽

Jane Thomson ◽

Jeremy Field

Keyword(s):

Functional Outcomes ◽

Ligament Reconstruction ◽

Carpometacarpal Joint ◽

Long Term Outcomes ◽

Level Of Evidence ◽

Thumb Carpometacarpal Joint ◽

Thumb Carpometacarpal ◽

Tendon Interposition

The purpose of this study was to investigate if there were any significant differences in the long-term outcomes of patients who participated in a randomized trial of trapeziectomy alone compared with trapeziectomy with ligament reconstruction and tendon interposition (LRTI). Sixty-five patients were invited for a follow-up visit at a mean of 17 years (range 15–20) postoperatively. Twenty-eight patients attended, who had 34 operations, 14 trapeziectomy alone and 20 with LRTI. There were no statistically significant differences between the two groups in terms of satisfaction with surgery or functional outcomes, with most measurements showing minimal or no differences in means between the two groups. There was no difference in the space between the metacarpal and scaphoid. Radial abduction was the only parameter that was significantly greater in the patients with simple trapeziectomy (median 79°) compared with trapeziectomy with LRTI (median 71°) ( p = 0.04). Even at 17 years there is no significant benefit of LRTI over trapeziectomy alone for thumb carpometacarpal joint osteoarthritis. Level of evidence: I

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Failure of an uncemented thumb carpometacarpal joint ceramic prosthesis

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193416688427 ◽

2017 ◽

Vol 42 (6) ◽

pp. 599-604 ◽

Cited By ~ 7

Author(s):

E. Kollig ◽

W. Weber ◽

D. Bieler ◽

A. Franke

Keyword(s):

Visual Analogue Scale Pain ◽

Carpometacarpal Joint ◽

Level Of Evidence ◽

Thumb Carpometacarpal Joint ◽

Bioactive Coating ◽

Early Loosening ◽

Analogue Scale Pain ◽

Trapezium Fracture ◽

Thumb Carpometacarpal

Thumb carpometacarpal joint replacement is associated with high rates of loosening and failure. We present our results for an uncemented ceramic–ceramic total joint prosthesis with a reverse ball-and-socket design and bioactive coating. Between 2008 and 2012, 29 prostheses were inserted into 28 patients (mean age 63 years) with advanced osteoarthritis. After a mean period of 33 months (range 9–62), 26 patients (27 implants) were available for follow-up. Six months postoperatively, 50% of the patients had radiological evidence of early loosening. Fifteen implants had been removed in 14 patients for aseptic loosening (13) or trapezium fracture (2). The 12 patients whose prosthesis was still in place had a mean visual analogue scale pain score of 1.9 (range 0–6) and a mean Disabilities of the Arm, Shoulder and Hand score of 23 (range 0–73.3). Eleven patients were satisfied with the procedure. The rate of early aseptic failure was unacceptably high. Level of evidence: IV

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Outcomes of denervation, joint lavage and capsular imbrication for painful thumb carpometacarpal joint osteoarthritis

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193416632149 ◽

2016 ◽

Vol 41 (9) ◽

pp. 904-909 ◽

Cited By ~ 10

Author(s):

D. Ehrl ◽

H. C. Erne ◽

P. N. Broer ◽

C. Metz ◽

E. Falter

Keyword(s):

Case Series ◽

Good Alternative ◽

Carpometacarpal Joint ◽

Level Of Evidence ◽

Thumb Carpometacarpal Joint ◽

Recovery Times ◽

Surgical Options ◽

Thumb Carpometacarpal ◽

Joint Lavage

Pain reduction remains the main aim in the treatment of thumb carpometacarpal joint osteoarthritis. We performed a retrospective analysis of a case series of patients with symptomatic thumb carpometacarpal joint arthritis treated with denervation, joint lavage and capsular imbrication. A total of 60 patients participated in this study. Follow-up, including a clinical examination, was performed on 37 patients at a mean of 46 months (range 12 to 81); an additional 23 patients were followed-up by telephone at a mean of 52 months (range 14 to 93) post-operatively. The patients assessed in person showed a significant decrease in pain and a significant improvement in thumb function. The information gathered by telephone gave similar results. The findings of our study indicate that the presented treatment approach could be a good alternative to more invasive surgical options in patients with earlier stages of thumb carpometacarpal joint osteoarthritis. Advantages include the low rate of complications and invasiveness, as well as short recovery times. Level of evidence: IV

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Arthroscopic Debridement vs Arthroscopic Hemi-Trapeziectomy on Patients With Thumb Carpometacarpal Joint Osteoarthritis

Case Medical Research ◽

10.31525/ct1-nct04217928 ◽

2020 ◽

Author(s):

Keyword(s):

Arthroscopic Debridement ◽

Carpometacarpal Joint ◽

Thumb Carpometacarpal Joint ◽

Thumb Carpometacarpal

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Arthroplasty in the hand: what works and what doesn’t?

Journal of Hand Surgery (European Volume) ◽

10.1177/17531934211017703 ◽

2021 ◽

pp. 175319342110177

Author(s):

Daniel B. Herren ◽

Hajime Ishikawa ◽

Marco Rizzo ◽

Mark Ross ◽

Michael Solomons

Keyword(s):

Surgical Technique ◽

Metacarpophalangeal Joint ◽

Distal Radioulnar Joint ◽

Proximal Interphalangeal Joint ◽

Interphalangeal Joint ◽

Carpometacarpal Joint ◽

Thumb Carpometacarpal Joint ◽

Radioulnar Joint ◽

What Works ◽

Thumb Carpometacarpal

This review describes the different possibilities for arthroplasties at the proximal interphalangeal joint, thumb carpometacarpal joint, distal radioulnar joint, metacarpophalangeal joint and the wrist. For each joint, the indication for arthroplasty is explained, the surgical technique with the suitable implant is described and a brief summary of the outcomes reported in the literature is given.

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