Description and Clinical Assessment of the Bone Block Tendon Interposition Technique for the Management of Thumb Carpometacarpal Joint Osteoarthritis

2018 ◽  
Vol 23 (04) ◽  
pp. 515-519
Author(s):  
Diego F. Rincon Cardozo ◽  
Wynston J. Alvarez Martinez ◽  
Jhon F. Castañeda Lopez ◽  
Fredy A. Angarita Maldonado ◽  
Juliana A. Rojas Neira ◽  
...  
Keyword(s):  
Case Series ◽  
Functional Results ◽  
Interference Screw ◽  
Pinch Strength ◽  
Bone Block ◽  
Dash Score ◽  
Carpometacarpal Joint ◽  
Thumb Carpometacarpal Joint ◽  
Thumb Carpometacarpal ◽  
And Function

Background: Pellegrini’s surgical technique is the most useful for thumb carpometacarpal joint osteoarthritis. The purpose of this paper is to describe the technique of a modified version using a bone block in the tunnel through which the flexor carpi radialis tendon is passed (BBTI). Methods: Case series of patients diagnosed with osteoarthritis of the thumb carpometacarpal joint, in stage II or higher based on Eaton’s classification, that were intervened using the BBTI technique for a 2-year period. Grip and pinch strength, range of motion, and 1–2 metacarpal angle were evaluated. Pain and function were measured using the visual analogue scale and the Disabilities of the Arm, Shoulder and Hand (DASH) scale. Results: The study included 16 cases in 14 patients (11 women and 3 men), with an average age of 55.7 ± 7.1 years. Encouraging results were obtained, with an average DASH score of 24.3 ± 17.9 and a minimum VAS pain score. A total of 58% showed a grip strength of over 80% and the postoperative movement was equivalent to the contralateral limb. No cases of infection were reported, and only two minor complications were observed. Conclusions: The BBTI technique is a surgical option that incorporates an interference screw, offering good functional results for managing osteoarthritis of the thumb carpometacarpal joint, with a similar complication rate to that of the original technique.

Trapeziometacarpal narrow pseudarthrosis: a new surgical technique to treat thumb carpometacarpal joint arthritis

2012 ◽  
Vol 38 (8) ◽  
pp. 844-850 ◽  
Author(s):  
M. Rubino ◽  
A. Civani ◽  
D. Pagani ◽  
V. Sansone
Keyword(s):  
Clinical Outcome ◽  
Surgical Techniques ◽  
Pinch Strength ◽  
Dash Score ◽  
Carpometacarpal Joint ◽  
Thumb Carpometacarpal Joint ◽  
Thumb Carpometacarpal ◽  
Excision Arthroplasty ◽  
Joint Arthritis

We describe a technique that arose from the observation of the clinical outcome of failed arthrodeses of the thumb carpometacarpal joint. In these cases a pseudoarthrosis developed which, surprisingly, rarely lead to a poor clinical outcome. Thus we developed a simple technique which deliberately caused the formation of a narrow pseudoarthrosis in the carpometacarpal joint. We present a retrospective review of 248 consecutive patients treated for Eaton stages II and III osteoarthritis. We observed a statistically significant improvement in mean appositional and oppositional pinch strength, mean DASH score (63.8 pre-operatively to 10.5 at final follow-up), and the mean pain score (8.3 to 0.2). We conclude that trapeziometacarpal limited excision arthroplasty is a simple and reliable alternative to existing surgical techniques for treating Stage II or III thumb carpometacarpal joint arthritis.

ARTHROSCOPIC EVALUATION AND TREATMENT BY TENDON INTERPOSITIONAL ARTHROPLASTY OF FIRST CARPOMETACARPAL JOINT ARTHRITIS

Hand Surgery ◽  
2007 ◽  
Vol 12 (01) ◽  
pp. 35-39 ◽  
Author(s):  
L. Pegoli ◽  
C. Parolo ◽  
T. Ogawa ◽  
S. Toh ◽  
G. Pajardi
Keyword(s):  
Pinch Strength ◽  
Carpometacarpal Joint ◽  
Thumb Carpometacarpal Joint ◽  
Mayo Score ◽  
Basal Joint ◽  
Palmaris Longus Tendon ◽  
Thumb Carpometacarpal ◽  
Tendon Interposition ◽  
Joint Arthritis

Basal joint arthritis of the thumb is usually seen in females beginning from the fourth and fifth decades. In the last two decades, arthroscopic techniques have brought new chances of diagnosis and treatment for this condition. In this paper, the authors describe the indications and their experience concerning arthroscopic hemitrapezectomy and tendon interposition using the palmaris longus tendon. A series of 16 patients with a maximum follow-up of 12 months is analysed. All of the 16 patients were followed and assessed with grasp strength, pinch strength, DASH and MAYO evaluation score both pre- and post-operatively at 12 months follow-up. According to the MAYO score, there were six excellent results, six good, three fair and one poor. No complications occurred. According to our preliminary results, this procedure with the proper indications gives a valid option for the treatment of thumb carpometacarpal joint arthritis in stages I and II according to Eaton's classification.

A systematic review and meta-analysis of arthroscopic assisted techniques for thumb carpometacarpal joint osteoarthritis

2018 ◽  
Vol 43 (10) ◽  
pp. 1098-1105 ◽  
Author(s):  
Suzanne C. Wilkens ◽  
Claudia A. Bargon ◽  
Amin Mohamadi ◽  
Neal C. Chen ◽  
J. Henk Coert
Keyword(s):  
Systematic Review ◽  
Grip Strength ◽  
Meta Analysis ◽  
Pinch Strength ◽  
Carpometacarpal Joint ◽  
Arthroscopic Management ◽  
Thumb Carpometacarpal Joint ◽  
Before And After ◽  
Thumb Carpometacarpal ◽  
Meta Analyses

Arthroscopic management of thumb carpometacarpal (CMC) osteoarthrosis (OA) is an approach that has unclear results. We performed a systematic review encompassing three electronic databases up to May 2016 for studies describing arthroscopic-assisted techniques for thumb CMC OA. Meta-analyses of visual analogue scores (VAS) for pain, Disabilities of the Arm, Shoulder and Hand (DASH) scores, grip strength and pinch strength before and after arthroscopy were performed for ten included non-randomized cohort studies comprising 294 patients. Based on Hedges’ g measure, we found a large effect on VAS and DASH scores, a small effect on grip strength and no effect on pinch strength. On average, VAS improved by 4.1 cm, DASH by 22 points and grip strength by 2.8 kg. Complications were reported in 4% of patients. The use of arthroscopic-assisted techniques for thumb CMC OA is still limited; however, it may be a reasonable option for patients with thumb CMC OA who do not respond to non-operative treatment.

scholarly journals TOUCH® Prosthesis for Thumb Carpometacarpal Joint Osteoarthritis: A Prospective Case Series

2021 ◽  
Vol 10 (18) ◽  
pp. 4090
Author(s):  
Stefan M. Froschauer ◽  
Matthias Holzbauer ◽  
Julian A. Mihalic ◽  
Oskar Kwasny
Keyword(s):  
Case Series ◽  
Pinch Strength ◽  
Dual Mobility ◽  
Neck Size ◽  
Thumb Carpometacarpal Joint ◽  
Preoperative Status ◽  
Prospective Case Series ◽  
Thumb Carpometacarpal ◽  
Inappropriate Choice

The dual mobility concept currently represents the newest generation of thumb carpometacarpal prostheses. The aim of this study was to evaluate the short-term outcomes of TOUCH® prosthesis. From September 2019 to July 2020, 40 prosthesis were implanted in 37 patients suffering from symptomatic stage III osteoarthritis. All included patients with a median age of 57.7 (IQR: 13.6) finished the systematic follow-up regimen (4, 8, 16 weeks, 6, and 12 months postoperatively). All parameters significantly improved (p < 0.0001) compared to the preoperative status. At 1 year follow-up, median DASH Scores decreased from 54 (IQR 22) to 12 (IQR 28) and pain levels improved from 8 (IQR 2) to 1 (IQR 2). Moreover, key-pinch strength increased from 3.8 (2.0) to 5.8 (2.5), while palmar abduction, radial abduction, and opposition also significantly improved. 35/37 patients were satisfied with the functional outcomes. We observed 10 complications, of which 6 were tendon-related issues, and 2 were due to an inappropriate choice of neck size. We could detect one dislocation but no evidence of cup loosening, tilting or subsidence in any patient. Despite the occurrence of some complications, we recommend implantation of this prosthesis type due to favorable clinical and radiological performance.

scholarly journals Modified Eaton-Littler's Reconstruction for Traumatic Thumb Carpometacarpal Joint Instability: Operative Technique and Clinical Outcomes

2017 ◽  
Vol 07 (03) ◽  
pp. 191-198 ◽  
Author(s):  
Karthikeyan Iyengar ◽  
William Loh ◽  
Hosam Matar
Keyword(s):  
Clinical Outcomes ◽  
Outcome Measures ◽  
Joint Instability ◽  
Case Series ◽  
Strength Analysis ◽  
Carpometacarpal Joint ◽  
Thumb Carpometacarpal Joint ◽  
Thumb Carpometacarpal ◽  
Cmc Joint

Background Injuries to thumb carpometacarpal joint ligaments lead to instability. Eaton-Littler's ligament reconstruction traditionally uses a strip of flexor carpi radialis to stabilize the CMC joint. Study Description We have modified this technique to reproduce the direction of active action of the anterior oblique ligament by reconstructing both the volar and dorsoradial ligaments. In this prospective study, we evaluated patients with confirmed traumatic thumb CMC joint instability who underwent modified Eaton-Littler's reconstruction. Strength analysis, Michigan Hand Outcome Questionnaire, QuickDASH, and subjective outcome measures were collected pre- and postoperatively with minimum 3 years of follow-up. Eleven patients were included in the final analysis, with mean age of 29 years (range: 16–52) and average follow-up of 6.2 years (range: 3–11). There was a statistically significant improvement in all outcome measures. Clinical Relevance Our modified technique helps to simultaneously address both volar and dorsal ligaments and yields satisfactory clinical outcomes at medium term follow-up. Level of Evidence Level IV, case series.

To Suspend or not to Suspend: A Randomised Single Blind Trial of Simple Trapeziectomy Versus Trapeziectomy and Flexor Carpi Radialis Suspension

2007 ◽  
Vol 32 (4) ◽  
pp. 462-466 ◽  
Author(s):  
J. FIELD ◽  
D. BUCHANAN
Keyword(s):  
Pinch Strength ◽  
Carpometacarpal Joint ◽  
Common Site ◽  
Range Of Movement ◽  
Strength Measurement ◽  
X Ray ◽  
Thumb Carpometacarpal Joint ◽  
Flexor Carpi Radialis ◽  
Thumb Carpometacarpal ◽  
Single Blind

The thumb carpometacarpal joint is the second most common site of osteoarthritis in humans. There are numerous operations for the condition but, perhaps, the commonest is trapeziectomy, sometimes supplemented by a suspension procedure, most commonly using part of the flexor carpi radialis tendon. In order to determine whether there is an advantage to a suspension procedure, or not, 65 patients with Eaton and Glickel Grade III or IV arthritis of the carpometacarpal joint of their thumbs were randomised into either undergoing trapeziectomy alone (with no wiring) or a trapeziectomy with flexor carpi radialis suspension. Patient satisfaction from both operations was similar. There was increased range of movement in the trapeziectomy alone group, but there was no difference in grip or pinch strength. Measurement of the gap on X-ray left by the trapeziectomy was less when trapeziectomy alone was performed.

scholarly journals Total Thumb Carpometacarpal Joint Arthroplasty: A Retrospective Functional Study of 28 MOOVIS Prostheses

Hand ◽  
2018 ◽  
Vol 14 (1) ◽  
pp. 59-65 ◽  
Author(s):  
Nicolas Dreant ◽  
Marie-Anne Poumellec
Keyword(s):  
Range Of Motion ◽  
Grip Strength ◽  
Functional Results ◽  
Joint Arthroplasty ◽  
Functional Study ◽  
Carpometacarpal Joint ◽  
Dual Mobility ◽  
Thumb Carpometacarpal Joint ◽  
The Mean ◽  
Thumb Carpometacarpal

Background: Trapeziometacarpal prostheses have been used for more than 50 years in the treatment of first carpometacarpal joint arthritis. Even though this technique is more expensive than trapeziectomy, it has many advantages such as faster convalescence with better patient comfort and improved strength and range of motion. The aim of this study was to report the early functional results of a patient cohort treated with a dual mobility thumb carpometacarpal joint prosthesis. Methods: A retrospective study was performed to assess the functional results of 25 patients treated for trapeziometacarpal advanced osteoarthritis (Eaton and Littler stage III) with 28 MOOVIS prostheses. Preoperative and postoperative assessments included pain, range of motion, and pinch and grip strength. The average follow-up time was 27.5 months. Results: The mean pain score measured by a visual analog scale was 8 preoperatively and 1 postoperatively. The mean preoperative Kapandji opposition score was 7 and counter-opposition score was 1; postoperative scores were 10 and 4, respectively. The grip strength improved after the surgery and the results were compared separately between dominant and nondominant sides. Final functional results were good: the mean Quick Disabilities of the Arm, Shoulder and Hand Questionnaire score was 12, and the mean Michigan Hand Outcomes score was 87%. Conclusions: Total joint arthroplasty with a dual mobility prosthesis appears to be a satisfactory solution in our series. The absence of prosthesis instability encourages us to recommend this technique for the treatment of advanced trapeziometacarpal osteoarthritis for people having an activity without too many manual constraints.

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

2016 ◽  
Vol 41 (9) ◽  
pp. 904-909 ◽  
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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