Benefits of Additional Procedures for Metacarpophalangeal Hyperextension on Simple Trapeziectomy in Thumb Basal Osteoarthritis: A Biomechanical Cadaver Study

Background: Patients with advanced osteoarthritis of the first carpometacarpal joint (CMC-1) may develop hyperextension of the first metacarpophalangeal joint (MCP-1). No clear clinical benefice has been reported consecutively to the surgical treatment of the MCP-hyperextension combined to a trapeziectomy. The reason of the missing benefit may be due to changes in the thumb position impairing the thumb stability secondary to the surgical procedures. We assessed changes in the transmission of forces at the thumb’s end phalanx following a trapeziectomy combined with the surgical adjustment of the hyperextension of the MCP-1-joint in a biomechanical investigation using cadavers. Methods: The thumb muscles were loaded with nylon cables connected to a tension meter in 8 forearm cadavers. A 6-axis force sensor assessed the termino-lateral key-pinch orthogonal strength vectors at the level of the thumb distal phalanx prior to any surgery, and following a simple trapeziectomy, a trapeziectomy combined to a MCP-1-capsulodesis and the transfer of the extensor pollicis brevis over the metacarpal-1 head, or to an MCP-1-arthrodesis. Results: Combination of the trapeziectomy with the MCP-1- joint palmar capsulodesis and EPB-transfer or with a MCP-arthrodesis in neutral pronation-supination resulted in a significant shift of the thumb in pronation-abduction with respect to the preoperative assessment. The lowest shift was achieved when performing the arthrodesis in 20° supination or by overloading of the adductor pollicis. Conclusions: Combining the trapeziectomy with surgeries addressing the MCP-1-joint hyperextension induced a shift of the thumb in pronation-abduction that could impair the key-pinch stability. When considering additional procedures for MCP-1-joint hyperextension deformities, it should be recommended to fix the EPB-tendon on the radial aspect of the metacarpal head if a tendon transfer is considered, otherwise the MCP joint arthrodesis should be performed in supinated position, in order to achieve lateral key-pinch stability.

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Metacarpophalangeal Arthrodesis with Resection-suspension Arthroplasty in First Carpometacarpal Osteoarthritis

Revista Iberoamericana de Cirugía de la Mano ◽

10.1055/s-0040-1712092 ◽

2020 ◽

Vol 48 (01) ◽

pp. 027-030

Author(s):

Jose A. Oteo-Maldonado ◽

Patricia Merino-Carretero

Keyword(s):

Functional Results ◽

Metacarpophalangeal Joint ◽

Wilcoxon Test ◽

Carpometacarpal Joint ◽

Medium Term ◽

Hand Grip ◽

First Carpometacarpal Joint ◽

Quick Dash ◽

Carpometacarpal Osteoarthritis

AbstractFirst carpometacarpal joint osteoarthritis (CMC-1) may develop first metacarpophalangeal joint hyperextension (MCP-1). We enrolled patients with CMC-1 osteoarthritis and MCP-1 hyperextension ≥40 degrees treated with resection-suspension arthroplasty and MCP-1 intramedullary arthrodesis with XMCP™ system. Minimum follow-up was five years. We evaluated: thumbinterphalangeal (IP) range ofmotion, key pinch, hand grip, Kapandji, VAS and Quick DASH. Wilcoxon test was uses for statistical analysis.Nineteen patients were reviewed. We found improvement in key pinch, hand grip, VAS and Quick DASH; statistical difference (p < 0.05) was observed in all of them except key pinch. IF thumb range of motion and Kapandji decreased.TMC arthrodesis with XMCP™ system associated with resection-suspension arthroplasty, as a treatment for CMC-1 osteoarthritis and MCP-1 hyperextension ≥40 degrees, achieves good functional results in the medium term.

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Trans-metacarpal Screw Fixation for Extra-articular Proximal Phalangeal Base Fractures

The Journal of Hand Surgery (Asian-Pacific Volume) ◽

10.1142/s021881041750006x ◽

2017 ◽

Vol 22 (01) ◽

pp. 35-38 ◽

Cited By ~ 1

Author(s):

Eichi Itadera ◽

Takahiro Yamazaki

Keyword(s):

Screw Fixation ◽

Proximal Phalanx ◽

Metacarpophalangeal Joint ◽

Fixation Method ◽

Compression Screw ◽

Metacarpal Head ◽

Headless Compression Screw ◽

Articular Fractures ◽

Intramedullary Canal ◽

Cannulated Drill

We developed a new internal fixation method for extra-articular fractures at the base of the proximal phalanx using a headless compression screw to achieve rigid fracture fixation through a relatively easy technique. With the metacarpophalangeal joint of the involved finger flexed, a smooth guide-pin is inserted into the intramedullary canal of the proximal phalanx through the metacarpal head and metacarpophalangeal joint. Insertion tunnels are made over the guide-pin using a cannulated drill. Then, a headless cannulated screw is placed into the proximal phalanx. All of five fractures treated by this procedure obtained satisfactory results.

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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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A custom-made neoprene thumb carpometacarpal orthosis with thermoplastic stabilization: An orthosis that promotes function and improvement in patients with the first carpometacarpal joint osteoarthritis

Prosthetics and Orthotics International ◽

10.1177/0309364613488621 ◽

2013 ◽

Vol 38 (1) ◽

pp. 79-82 ◽

Cited By ~ 10

Author(s):

Monireh Ahmadi Bani ◽

Mokhtar Arazpour ◽

Stephen William Hutchins ◽

Fereydoun Layeghi ◽

Mahmood Bahramizadeh ◽

...

Keyword(s):

Grip Strength ◽

Clinical Relevance ◽

Hand Function ◽

Pinch Strength ◽

Conservative Approach ◽

Carpometacarpal Joint ◽

Custom Made ◽

First Carpometacarpal Joint ◽

Thumb Carpometacarpal ◽

Improved Function

Background and aim: Patients with mild to moderate first carpometacarpal joint osteoarthritis report pain, a reduction in pinch and grip strength and hand function. The purpose of this study was to analyze the effect of a custom-made neoprene thumb carpometacarpal orthosis with thermoplastic stabilization on pain, function, grip strength, and key pinch in these patients. Technique: A total of 11 volunteer patients participated in this study. All the above-mentioned parameters were evaluated at baseline and also 30, 60, and 90 days after using the splint. Discussion: A decrease in pain was observed after 30 days, and this continued to improve during treatment with the splint. After 90 days of using the splint, grip strength was improved. Function and pinch strength also increased significantly and was maintained during the study period compared to baseline. Clinical relevance A custom-made neoprene thumb carpometacarpal orthosis with thermoplastic stabilization may be a suitable conservative approach for the treatment of first carpometacarpal joint osteoarthritis.

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Mechanical thumb pain in a systemic sclerosis patient: simple first carpometacarpal osteoarthritis?

Rheumatology ◽

10.1093/rheumatology/keab120 ◽

2021 ◽

Author(s):

Guillaume LARID ◽

Pier-Olivier DUBOE ◽

Jean-Denis LAREDO ◽

Elisabeth GERVAIS

Keyword(s):

Systemic Sclerosis ◽

Signal Intensity ◽

Topoisomerase I ◽

Joint Space ◽

Carpometacarpal Joint ◽

Cross Sectional ◽

First Carpometacarpal Joint ◽

Provide Pain Relief ◽

Long Time ◽

Carpometacarpal Osteoarthritis

Abstract A 70-year-old female patient treated with methotrexate for diffuse cutaneous systemic sclerosis (SSc) came up with mechanical pain over the left thumb for several months. SSc was diagnosed based on a clinical picture associating puffy fingers, skin sclerosis, wrist arthralgia, pulmonary hypertension, presence of antinuclear factors and antibodies against Topoisomerase-I. Her complaint was attributed to first carpometacarpal joint osteoarthritis and treated with orthesis, which did not provide pain relief after 5 months of regular use. Hand radiograph showed first carpometacarpal arthropathy with joint space narrowing and marked sclerosis of the first proximal metacarpal (A). MRI showed an area of very low signal intensity on T1- and T2-weighted images (B) within the proximal metacarpal, distal trapezium and medial joint recess surrounded by bone marrow edema. Mild peripheral enhancement was present after gadolinium injection. CT-scan (C) showed that the low signal intensity material visible at MRI consisted of calcium. These aspects are suggestive of scleroderma arthropathy rather than common first carpometacarpal osteoarthritis. Though involvement of the first carpometacarpal joint is long time known in SSc [1], it remains exceptional when looking at cross-sectional studies [2]. Carefully analyzing imaging exams is the key point in order not to miss this rare scleroderma feature.

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Local anaesthesia for first carpometacarpal joint arthroplasty

European Journal of Plastic Surgery ◽

10.1007/bf00175699 ◽

1993 ◽

Vol 16 (4-5) ◽

Author(s):

S. Lusthaus ◽

H. Ashur ◽

P. Benmeir ◽

A. Neuman ◽

A. Weinberg ◽

...

Keyword(s):

Local Anaesthesia ◽

Joint Arthroplasty ◽

Carpometacarpal Joint ◽

First Carpometacarpal Joint

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Diagnosis of the Aetiology of a Locked Metacarpophalangeal Joint Using MRI

Journal of Hand Surgery (European Volume) ◽

10.1016/0266-7681(93)90025-b ◽

1993 ◽

Vol 18 (5) ◽

pp. 645-647 ◽

Cited By ~ 8

Author(s):

F. SCHUIND ◽

B. STALLENBERG

Keyword(s):

Metacarpophalangeal Joint ◽

Mri Scan ◽

Metacarpal Head

A case is reported of a locked MP joint due to ulceration of the metacarpal head. This was clearly visible on MRI scan.

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Estimation of the Abduction/Adduction Movement of the Metacarpophalangeal Joint of the Thumb

Applied Sciences ◽

10.3390/app11073158 ◽

2021 ◽

Vol 11 (7) ◽

pp. 3158

Author(s):

Néstor J. Jarque-Bou ◽

Margarita Vergara ◽

Joaquín L. Sancho-Bru

Keyword(s):

3D Modeling ◽

Daily Living ◽

Degrees Of Freedom ◽

Estimation Error ◽

Metacarpophalangeal Joint ◽

Joint Movement ◽

Carpometacarpal Joint ◽

Small Space ◽

Joint Motions

Thumb opposition is essential for grasping, and involves the flexion and abduction of the carpometacarpal and metacarpophalangeal joints of the thumb. The high number of degrees of freedom of the thumb in a fairly small space makes the in vivo recording of its kinematics a challenging task. For this reason, along with the very limited independence of the abduction movement of the metacarpophalangeal joint, many devices do not implement sensors to measure such movement, which may lead to important implications in terms of the accuracy of thumb models. The aims of this work are to examine the correlation between thumb joints and to obtain an equation that allows thumb metacarpophalangeal abduction/adduction movement to be estimated from the other joint motions of the thumb, during the commonest grasps used during activities of daily living and in free movement. The correlation analysis shows that metacarpophalangeal abduction/adduction movement can be expressed mainly from carpometacarpal joint movements. The model thus obtained presents a low estimation error (6.29°), with no significant differences between grasps. The results could benefit most fields that do not typically include this joint movement, such as virtual reality, teleoperation, 3D modeling, prostheses, and exoskeletons.

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