Thumb Carpometacarpal Arthroplasty with Dynamic Suspension Sling Using Extensor Carpi Radialis Tendon

2019 ◽  
Vol 24 (03) ◽  
pp. 353-358
Author(s):  
Takehiko Takagi ◽  
Yuka Kobayashi ◽  
Masahiko Watanabe
Keyword(s):  
Insertion Site ◽  
Dorsal Side ◽  
Pinch Strength ◽  
Reconstruction Method ◽  
Dash Score ◽  
Post Surgery ◽  
Significant Difference ◽  
Thumb Carpometacarpal ◽  
Extensor Carpi Radialis ◽  
Cmc Joint

Background: Despite various treatment methods, complications are reported with ligament reconstruction for thumb carpometacarpal (CMC) arthropathy, such as proximal migration, dorsal subluxation of the first metacarpal base, and hyperextension of the first CMC joint. The flexor carpi radialis (FCR) tendon is, in some cases, too thin to maintain suspension on the first metacarpophalangeal (MCP) joint. We used one-half of the extensor carpi radialis longus (ECRL) tendon instead of the FCR tendon, and compared this method with conventional reconstruction using the FCR tendon. Methods: The procedures were performed during 12 thumb CMC arthropathies. One-half of the ECRL tendon was passed and then wrapped around the intact FCR tendon several times for 6 cases (ECRL group). One-half of the FCR tendon was passed for 6 cases (FCR group). On radiography, we compared the thumb to index finger metacarpal angle (M1M2) and the first MCP angle (P1M1) between groups. Grip strength, pinch strength, and DASH score were also evaluated up to 2 years post-surgery. Results: In the ECRL group, M1M2 and P1M1 1 year post-surgery showed significant improvements compared to those before surgery; they showed no significant difference in the FCR group, although they achieved a peak at 3 months post-surgery in both groups. Both groups showed improvements in other parameters from 3 months to 1 year post-surgery. Conclusions: Postoperative progression of hyperextension of the first CMC joint was significantly reduced in the ECRL group. The ECRL tendon is thicker than the FCR tendon. In addition, the insertion site of the ECRL tendon is at the dorsal side of the second metacarpal, and the tendon can extend from the dorsal side to the volar side to stabilize the first metacarpal. Thumb CMC arthroplasty using one-half of the ECRL tendon is a useful reconstruction method.

Proprioceptive Neuromuscular Facilitation Protocol for Thumb Osteoarthritis: A Pilot Study

Hand ◽  
2021 ◽  
pp. 155894472199078
Author(s):  
Raquel Cantero-Tellez ◽  
Nancy Naughton ◽  
Lori A. Algar ◽  
Ivan Medina-Porqueres ◽  
Leire Cruz-Gambero ◽  
...  
Keyword(s):  
Training Program ◽  
Effect Size ◽  
Standard Treatment ◽  
Pinch Strength ◽  
Control Group ◽  
Significant Difference ◽  
Proprioceptive Training ◽  
Thumb Carpometacarpal ◽  
Experimental Group ◽  
Cmc Joint

Background Osteoarthritis (OA) of the thumb carpometacarpal (CMC) joint often presents with joint instability and proprioceptive deficits. Proprioception has been found to play an important role in the rehabilitative process. The purpose of this study was to evaluate the effectiveness of a proprioceptive training program on pain and function in individuals with early-stage thumb Carpometacarpal joint OA. Methods A double-blind experimental trial using a 2-group pretest/posttest design was used in this pilot study. Participants had a diagnosis of grade I and II thumb CMC joint OA in their dominant hand and a pain rating of >4/10 on Visual Analogue Scale. Participants received either standard treatment (control group) or standard treatment plus a proprioceptive training program (experimental group). Outcome measures were lateral pinch strength, pain intensity during activities, and proprioceptive response via joint position sense (JPS) testing. Results Twelve individuals (average age of 66.25 years) participated. Both groups had a statistically significant decrease in pain and increase in lateral pinch strength, all occurring with a large effect size but no statistically significant difference between groups. The experimental group experienced a large effect size for JPS testing, whereas the control group experienced a trivial effect size, and there was a statistically significant difference between groups for JPS testing. Conclusions Individuals who completed the proprioceptive training program in this study had an improvement in proprioceptive functioning. This program shows potential for routine inclusion in hand therapy for thumb CMC joint OA; however, additional high-level studies with larger sample sizes are required.

Anatomic Pyrocarbon Hemiarthroplasty for Thumb Carpometacarpal Osteoarthritis in Patients under 65 Years: Mid Term Results

2018 ◽  
Vol 23 (04) ◽  
pp. 469-473
Author(s):  
Michelle Caudwell ◽  
Grant Bayne ◽  
Richard S. Page
Keyword(s):  
Grip Strength ◽  
Hand Function ◽  
Pyrolytic Carbon ◽  
Pinch Strength ◽  
Consecutive Series ◽  
Dash Score ◽  
Midterm Outcome ◽  
Significant Difference ◽  
Thumb Carpometacarpal ◽  
Active Patients

Background: To assess the midterm outcome of patients under 65 who underwent anatomic pyrocarbon hemiarthroplasty for thumb carpometacarpal (CMC) osteoarthritis. Methods: A prospective analysis was performed of a consecutive series of active patients, less than 65 years of age, with symptomatic osteoarthritis who had undergone a CMC hemiarthroplasty using a stemmed metacarpal based, anatomic pyrolytic carbon resurfacing with an additional one third flexor carpi radialis (FCR) tendon transfer to maintain stability. The Wrightington Hand Score, Disability Arm Shoulder and Hand (DASH) Score, and the Patient Rated Wrist Evaluation Score (PRWE) were utilised. Clinical data was obtained for grip strength, pinch strength, and range of motion. Results: The MEAN age was 57.6 years. MEAN follow up was 6.5 years. All patients had improvement in pain, grip strength and function. There was no significant difference in grip and pinch strengths between the individual’s left and right hand. All patients stated that they would undergo the procedure again. There was one revision following a traumatic trapezium fracture. One patient underwent a neurolysis of a superficial radial nerve neuroma associated with an impinging trapezial osteophyte. Conclusions: Active patients, under 65 years of age with Eaton-Littler stage III osteoarthritis of the thumb CMC joint who are treated with anatomic pyrolytic carbon resurfacing hemiarthroplasty and stabilisation may achieve sustained improvement in pain and hand function for up to 6.5 years.

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.

scholarly journals The Accuracy of Common Hand Injections With and Without Ultrasound: An Anatomical Study

Hand ◽  
2017 ◽  
Vol 12 (6) ◽  
pp. 591-596 ◽  
Author(s):  
Philip To ◽  
Kaylan N. McClary ◽  
Micah K. Sinclair ◽  
Brittany A. Stout ◽  
Mohab Foad ◽  
...  
Keyword(s):  
Carpal Tunnel ◽  
Anatomical Study ◽  
Blue Dye ◽  
Success Rates ◽  
Additional Information ◽  
Lower Accuracy ◽  
Significant Difference ◽  
Fresh Frozen ◽  
Thumb Carpometacarpal ◽  
Cmc Joint

Background: The aim of the study is to determine the accuracy of hand injections with and without the aid of ultrasound (U/S) into the carpal tunnel, thumb carpometacarpal (CMC) joint, first dorsal compartment (DC) and the radiocarpal (RC) joint. Methods: Four participants of various level of experience injected the carpal tunnel, thumb CMC, first DC, and RC joint into 40 fresh frozen cadaver specimens with blue dye and radiographic contrast. Participants 1 and 2 were injected without U/S guidance, and participants 3 and 4 were injected with U/S guidance. A successful injection was determined by both fluoroscopy and dissection/direct observation. Additional information was recorded for each injection such as median nerve infiltration and evidence of thumb CMC arthrosis. Results: The overall accuracy for carpal tunnel, thumb CMC, first DC, and RC injections were 95%, 63%, 90%, and 90%, respectively. Success was compared with and without U/S guidance. Success rates were similar for each injection site, except the thumb CMC joint, where U/S participants had 25% higher accuracy. In the setting of thumb CMC arthrosis, the incidence of success was 38% for participants with no U/S aid and 72% for participants with U/S aid. There was a significant difference between participants who used U/S with the participant with more U/S experience being more successful. Conclusion: Carpal tunnel, first DC, and RC injections had an accuracy of greater than 90%. Thumb CMC injections have a lower accuracy (63%) and one can improve accuracy with U/S. The accuracy of U/S-guided injections is dependent on the user and their experience.

Is Pulley Reconstruction Better Than Pulley Release for De Quervain's Tenosynovitis? A Double-Blind Randomized Controlled Trial

2021 ◽  
Author(s):  
Burhan Salim ◽  
Mohammed Tahir Ansari ◽  
Venkatesan Sampath Kumar ◽  
Ankur Goyal ◽  
Rajesh Malhotra
Keyword(s):  
Controlled Trial ◽  
P Value ◽  
Reconstruction Method ◽  
Dash Score ◽  
Vas Score ◽  
De Quervain’S Tenosynovitis ◽  
Mayo Wrist Score ◽  
Significant Difference ◽  
Release Group ◽  
Quick Dash

AbstractPurpose The aim of this study was to compare the results of surgeries of the De Quervain's disease (DQD) through a randomized control trial.Materials and Methods We treated 40 cases of De Quervain's tenosynovitis in 2 groups: 20 patients by pulley release method and another 20 patients by pulley reconstruction method. The patients were selected as per the random table number. The clinical data, numeric Visual Analogue Scale (VAS) score, Quick DASH—Disabilities of the Arm, Shoulder, and Hand—score, Mayo Wrist Score, and subluxation of the tendons in dynamic ultrasonography (USG) during wrist hyperflexion and abduction of the thumb test were noted preoperatively and 6 months after the operation. All patient charts were reviewed and data analysis was done after completion of the study.Results All patients improved after surgery. There was no difference in clinical outcome data, numeric VAS score, Quick DASH Score, and Mayo Wrist Score (p-value > 0.05). There were four patients with tendon subluxation under USG in pulley release group, out of which only one patient was clinically symptomatic. There was no tendon subluxation in pulley reconstruction group. The tendon subluxation between the two groups was not found to be statistically significant (p-value: 0.661).Conclusion Although, higher numbers of subluxation were found in release group, there was no statistically significant difference in the outcome of the two surgical procedures for DQD. This study is a pilot study, and it may act as the groundwork over which further studies may be performed.Level of Evidence This is a Level I study.

ISOLATED SCAPHOTRAPEZIOTRAPEZOID OSTEOARTHRITIS: PRELIMINARY RESULTS OF TREATMENT USING A PYROCARBON IMPLANT

Hand Surgery ◽  
2007 ◽  
Vol 12 (02) ◽  
pp. 73-77 ◽  
Author(s):  
A. K. Low ◽  
I. A. Edmunds
Keyword(s):  
Good Alternative ◽  
Pinch Strength ◽  
Dash Score ◽  
Wrist Flexion ◽  
Interposition Arthroplasty ◽  
Results Of Treatment ◽  
Post Surgery ◽  
Flexion Extension ◽  
The Mean ◽  
Pyrocarbon Implant

The scaphotrapeziotrapezoid (STT) joint is the second most common site in the wrist affected by degenerative arthritis. STT fusion has been the traditional treatment for patients with isolated STT arthritis but there are concerns about the complication rate and loss of wrist movement post-surgery. The current study presents the results of an interposition arthroplasty using a scaphoid trapezium pyrocarbon implant (STPI, BIOProfile). Ten STPI's were implanted in nine patients (mean age 66, 58–76 years) with isolated STT arthritis. The mean follow-up was 16.4 (3–35) months. Following surgery, VAS pain scores improved significantly and most patients had minimal restrictions in function, with a mean DASH score of 21. The mean wrist flexion-extension arc was 126° and radioulnar deviation was 43°. Mean grip strength was 82% and pinch strength 85% compared to the non-operated side. Patients were highly satisfied with the results of their surgery (mean VAS score 9.1). No surgical complications were encountered and no significant changes in carpal alignment were noted on radiographs. The results of this study suggest that STPI interposition arthroplasty may be a good alternative to STT fusion for isolated STT arthritis.

scholarly journals Outcomes after thumb carpometacarpal joint stabilization with an abductor pollicis longus tendon strip for the treatment of chronic instability

2019 ◽  
Vol 140 (2) ◽  
pp. 275-282
Author(s):  
Alexandra Stauffer ◽  
Yvonne Schwarz ◽  
Marion Uranyi ◽  
Florian Schachinger ◽  
Werner Girsch ◽  
...  
Keyword(s):  
Postoperative Outcomes ◽  
Radiographic Examination ◽  
Pinch Strength ◽  
Dash Score ◽  
Level Of Evidence ◽  
Chronic Instability ◽  
Joint Stabilization ◽  
Abductor Pollicis Longus ◽  
Thumb Carpometacarpal

Abstract Introduction Instabilities of the thumb carpometacarpal (CMC) joint, caused by idiopathic ligamentous hyperlaxity, trauma or other conditions may lead to pain, functional impairment and eventually osteoarthritis. Several techniques have been described to enhance stability of the CMC 1. The aim of this study was to evaluate postoperative outcomes after CMC 1 joint stabilization using a soft-tissue procedure in patients with chronic instability. Materials and methods This study was designed as a retrospective study with a single follow-up visit after a minimum of 1 year postoperatively. All patients who underwent stabilization of the CMC 1 with an abductor pollicis longus (APL) tendon strip for chronic, habitual instability were re-assessed using clinical examination, dedicated outcome scores [Visual Analogue Scale (VAS); The Disability of the Arm, Shoulder and Hand (DASH) score; Nelson score; Kapandji opposition score], grip and pinch strength measurements, and radiographic examination. Results 12 patients (15 operated thumbs) with a mean age at surgery of 23.2 (± 9.3) years were included after a mean follow-up period of 3.5 (± 1.3) years. The postoperative outcomes indicated excellent results, with a mean DASH score of 13.3 (± 11.3), VAS 1.1 at rest (and 2.8 during stress) and Nelson score of 87.7 (± 11.3). Postoperative grip, pinch strength and passive stability were not significantly different between operated and non-operated sides (p = 0.852; p = 0.923 and p = 0.428, respectively). We observed one case of recurrent instability besides no other complications. However, patients with trapezium hypoplasia (5 of 12) were more prone to signs of radiographic instability during stress testing. Conclusions Thumb carpometacarpal stabilization with an APL tendon strip yielded excellent clinical outcomes and low morbidity in the mid-term. However, long-term follow-up is needed to assess specifically whether patients with trapezium hypoplasia may be more prone to clinical symptom recurrence than those with normal anatomy. Level of evidence Level IV

scholarly journals Comparison of arthrodesis and arthroplasty of Chinese thumb carpometacarpal osteoarthritis

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Jianfeng Li ◽  
Dacun Li ◽  
Guanglei Tian ◽  
Wentong Zhang
Keyword(s):  
Grip Strength ◽  
Ligament Reconstruction ◽  
Subjective Evaluation ◽  
Chinese Patients ◽  
Pinch Strength ◽  
Dash Score ◽  
Advantages And Disadvantages ◽  
Thumb Carpometacarpal ◽  
Tendon Interposition ◽  
Carpometacarpal Osteoarthritis

Abstract Background The thumb carpometacarpal (CMC) osteoarthritis is very common. Multiple methods are used to treat progressive thumb CMC osteoarthritis, among which trapeziometacarpal arthrodesis and trapezial excision with ligament reconstruction and tendon interposition (LRTI) are the most common. These two surgical treatment methods have received mixed reviews in previous studies in the west patients. This retrospective study studied the effects, advantages, and disadvantages of arthrodesis and arthroplasty for treating thumb carpometacarpal osteoarthritis in Chinese patients. Methods Between February 2012 and September 2017, 39 Chinese patients with stage II or III thumb carpometacarpal osteoarthritis underwent surgery (trapeziometacarpal arthrodesis in 22, trapezial excision with ligament reconstruction and tendon interposition in 17). Postoperative objective and subjective evaluations were performed. The objective evaluation involved grip strength, pinch strength, thumb abduction degree (palmar and radial), and Kapandji opposition scores. The subjective evaluation involved visual analog scale (VAS) and Disabilities of the Arm, Shoulder, and Hand (DASH) scores. Results Intergroup differences in pinch strength, thumb abduction degrees (palmar and radial), and Kapandji opposition scores were obvious, whereas those in grip strength, VAS score, and DASH score were not. Conclusion In Chinese patients, both techniques relieved pain and improve grip strength. Arthrodesis displayed better pinch strength, while arthroplasty displayed better motor function. Patients were satisfied with the effects of both techniques.

scholarly journals Ligament Reconstruction of Traumatic Pure Dislocation of Carpometacarpal Joint of the Thumb: A Series of Acute and Chronic Cases

2020 ◽  
Vol 12 (S 01) ◽  
pp. S16-S20
Author(s):  
Farid Najd Mazhar ◽  
Davod Jafari ◽  
Seyed Sajjad Jafari ◽  
Alireza Mirzaei
Keyword(s):  
Grip Strength ◽  
Outcome Measures ◽  
Ligament Reconstruction ◽  
Reconstruction Technique ◽  
Reconstruction Method ◽  
Dash Score ◽  
The Mean ◽  
Quick Dash ◽  
Cmc Joint

Abstract Background Traumatic instability of carpometacarpal (CMC) joint of the thumb without a fracture (pure dislocation of CMC joint) is an uncommon injury, and a universally accepted protocol has not yet been developed for its management. Here, we aim to evaluate the outcome of this injury managed with ligament reconstruction technique, in a series of acute and chronic injuries. Patients and Methods Total nine patients (six acute and three chronic) with pure dislocation of CMC joint who underwent ligament reconstruction surgery were included in this retrospective study. Outcome measures included disabilities of the arm, shoulder, and hand (quick-DASH) questionnaire; visual analog scale (VAS) scoring system; patient-rated wrist/hand evaluation (PRWHE) system; pinch and grip strength; and Kapandji thumb opposition scores. Results The patients’ mean age was 32.55 ± 11.4 years. Their mean follow-up period was 27 ± 12.8 months. The mean postoperative pinch and grip strength was equivalent to 91.5% and 108% of the contralateral hand, respectively. The mean Quick-DASH score was 14.7 ± 19.4. The mean PRWHE score was 18.7 ± 22.4. The mean VAS was 1.1 ± 1.5. The mean Kapandji score was 8.3 ± 1.4. The pinch and grip strength were considerably superior in acute injuries. Degenerative changes were seen in all joints at the latest follow-up. None of our patients needed a revision surgery. Conclusion Ligament reconstruction method could result in favorable outcome in the management of pure dislocation of CMC joint. However, delayed surgery of this injury might adversely affect the outcome measures.

A Modified Suture Suspension Arthroplasty Technique for the Treatment of Basal Joint Arthritis: Short- to Intermediate-Term Outcomes

Hand ◽  
2020 ◽  
pp. 155894471988666 ◽  
Author(s):  
Ather Mirza ◽  
Justin B. Mirza ◽  
Laura Klingbeil ◽  
Joseph F. Pavlik ◽  
Jonathan Muratori ◽  
...  
Keyword(s):  
Contralateral Side ◽  
Pinch Strength ◽  
Dash Score ◽  
Radiographic Images ◽  
Basal Joint ◽  
Thumb Carpometacarpal ◽  
Relationship Of ◽  
Joint Arthritis ◽  
Suture Suspension

Background: To present a retrospective study on the outcomes of a modified version of suture suspension arthroplasty with trapeziectomy on patients with thumb basal joint arthritis and to evaluate the relationship between the degree of subsidence and functional outcome. Methods: We performed a chart review on 67 patients (75 thumbs) who were surgically treated for thumb carpometacarpal osteoarthritis with trapeziectomy and suture suspension arthroplasty from May 2010 to May 2016. Outcome measures included Disabilities of the Arm, Shoulder and Hand (DASH), grip strength, lateral/precision pinch strength, range of motion, and return to work/resumption of usual activities. Radiographic images were used to measure first metacarpal subsidence into the trapezial space. Results: Clinical outcomes were satisfactory, showing an initial postoperative DASH score of 45.94, which decreased to 27.93 at 6 months postoperatively and to 19.69 at 1 year postoperatively. Radiographic images revealed a mean first metacarpal subsidence of 39% compared with the preoperative images. Grip and pinch strengths showed steady improvement from initial postoperative to final follow-up visits, resulting in 90% recovery of gross grasp, 77% recovery of lateral pinch, and 79% recovery of precision pinch compared with the contralateral side. Conclusions: Our study has found that suture suspension arthroplasty with trapeziectomy is an effective treatment for thumb basal joint arthritis. Suture suspension arthroplasty allows for short immobilization time, avoids tendon sacrifice, avoids anchor use, and leaves a cosmetically appealing scar. Furthermore, a relationship of any significance between postoperative first metacarpal subsidence and functional outcomes does not appear.

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