Botulinum Toxin Injection for Painful Adductor Pollicis Contracture after Thumb Carpometacarpal Resection Arthroplasty

Pollux adductus deformity is an accompanying symptom of thumb carpometacarpal osteoarthritis. We describe a case of a patient who presented with increased muscle tone of the adductor pollicis muscle and chronic pain in the thenar musculature, i.e., recurrence of an adduction deformity. The patient reported a symptom-free period of 5.5 years after having received resection-suspension-arthroplasty for stage IV thumb carpometacarpal osteoarthritis until spasmodic pain appeared. Due to the functional impairment of this condition, we administered therapy including 100 units of Botox® (onabotulinumtoxinA, Allergan, Dublin, Ireland) injected with a fanning technique into the adductor pollicis muscle. Thus, we observed a substantial improvement in the patient-reported outcome measures as well as pain levels compared with initial values. The current case shows the pivotal role of the adductor pollicis muscle when patients report pain at the base of the thumb, which can cause considerable impairments despite the complication-free surgical treatment of thumb CMC OA.

The development of the Kitasato thumb splint as a conservative therapy treatment for patients with thumb carpometacarpal (CMC) arthropathy

Orthoses are devices that are applied externally to help in the rehabilitation of specific bones or joints. Dr Shuichi Sasaki, Department of Rehabilitation, Kitasato University Hospital, Japan, and his team is working to develop a new orthosis for repatriating thumb arthropathies called the Kitasato thumb splint. It is designed to improve usability of the thumb joint, especially in cases of thumb carpometacarpal (CMC) arthropathy, by taking into consideration the thumb CMC joint structure. It exerts force at the base of the CMC joint to move the thumb into the correct joint alignment, improving symptoms for patients. With the Kitasato thumb splint, Sasaki and the team are also eager to provide patients with an alternative to surgery as they believe that the use of more conservative measures with orthoses can prove effective and also prevent costly surgery. The Kitasato thumb splint is made of a low-temperature thermoplastic knit material and can be assembled in as little as 10 minutes, quickly and conveniently providing patients with additional support during painful daily tasks. In his work, Sasaki and the team are looking at orthoses used to treat thumb CMC osteoarthritis and analysing the pressure on CMC joints using quantitative analysis. So far, the Kitasato thumb splint has been found to help in pain reduction and improvements in the activities of daily living in patients with mild cases (Eaton Classifications I to II) of thumb CMC joints and to also provide some improvement in severe cases (Eaton Classifications III-IV).

Percutaneous Trapeziometacarpal Arthrodesis in Thumb Carpometacarpal Joint Arthritis: A New Surgical Approach

The high prevalence of trapeziometacarpal arthritis has resulted in the development of several surgical techniques intended to treat patients failing conservative treatment. However, there is no scientific evidence of the superiority of one technique over others. Open arthrodesis has up to now been successfully used to treat this condition. We believe that performing the technique using a minimally invasive approach with long and short Shannon burrs together with the tapered burr included in the MIS foot instrument set can yield satisfactory results. This article provides a description of this minimally invasive technique performed on a seventy-year-old woman with rhizarthrosis and an anatomical description of the approach in a human cadaver.

Poor Patient-Reported Outcomes following Surgical Treatment of Eaton Grade 1 Osteoarthritis of the Thumb Carpometacarpal Joint

Background Osteoarthritis of the thumb carpometacarpal joint (CMC-1 OA) is increasingly common with age. Conservative treatment with anti-inflammatory medication, thumb spica splinting, and steroid injection is recommended for early-stage OA, but some patients will continue to have refractory symptoms and surgery may be considered. We found it interesting to study outcomes of surgical treatment of cases with mild radiographic changes and yet symptoms severe enough to indicate surgery. The specific research question is, if there is a limit of radiographic changes, below which a poor patient-reported outcome (PRO) can be expected. Purpose In a retrospective cohort of patients with prospectively collected PROs, we intend to study the effect of the radiographic CMC-1 OA severity on the PRO improvement and satisfaction after interposition arthroplasty. Patients and Methods Radiographs of 347 patients, who had CMC-1 surgery, were retrospectively analyzed. Each rater independently assessed all radiographs classifying each according to the Eaton classification. All patients had surgery with CMC-1 interposition arthroplasty using three well-known techniques that all include a complete trapeziectomy. Comparison between stage 1 and stage 2–4 was done using Chi-square test and t-test. Results Patients with Eaton stage 1 had a mean improvement in Quick-DASH (Quick-Disability of the Arm, Shoulder, and Hand questionnaire) scores of 14.6 points. Patients with Eaton stage 2 to 4 had a mean improvement of 25.3 points. The difference between these two groups was 10.6 points (p = 0.009). Only 52% of patients with Eaton stage 1 OA were satisfied. However, 76% of patients with Eaton stage 2 to 4 were satisfied (p = 0.008, chi-square between stage 1 and stage 2–4). Conclusion Patients with Eaton stage 1 CMC-1 OA had poorer PROs, as compared with more advanced stages of OA, 6 months following surgical treatment with interposition arthroplasty. Based on our results, we advise against surgical treatment with interposition arthroplasty of the very mildest CMC-1 OA, regardless of the preoperative PROs.

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

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.