Treatment of advanced carpometacarpal joint disease: trapeziectomy and hematoma arthroplasty.

Division of Hand and Microvascular Surgery, Department of Orthopaedic Surgery, Naval Medical Center San Diego, 34800 Bob Wilson Drive, Suite 112, San Diego, CA 92131, USA.
Hand Clinics (Impact Factor: 1.07). 09/2008; 24(3):271-6, vi. DOI: 10.1016/j.hcl.2008.03.003
Source: PubMed

ABSTRACT Some surgical treatment options of painful basal joint arthritis do not require complex arthroplasty or suspensionplasty techniques. Simple trapeziectomy with temporary pinning of a slightly overdistracted thumb metacarpal can provide reliable pain relief, good motion, and functional stability. Recent literature supports alternative options when compared with formal ligament reconstruction or suspensionplasty procedures. Simple trapeziectomy is associated with less morbidity due to shorter operative times and the lack of need for graft harvest and ligament reconstruction.

1 Follower
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background The Intercarpometacarpal Cushion (ICMC; Articulinx, Cupertino, CA, USA) is an implantable spacer designed as a less invasive surgical treatment for osteoarthritis (OA) of the first carpometacarpal joint (CMC-1). Description of Technique Following local anesthesia and exposure of the joint capsule the ICMC, attached to a needle and suture tethers, is guided into the joint space under fluoroscopic visualization through a dorsal approach. The needle is pulled through the thenar eminence to the opposite side of the hand and, once proper device placement is confirmed, cut free and the joint capsule closed. Patients and Methods Eight female patients (median age 56 years; range, 42-83) were treated and followed for 6 to 24 months. Safety of the implant procedure was evaluated intraoperatively. Pain, joint function, and strength were evaluated at 6 weeks, 3, 6, 12 and 24 months with a Visual Analog Scale (VAS) for pain, the QuickDASH inventory, Canadian Occupational Performance Measure (COPM), and pinch and grip strength measurements. Results At 2 years (n = 6), mean VAS pain scores decreased from 6.3 (± 1.5) to 2.2 (± 1.1) (p < 0.001), mean QuickDASH scores improved from 47 (± 15) to 31 (± 11) (p < 0.10), mean COPM performance scores improved from 5.0 (± 1.2) to 5.5 ( ± 1.3) (p = NS). Mean pinch and grip strength measurements also improved compared with baseline. No serious adverse events occurred. Two device removals occurred, associated with a traumatic event and Stage IV OA with device displacement, at 6 and 9 months respectively. Conclusion The ICMC can be implanted safely. Effectiveness needs to be confirmed in future studies.
    08/2013; 2(3):276-81. DOI:10.1055/s-0033-1353243
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Purpose To investigate the influence of trapeziometacarpal (TMC) osteoarthritis (OA) on the 3-dimensional motion capability of the TMC and thumb metacarpophalangeal (MCP) joints. In order to examine other factors affecting the thumb's motion kinematics, we further aimed to address the influence of sex and handedness on the motion capability of normal TMC and MCP joints. Methods We included 18 healthy subjects (9 women, 9 men; 8 dominant hands, 10 nondominant hands) and 18 women with stage 111111 TMC OA. A motion analysis system using surface markers was used to quantify the thumb's 3-dimensional opposition-reposition kinematics. The range of motion of the thumb's TMC and MCP joints in flexion extension, abduction adduction, and pronation supination were determined. Results TMC OA led to a loss in abduction adduction in the TMC joint (38 degrees in controls, 26 degrees in TMC OA subjects), although neither flexion extension nor pronation supination were affected. At the MCP joint, the TMC OA subjects showed a 48% reduction in abduction adduction (32 degrees controls, 16 degrees TMC OA subjects) and 42% reduction in pronation supination (34 degrees in controls, 20 degrees in TMC OA subjects) than the healthy controls. Ranges of motion of the healthy TMC and MCP joints were similar in dominant and nondominant hands as well as in women and men. Discussion The study demonstrated that stage II/III TMC OA restricts the motion of the TMC joint in abduction-adduction and of the MCP joint in abduction-adduction and pronation-supination. Thumb motion capability was unaffected by sex and handedness. Copyright
    The Journal Of Hand Surgery 09/2014; 39(11). DOI:10.1016/j.jhsa.2014.08.012 · 1.66 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background Thumb orthoses have to reconcile and satisfy competing goals: stability and mobility. The purpose of the study was to characterize the stabilization effectiveness and functionality of different thumb carpometacarpal osteoarthritis orthoses. Methods Eighteen female carpometacarpal osteoarthritis subjects were included. Four orthoses were compared: BSN medical (BSN); Push braces (PUSH); Sporlastic (SPOR); and medi (MEDI). Three-dimensional thumb kinematics during active opposition–reposition with and without orthosis was quantified. Ranges-of-motion of the carpometacarpal and metacarpophalangeal joint in x- (flexion–extension), y- (adduction–abduction) and z-direction (pronation–supination) were determined. Hand functionality was examined by Sollerman test. Findings All orthoses restricted carpometacarpal range-of-motion in all directions. In x-direction carpometacarpal range-of-motion was smallest with MEDI and BSN, in y-direction largest with PUSH compared to all other orthoses, in z-direction smaller with BSN and MEDI compared to PUSH, but similar to SPOR. All orthoses restricted metacarpophalangeal range-of-motion in x-direction, except PUSH. In x-direction metacarpophalangeal range-of-motion was smallest with MEDI compared to all other orthoses. In y-direction and z-direction only BSN and MEDI restricted metacarpophalangeal range-of-motion. Sollerman score was highest with PUSH, lowest with MEDI and both differed from other orthoses. Values for BSN and SPOR were similar and lay between PUSH and MEDI. Interpretation Stabilization is borne by functionality. The high stabilization effectiveness provided by MEDI resulted in lowest hand functionality. PUSH, which partially stabilized the CMC joint and allowed large motions in the MCP joint, afforded largest hand functionality. Best compromise of stability and functionality could be reached with BSN. Long-term studies are needed to monitor clinical efficacy.
    Clinical Biomechanics 09/2014; 29(10). DOI:10.1016/j.clinbiomech.2014.09.007 · 1.88 Impact Factor