Clinical Assessments of Hand Function in First Carpometacarpal Osteoarthritis Do Not Appear to Correlate with Radiographic Findings

Abstract

Background: Thumb carpometacarpal (first CMC) osteoarthritis (OA), a degenerative process affecting hand use, is typically assessed by clinical examination and radiographs. This assessment determines treatment, but it may not reflect functional limitations. Questions/Purposes: We aimed to explore the relationship between measures of hand function and radiographs in individuals with and without first CMC OA. Methods: We designed a cross-sectional, observational pilot study, enrolling five patients with first CMC OA (nine thumbs with modified Eaton-Littler grades ranging from 1 to 4, using retrospective radiographic data) and nine healthy controls. They underwent evaluation of hand function using four patient-reported outcome measures (PROMs)-the Patient-Specific Functional Scale (PSFS); the Patient-Rated Wrist/Hand Evaluation (PRWHE); the Disabilities of the Arm, Shoulder, and Hand (DASH); and the Modified Score for the Assessment and Quantification of Chronic Rheumatoid Affections of the Hands (M-SACRAH)-and one performance measure, the Arthritis Hand Function Test (AHFT). Spearman's ρ with 95% subject clustered bootstrapped confidence intervals was calculated to assess for correlations between radiographic findings and measures of hand function. Results: Only the DASH work score showed strong positive correlation with radiographic OA grade, with PSFS, PRWHE, M-SACRAH, and AHFT scores demonstrating low to moderate correlations. Notable differences were found between patients and control subjects in median scores of the DASH, PSFS, PRWHE, and M-SACRAH, as well as in the grip, pinch, and button scores of the AHFT. Conclusion: While only the DASH work score strongly correlated with radiographic grade of first CMC OA, several measures detected considerable differences in functional hand use between patients and control subjects. The findings of this pilot study suggest that hand function scores be considered in addition to radiographs when determining severity of first CMC OA. The findings can also inform the design of a larger, powered study. Keywords first carpometacarpal osteoarthritis. radiographic grading. basilar joint. functional hand measures. patient reported outcome measures

Association of Clinical Assessments of Hand Function and Quantitative Ultrasound Metrics in First Carpometacarpal Osteoarthritis

“…More explicitly, subjects in this study with stiffer APB and FPB muscles showed better functional hand use, strength, and dexterity. When specifically comparing groups, our aforementioned prior investigation found significant differences in hand function between first CMC OA patients and control subjects, with control subjects performing better [18]. SWE metrics of muscle stiffness in the current study also revealed differences between groups, where the less stiff muscle was seen in first CMC patients.…”

“…The limitations of radiographic scoring systems of first CMC OA such as the E-L system have been well reviewed [9, 12] and include poor correlation with clinical symptoms and intraoperative findings, and limited ability to guide surgical treatment. In a recent publication [18], our group demonstrated a poor correlation between basilar joint x-ray findings and measures of hand function. It follows that SWE measures of thenar eminence muscle stiffness in this study are poorly correlated with x-ray grades of first CMC OA.…”

“…Patients and volunteers subsequently underwent a clinical evaluation of hand function by an occupational therapist certified in hand therapy with 10 years of experience. This clinical evaluation consisted of physical, performance, and self-report outcome measures (Patient-Specific Functional Scale [PSFS]; Patient Rated Wrist/Hand Evaluation [PRWHE]; Disabilities of the Arm, Shoulder, and Hand [DASH]; Modified Score for the Assessment and Quantification of Chronic Rheumatic Affections of the Hands [M-SACRAH]; Arthritis Hand Function Test [AHFT]) [18]. Higher PSFS scores indicate greater functional hand use, whereas lower DASH, PRWHE, and M-SACRAH scores indicate greater functional hand use.…”

Misperception of Disease Onset in People with Gradual-Onset Disease of the Upper Extremity

“…Fourth, we did not track the severity of the disease as an independent variable, largely because we mixed diagnoses. We felt comfortable doing so because studies of patients with carpal tunnel syndrome 23 , trapeziometacarpal osteoarthritis 24,25 , and shoulder 26 and spine problems 27 have shown that objective measures of disease severity accounted for relatively little variation in the intensity of symptoms and magnitude of limitations. Fifth, the findings may not be applicable to different populations, different geographical areas, or different races or ethnicities.…”

Hatástanulmány a nyeregízületi arthrosis intraarticularis hialuronsavas kezeléséről Sinoval HL® injekcióval

“…Fontos azonban megjegyezni, hogy a radiológiai eltérések nem minden esetben, sőt inkább gyakran, csak csekély mértékben korrelálnak a kézfunkció csökkenésével, illetve a megélt fájdalommal, így mindenképpen komplex módon javasolt figyelembe venni a tüneteket, a fájdalmat, a funkcióra vonatkozó információkat, illetve a releváns kérdőívek eredményét is a kezelési terv kialakításakor (27).…”