Current trends in the management of trapeziometacarpal arthritis

Eltorai, Adam E.M.; Han, Alex

doi:10.4081/or.2017.7195

Cited by 7 publications

(3 citation statements)

References 46 publications

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“…Eine chirurgische Behandlung (d. h. Trapezektomie mit oder ohne Interposition, Arthrodese, Transfixation oder Endoprothesenimplantation) ist bei Patienten notwendig, die trotz angemessener konservativer Behandlung symptomatisch bleiben oder sich bereits bei der Erstdiagnose in fortgeschrittenen Stadien befinden [9]. Diese Arbeit zielt darauf ab, die wissenschaftliche Literatur über die Wirksamkeit der existierenden konservativen Interventionen für die Rhizarthrose zusammenzufassen.…”

Section: Therapeutische Verfahrenunclassified

Konservative Therapieverfahren zur Behandlung der symptomatischen Daumensattelgelenksarthrose

et al. 2021

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Ergebnisse: Intraartikuläre Injektionen haben eher kurzfristige positive Effekte mit nicht zu unterschätzendem Infektionsrisiko. Radiotherapie scheint eine effiziente Behandlung zu sein, die jedoch bisher wenig erforscht wurde. Physiotherapie und Schienenbehandlung versprechen eine längerfristige Besserung der klinischen Symptomatik und der Handfunktion. Schlussfolgerung: Die Rhizarthrose ist ein häufiges Krankheitsbild, welches bei Beschwerden adäquat diagnostiziert und behandelt werden sollte. Ein multimodales Therapieschema mit Vermeidung repetitiver intraartikulärer Injektionen scheint die besten Langzeiterfolge zu liefern. Schlüsselwörter Intraartikuläre Injektionen • Schienentherapie • Konservativ • Physiotherapie • Rhizarthrose a b c Abb. 3 8 Individuell hergestellter Daumenbrace mit Einschluss des Daumengrundgelenks. a, b, c Die Anlage erfolgt in 30°P almarabduktion im Daumensattelgelenk und 15°Flexion im Daumengrundgelenk. Die Bewegung im Handgelenk bleibt (Mit freundl. Genehmigung, © BG Klinik Ludwigshafen, alle Rechte vorbehalten) a b c Abb. 4 8 Hilfsmittel für den Alltag. a Der CMCBrace (Fa. Basko, Hamburg, Deutschland) stabilisiert das Daumensattelgelenk und positioniert den Mittelhandknochen des Daumens; b verdickter Stift; c Griffverdickung Besteck. (Mit freundl. Genehmigung, © BG Klinik Ludwigshafen, alle Rechte vorbehalten) a b Abb. 5 8 Der Therapeut fixiert mit der einen Hand das Os trapezium und mit der anderen Hand den ersten Mittelhandknochen. Das Ziel ist es, durch Traktionstechniken (a) und Roll-Gleit-Mobilisation die Gelenkführung zur verbessern und die Gelenkkapsel zu stabilisieren (b) . (Mit freundl. Genehmigung, © BG Klinik Ludwigshafen, alle Rechte vorbehalten)

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Section: Therapeutische Verfahrenunclassified

Konservative Therapieverfahren zur Behandlung der symptomatischen Daumensattelgelenksarthrose

et al. 2021

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“…In fact, it has been documented that TMC prosthesis leads to a faster recovery and return to work and sport activities with much more tolerable painful symptoms without the need to assume painkiller therapy. In addition, postoperative immobilization of the thumb after TMC prosthesis is not mandatory, while in arthroplasty, it is maintained for 3–4 weeks [ 2 , 3 ]. However, TMC prosthesis has been limited by inherently linked complications: dislocation, aseptic loosening, etc.…”

Section: Introductionmentioning

confidence: 99%

Proposed Radiographic Parameters to Optimize Clinical Outcomes in Trapezio-Metacarpal Prosthesis Placement Using CT Imaging, with 1-Year Follow-Up

Piccirilli,

Primavera,

Salvati

et al. 2024

JPM

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Purpose: Addressing trapezio-metacarpal (TMC) osteoarthritis often involves considering TMC joint replacement. Utilizing TMC prostheses offers advantages such as preserving the thumb length and more accurately replicating the thumb’s range of motion (ROM). TMC prostheses have an intrinsic risk of dislocation and aseptic loosening. Analyzing pre- and postoperative imaging can mitigate complications and improve prosthetic placement, providing insights into both successes and potential challenges, refining overall clinical outcomes. Materials and methods: We conducted a prospective analysis of 30 patients with severe TMC arthritis treated with a Touch© (Kerimedical, Geneva, Switzerland) prosthesis in 2021–2023: X-ray and CT protocols were developed to analyze A) the correct prosthesis placement and B) its correlation with clinical outcomes (VAS, Kapandji and QuickDASH scores) by performing Spearman correlation analysis. Results: The average differences in trapezium height and M1-M2 ratio pre- and post-surgery were, respectively, 1.8 mm (SD ± 1.7; p < 0.001) and 0.04 mm (SD ± 0.04; p = 0.017). Pre-to-postoperative M1 axis length increased by an average of 2.98 mm (SD ± 3.84; p = 0.017). Trapezial cup sinking, indicated by the trapezium index, measured 4.6 mm (SD ± 1.2). The metacarpal index averaged at 11.3 mm (SD ± 3.3). The distance between the centers of the trapezium distal surface and the prosthesis cup was 2.23 mm (SD ± 1.4). The Spearman correlation analysis gave the following results: negative correlations were highlighted between postoperative VAS scores and the M1/M2 ratio and residual trapezium height (correlation coefficient: −0.7, p = 0.03 and −0.064, p = 0.03, respectively) at 6 months; a negative correlation was found at the 3-month mark between QuickDASH and the trapezium residual height (correlation coefficient: −0.07, p = 0.01); and a positive correlation was found for the trapezium index at 1 month (correlation coefficient: 0.07, p = 0.03) and 3 months (p = 0.04) using the Kapandji score. Similarly, we found a positive correlation between the distance between the prosthesis and trapezium centers and QuickDASH score at 1 and 3 months (correlation coefficient: 0.066, p = 0.03; correlation coefficient: 0.07, p = 0.05, respectively) and a positive correlation between prosthesis axis and the residual first metacarpal angle with QuickDASH score at 3 months (correlation coefficient: 0.07, p = 0.02). Conclusions: Pre- and postoperative systematic imaging analysis should become a method for predicting complications and guiding recovery in TMC prosthesis: CT imaging could provide us with radiographical landmarks that are intrinsically linked to clinical outcomes. Further research is necessary to fuel a protocol for the correct intraoperative TMC prosthesis implantation.

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“…Operative treatment is an option for patients with TMC OA that are not satisfied with accommodation and palliative measures. 169,170 Prior studies found that people who request TMC arthroplasty for OA have a greater tendency to limit activity owing to pain 171 , a more negative cognitive and emotional representation of the illness 70 , and greater catastrophic thinking 172 compared to people that accommodate TMC OA. The influence of mental health prior to surgery on patient reported outcomes 1 year after surgery is less studied.…”

Section: Baseline Psychosocialmentioning

confidence: 99%

Factors Associated with Outcome in Extremity Surgery

al Salman

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Introduction: Understanding musculoskeletal disability is essential for the treatment protocols of surgeons. Associations between mental health measures and disability have been studied extensively in Upper-extremity injuries but less so in lower extremity trauma patients.It is less clear which factors are most consistently associated with disability in the orthopaedic lower-extremity trauma population and which outcome measurements are used to represent disability. Questions:(1) What factors are most consistently associated with disability after lowerextremity injuries in adults? (2) What are the trends in types of outcome measures used to represent disability and conceptualization of disability in patients with lower-extremity injuries. Methods:We conducted searches in PubMed (NLM), Web of Science (Clarivate) and CINAHL (EBSCO). No limits were imposed for publication type except for publication dates (2000 through current), language (English), and age (adult only). Our search provided 6298 unique entries. Of these studies, 8 involved traumatic conditions in which disability was measured and psychological variables were tested.Results: Greater magnitude of disability after lower extremity injury was most consistently associated with symptoms of depression (6 cohorts) and symptoms of anxiety (2 cohorts).Other psychological factors associated with disability included pain interference (1 cohort), pain catastrophizing (1 cohort), kinesiophobia (1 cohort) and pain self-efficacy (1 cohort).Satisfaction of social life and the level of activity were also correlated with disability. The Patient Reported Outcome Measure Information System Computer Adaptive Test (PROMIS CAT) 1) Physical Function, 2) Depression and 3) Anxiety were most frequently used to measure disability, depression and anxiety, respectively. Of the 8 included studies, 3 were of moderate quality and 5 were of high quality. Conclusion:Symptoms of depression are most commonly associated with disability after a lower extremity trauma. Future longitudinal studies may focus on factors associated with 13 specific lower extremity trauma on both short and long term to better understand disability in this population and study the effects of several factors on recovery.

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Current trends in the management of trapeziometacarpal arthritis

Cited by 7 publications

References 46 publications

Konservative Therapieverfahren zur Behandlung der symptomatischen Daumensattelgelenksarthrose

Konservative Therapieverfahren zur Behandlung der symptomatischen Daumensattelgelenksarthrose

Proposed Radiographic Parameters to Optimize Clinical Outcomes in Trapezio-Metacarpal Prosthesis Placement Using CT Imaging, with 1-Year Follow-Up

Factors Associated with Outcome in Extremity Surgery

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