Optimal management of thumb basal joint arthritis: challenges and solutions

Higgenbotham, Christopher; Boyd, Alan; Busch, Michelle H.; Heaton, Dennis; Trumble, Thomas E.

doi:10.2147/orr.s138809

Cited by 9 publications

(14 citation statements)

References 36 publications

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“…The finding that reduced pain and improved hand and arm use were the most frequently reported goals for undergoing surgery are consistent with findings in previous studies, 6,21 and supports the recommendation that persistent pain and reduced function, caused by the affected OA joint, can help surgeons in the decision on whether or not to conduct surgery. 5,11,12 Nevertheless, we did not find any statistical significant differences between the 3 groups with different goals; they all reported approximately the same levels of pain and activity limitations.…”

Section: Discussioncontrasting

confidence: 65%

“…The main indication for CMCJ surgery is persistent pain and reduced function. 5 , 11 , 12 Pain and function measures and personal factors were therefore used as covariates to investigate factors that characterized patients that were highly motivated for surgery. As no cut-off value for the motivation question (measured on NRS) exists, we used the 75th percentile from this sample as a cut-off to identify highly motivated patients (individual NRS score ≥ 8 indicated highly motivated patients).…”

Section: Methodsmentioning

confidence: 99%

“… 10 Surgery should only be considered when nonsurgical interventions have yielded unsatisfactory outcomes. The main indications for surgery are persistent pain and reduced function 5 , 11 , 12 in joints with evidence of radiographic OA. Surgical techniques might provide pain relief and improve function, but results vary with the stage and the nature of the disease.…”

Section: Introductionmentioning

confidence: 99%

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Patient Goals and Motivation for Thumb Carpometacarpal Osteoarthritis Surgery

Gravås

Kjeken

Nossum

et al. 2020

Hand (New York, N,Y.)

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Background: Knowledge is lacking on patient goals and motivation for carpometacarpal joint osteoarthritis (CMCJ OA) surgery. The objective of this study was to explore patient goals and motivation for surgery, whether patient goals were reflected in self-reports of pain and function, and factors characterizing patients highly motivated for surgery. Methods: This cross-sectional study included 180 patients referred from their general practitioner for CMCJ surgical consultation. Goals for surgery were collected with an open-ended question, categorized with the International Classification of Functioning, Disability and Health coding system, and compared to self-reports of pain and function. Motivation for surgery was rated with a Numeric Rating Scale (NRS, 0-10, 0 = not motivated). Factors characterizing patients highly motivated for surgery (NRS ≥ 8) were explored with multivariate regression analyses. Results: The mean age of the participants was 63 years (SD = 7.6), and 142 (79%) were women. The most common goals for surgery were to reduce pain and improve arm and hand use, but these were not reflected in self-reports of pain and function. Fifty-six (31%) of the patients were characterized as highly motivated for surgery. High motivation for surgery was strongly associated with reporting more activity limitations (odds ratio [OR] = 4.00, P = .008), living alone (OR = 3.18, P = .007), and a young age (OR = 0.94, P = .002). Conclusions: Decisions on CMCJ OA surgery should be based on assessment and discussion of patients’ life situation, hand pain, activity limitations for, and goals and motivation for surgery. According to the european league against rheumatism (EULAR) recommendations, previously received conservative and pharmacological treatment should also be evaluated.

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Section: Discussioncontrasting

confidence: 65%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Patient Goals and Motivation for Thumb Carpometacarpal Osteoarthritis Surgery

Gravås

Kjeken

Nossum

et al. 2020

Hand (New York, N,Y.)

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“…On physical examination, patients may have a positive grind test which shows point tenderness at the thumb basal joint with swelling and crepitus when the joint is compressed. 6 , 7 Within the senior author’s clinic, it is standard to recommend a trial of splinting/hand therapy for 4–6 weeks for any new patient presenting with symptoms of thumb arthritis. Therapy includes daily exercise focusing on thenar cone and first dorsal interosseous strengthening.…”

Section: Methodsmentioning

confidence: 99%

Evaluation of PROMIS Scores 6 Weeks after Conservative Management of Carpometacarpal Thumb Arthritis

Phan

Calderon

Hammert

2022

Plastic and Reconstructive Surgery - Global Open

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Background: Patient-reported outcome measures are being increasingly emphasized to assign value to care‚ given the current trend toward pay-for-performance healthcare. We sought to determine if the Patient-reported Outcomes Measurement Information System (PROMIS), a general questionnaire, is sensitive enough to detect improvement after corticosteroid injection or splinting/hand therapy for thumb carpometacarpal (CMC) arthritis. Methods: This is a retrospective study analyzing two groups with thumb CMC arthritis: 88 patients who received splinting/hand therapy and 6-week follow-up and 70 patients with steroid injection and 6-week follow-up. PROMIS Physical Function (PF), Pain Interference (PI), Depression, and Upper Extremity (UE) scores were collected at each visit. We used paired t-tests to compare 6-week follow-up scores to baseline scores within each group. Results:The mean age for the steroid injection group was 60.1 years old, and it was 61.8 years old for the returning splinting/hand therapy group. There were no significant differences in PROMIS PF, PI, Depression, or UE scores for patients who returned after 6 weeks of treatment with splinting/hand therapy. Moreover, at 6 weeks postinjection, PROMIS PF and UE scores marginally increased, whereas PI and Depression scores decreased with statistical significance. Conclusions: Hand surgeons should be aware of the limitations of PROMIS when evaluating patients after conservative treatment for thumb CMC arthritis. There were no significant differences in PROMIS scores for patients with thumb CMC arthritis who returned after receiving splinting/hand therapy for 6 weeks. Meanwhile, PI scores can be used primarily to monitor for improvement after steroid injection for thumb CMC arthritis.

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“…Several procedures have been described for trapeziometacarpal joint arthritis, but none has shown a clearly defined superiority (Higginbotham et al, 2017). Trapeziectomy offers a good therapeutic option and a durable result (Jager, 2021).…”

Section: Introductionmentioning

confidence: 99%

Targeted partial arthroscopic trapeziectomy with temporary distraction: a retrospective study with 5-year follow-up

de Villeneuve Bargemon,

Lupon,

Soudé

et al. 2023

J Hand Surg Eur Vol

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Targeted partial arthroscopic trapeziectomy with temporary distraction is a minimally invasive treatment for trapeziometacarpal osteoarthritis. We performed a retrospective single centre study from March 2011 to May 2022 and included patients with at least 5 years of follow-up. A failure was defined as a patient requiring a second procedure. Of the 28 patients with at least 5 years of follow-up, 23 were reviewed. Five of the 23 patients underwent revision surgery with a 5-year survival rate of 78%. There was a significant improvement in pain and the Quick Disabilities of the Arm, Shoulder and Hand (Q-DASH) score. There were three postoperative complications, one with complex regional pain syndrome, and two with hyperesthesia in the distribution of the sensory branch of the radial nerve. Targeted partial arthroscopic trapeziectomy with temporary distraction is a feasible temporary solution for early stage trapeziometacarpal joint osteoarthritis. However, there remains a 20% risk of failure. Level of evidence: IV

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Optimal management of thumb basal joint arthritis: challenges and solutions

Cited by 9 publications

References 36 publications

Patient Goals and Motivation for Thumb Carpometacarpal Osteoarthritis Surgery

Patient Goals and Motivation for Thumb Carpometacarpal Osteoarthritis Surgery

Evaluation of PROMIS Scores 6 Weeks after Conservative Management of Carpometacarpal Thumb Arthritis

Targeted partial arthroscopic trapeziectomy with temporary distraction: a retrospective study with 5-year follow-up

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