The Carpometacarpal Stress View Radiograph in the Evaluation of Trapeziometacarpal Joint Laxity

Wolf, Jennifer Moriatis; Oren, Trevor W.; Ferguson, Bradley S.; Williams, Allison; Petersen, Brian

doi:10.1016/j.jhsa.2009.06.030

Cited by 55 publications

(46 citation statements)

References 15 publications

(13 reference statements)

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“…We found a mean radial subluxation of 2.8-3.4 mm and a dorsal subluxation of 1.8-2.0 mm. This is in accordance to an X-ray study of 69 healthy volunteers with a range of radial subluxation of 1.72-8.69 mm [29]. This amount of subluxation should not be misinterpreted as a possible sign of prior trauma or osteoarthritis in a resting thumb position.…”

Section: Discussionsupporting

confidence: 90%

The carpometacarpal joint of the thumb: MR appearance in asymptomatic volunteers

et al. 2013

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PURPOSE: To prospectively characterize the MR appearance of the carpometacarpal (CMC) joint of the thumb in asymptomatic volunteers. MATERIALS AND METHODS: Thirty-four asymptomatic volunteers (17 women, 17 men, mean age, 33.9 ± 9.2 years) underwent MR imaging of the thumb after approval by the local ethical committee. Two musculoskeletal radiologists independently classified visibility and signal intensity (SI) characteristics of the anterior oblique (AOL/beak ligament), the posterior oblique (POL), the intermetacarpal (IML), and the dorsoradial ligaments (DRL) on a threepoint Likert scale. The thickness of all ligaments, cartilage integrity, and presence of joint fluid were assessed. The alignment of the first metacarpal base with the trapezium was quantified on sagittal and coronal planes. RESULTS: The ligaments of the CMC joint were constantly visible in all volunteers for the POL and IML, and in all but one for the AOL and DRL. On intermediate-weighted fat-saturated images the POL (65 %/74 % reader 1/reader 2) and DRL (58 %/64 %) were commonly of increased SI, while the IML had a striated appearance in 91 %/76 % of subjects. The AOL showed a variable SI (36 %/42 % low, 27 %/27 % increased, 36 %/30 % striated). The IML was the thickest ligament with a mean of 2.9 mm/3.1 mm and the DRL the thinnest (1.2 mm/1.4 mm). There was a mean dorsal subluxation of 1.8 mm/2.0 mm and radial subluxation of 2.8 mm/3.4 mm of the metacarpal base. The AOL was significantly thicker in men (1.7 mm) than in women (1.2 mm; p = 0.02). Radial subluxation was significantly larger in men (3.4 mm) than in women (2.2 mm; p = 0.02). No subluxation in palmar or ulnar direction was seen. CONCLUSIONS: Radial and dorsal subluxation of the CMC joint can be a normal finding in a resting position at MR imaging. The CMC ligaments showed a considerable variability of signal intensity with a typically striated IML; thickness of the AOL is typically less than 2.2 mm, of the POL typically less than 2.9 mm. Abstract Purpose To prospectively characterize the MR appearance of the carpometacarpal (CMC) joint of the thumb in asymptomatic volunteers. Materials and methods Thirty-four asymptomatic volunteers (17 women, 17 men, mean age, 33.9 ± 9.2 years) underwent MR imaging of the thumb after approval by the local ethical committee. Two musculoskeletal radiologists independently classified visibility and signal intensity (SI) characteristics of the anterior oblique (AOL/beak ligament), the posterior oblique (POL), the intermetacarpal (IML), and the dorsoradial ligaments (DRL) on a three-point Likert scale. The thickness of all ligaments, cartilage integrity, and presence of joint fluid were assessed. The alignment of the first metacarpal base with the trapezium was quantified on sagittal and coronal planes. Results The ligaments of the CMC joint were constantly visible in all volunteers for the POL and IML, and in all but one for the AOL and DRL. On intermediate-weighted fat-saturated images the POL (65 %/74 % reader 1/reader 2) and DRL (58 %/64 ...

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Section: Discussionsupporting

confidence: 90%

The carpometacarpal joint of the thumb: MR appearance in asymptomatic volunteers

et al. 2013

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“…One of the variables for examination in the Burton [3], Eaton [9], and modified Eaton [2,8] classifications is subluxation [3] and extent of subluxation [8,9,15] of the first metacarpal on the trapezium. Recent studies have confirmed that subluxation is present in asymptomatic subjects, measured with precise stress radiographs [17] and CT [6]. Thus, using degree of subluxation as criteria for staging, rather than a supporting variable, suggests current Eaton stratification is an inaccurate measure of disease severity.…”

Section: Discussionmentioning

confidence: 99%

“…We assessed the potential relevance of the 242 unique citations and excluded 235 based on review of title and abstract. Of the seven remaining articles, three [2,14,17] were excluded after full-text review, as they were ultimately deemed not relevant to the study question. This process left four articles [5,12,13,15] that met criteria for final analysis, which together included analysis of 163 patients' radiographs, and these were critically reviewed.…”

Section: Search Criteria and Strategymentioning

confidence: 99%

Intra- and Interobserver Reliability of the Eaton Classification for Trapeziometacarpal Arthritis: A Systematic Review

Berger

Momeni

Ladd

2014

Clinical Orthopaedics &Amp; Related Research

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Background Trapeziometacarpal, or thumb carpometacarpal (CMC), arthritis is a common problem with a variety of treatment options. Although widely used, the Eaton radiographic staging system for CMC arthritis is of questionable clinical utility, as disease severity does not predictably correlate with symptoms or treatment recommendations. A possible reason for this is that the classification itself may not be reliable, but the literature on this has not, to our knowledge, been systematically reviewed. Questions/purposes We therefore performed a systematic review to determine the intra-and interobserver reliability of the Eaton staging system. Methods We systematically reviewed English-language studies published between 1973 and 2013 to assess the degree of intra-and interobserver reliability of the Eaton classification for determining the stage of trapeziometacarpal joint arthritis and pantrapezial arthritis based on plain radiographic imaging. Search engines included: PubMed, Scopus 1 , and CINAHL. Four studies, which included a total of 163 patients, met our inclusion criteria and were evaluated. The level of evidence of the studies included in this analysis was determined using the Oxford Centre for Evidence Based Medicine Levels of Evidence Classification by two independent observers. Results A limited number of studies have been performed to assess intra-and interobserver reliability of the Eaton classification system. The four studies included were determined to be Level 3b. These studies collectively indicate that the Eaton classification demonstrates poor to fair interobserver reliability (kappa values: 0.11-0.56) and fair to moderate intraobserver reliability (kappa values: 0.54-0.657).

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“…Our study is the first to report an incidence rate ratio between genders. The predominance of JHS in women has been hypothesized to be due to hormonal influences [37], or other molecular level genderspecific distinctions [40].…”

Section: Discussionmentioning

confidence: 99%

Incidence of Joint Hypermobility Syndrome in a Military Population: Impact of Gender and Race

Scher¹,

Owens²,

Sturdivant³

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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The Carpometacarpal Stress View Radiograph in the Evaluation of Trapeziometacarpal Joint Laxity

Cited by 55 publications

References 15 publications

The carpometacarpal joint of the thumb: MR appearance in asymptomatic volunteers

The carpometacarpal joint of the thumb: MR appearance in asymptomatic volunteers

Intra- and Interobserver Reliability of the Eaton Classification for Trapeziometacarpal Arthritis: A Systematic Review

Incidence of Joint Hypermobility Syndrome in a Military Population: Impact of Gender and Race

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