Efficacy of Nonsurgical Interventions for Trapeziometacarpal (Thumb Base) Osteoarthritis: A Systematic Review (original) (raw)

2020, Arthritis Care and Research

Objective This systematic review (SR) aimed to synthesize the literature on the efficacy of existing non-surgical interventions for trapeziometacarpal osteoarthritis (TMO). Methods A medical librarian conducted an electronic search in 16 databases. Two authors independently carried out study selection, data extraction, and risk of bias assessment. The Agency for Healthcare Research and Quality guidance was followed to integrate a valid body of evidence Accepted Article This article is protected by copyright. All rights reserved from the existing SRs. Intervention effects were estimated based on the Cochrane Collaboration review methodology. Results We identified 17 SRs, 34 randomized controlled trials (RCTs), and 6 non-RCTs. Most of them had unclear or high risk of biases. Evidence of low to moderate quality supports the superiority of the following interventions for pain and/or physical function: 1) saline over steroid intra-articular injections confirmed by radiography; 2) saline injections over sham (i.e., pressure) in tender subcutaneous areas; 3) custom-made thermoplastic thumb orthosis over no intervention or a control; 4) custom-made thermoplastic hand-based trapeziometacarpal (TM) joint orthosis over no intervention; 5) radial nerve mobilization over sham ultrasound; 6) combination of hand exercises, TM-joint and median/radial nerve mobilization over sham ultrasound. Conclusion This comprehensive SR allowed collating evidence-based data on the efficacy of nonsurgical interventions for TMO. Steroid intra-articular injections would not be more effective than saline injections. Rehabilitative interventions (orthosis, exercises, nerve mobilization) would be efficacious. However, these findings must be treated with circumspection due to methodological limitations in many studies. Significance and Innovations  This systematic review is the first to include all non-surgical interventions (pharmacology, rehabilitation, alternative medicine) for trapeziometacarpal osteoarthritis (TMO). Our findings will be useful to clinicians for making scientific evidence-based decisions regarding the choice of the best therapeutic options.  Although steroid intra-articular injections are commonly used for osteoarthritis, this intervention would not be more effective than saline injections for TMO according to scientific evidence of moderate quality.  The efficacy for pain reduction and/or improvement of physical function of saline injections in tender subcutaneous areas, custom-made thermoplastic thumb, custom-made thermoplastic Accepted Article This article is protected by copyright. All rights reserved hand-based trapeziometacarpal (TM) joint orthosis, radial nerve mobilization and a combination of hand exercises, TM-joint/nerve mobilization is supported by scientific evidence of low quality which is still the best available evidence.