Trapeziometacarpal arthrosis: predictors of a second visit and surgery (original) (raw)
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QuickDASH Score Is Associated With Treatment Choice in Patients With Trapeziometacarpal Arthrosis
Hand (New York, N.Y.), 2017
Trapeziometacarpal (TMC) arthrosis has a variety of treatment options, including nonoperative (eg, education, splint, injection) and operative management. Symptoms and limitations vary greatly among patients. The purpose of this study was to determine an association of symptoms and limitations, quantified using the Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, with treatment choice in patients newly diagnosed with TMC arthrosis. We also addressed the association of the QuickDASH score with radiographic severity and sought factors associated with higher QuickDASH scores. As part of the routine new patient intake paperwork, all new patients completed a QuickDASH form. We included 81 new patients with newly diagnosed TMC arthrosis visiting the office of 1 of 5 orthopedic hand surgeons between March 1, 2015, and November 30, 2015. Eight patients were excluded because of incomplete QuickDASH forms. Based on QuickDASH tertiles, patients with a low QuickDASH score were mor...
The Journal of Hand Surgery, 2009
Purpose Reported outcomes of trapeziometacarpal (TM) arthrodesis have been contradictory. The purpose of this paper is to review the long-term results of TM arthrodesis for arthritis with respect to clinical outcomes, union, development of adjacent joint arthritis, and complications. Methods A retrospective review of TM arthrodeses performed between 1970 and 2003 was undertaken. Among a total of 241 arthrodeses performed, 126 thumbs in 114 patients (79 women, 35 men) treated for osteoarthritis were available for follow-up evaluation. Pre-and postoperative clinical and radiographic data were reviewed. The average age was 57 years (range 32-77). The dominant hand was involved in 76 cases. Supplemental bone graft was used in 90 thumbs. Preoperative appositional (key) pinch, oppositional (tip) pinch, and grip strengths were 3.0 kg, 2.7 kg, and 14 kg, respectively. The average pain score on a scale of 0-10 was 6.6 (range 4-10). The average follow-up was 11.2 years (range 3-28 years). Results There were 17 nonunions. No correlation existed between the incidence of nonunion and the use of supplemental bone graft. Nine of 17 thumbs had re-operation, including revision arthrodesis (6) and interposition or suspensionplasty (3). The appositional pinch, oppositional pinch, and grip strengths improved to 5.9 kg, 5.4 kg, and 23 kg, respectively (p Ͻ .01). The average pain score improved to 0.4 (p Ͻ .01). Radiographic progression of scaphotrapeziotrapezoid arthritis occurred in 39 cases; however, only 8 of these were symptomatic. Development of metacarpophalangeal arthritis was noted in 16 thumbs; none have been clinically relevant. Conclusions For most patients TM arthrodesis reduces pain, improves function and results in excellent patient satisfaction. Despite the development of metacarpophalangeal and scaphotrapeziotrapezoid joint arthritis, intervention for these joints was rarely warranted.
Management of Advanced Trapeziometacarpal Arthrosis
The Journal of Hand Surgery, 2009
A 61-year-old, right-handed woman has experienced difficulty opening jars and buttoning her pants for several years. She has managed her symptoms with splints, nonsteroidal anti-inflammatory medications, and a steroid injection. She is not satisfied with her comfort level during tennis and gardening and wants to learn about surgical treatment options. She is confused by differences between her mother's surgery to "remove the arthritis" 20 years ago, a friend recently treated with "little poke holes and lasers," and another friend who had a "thumb replacement." On examination, the trapeziometacarpal (TM) joint is prominent dorsally and tender. There is crepitation and pain with circumduction under an axial load. The thumb metacarpophalangeal joint extends slightly beyond neutral but is not unstable. The patient is able to oppose the tip of her thumb to the palmodigital crease of her small finger. Grip and pinch strength are markedly diminished compared with the nondominant left side. Standard hand x-rays supplemented with an anteroposterior view in maximal pronation confirm severe TM arthritis (Fig. 1).
HAND, 2008
Among 44 consecutive patients electing operative treatment of trapeziometacarpal arthrosis, three age- and gender-matched controls that presented during the same time period but had not yet requested operative treatment were selected from billing records. Each patient and control was mailed a survey that included an upper extremity-specific health status measure (Disabilities of the Arm, Shoulder, and Hand questionnaire; DASH) and a set of questionnaires evaluating psychological factors including the Pain Anxiety Symptoms Scale (PASS), the Pain Catastrophizing Scale (PCS) and the Center for the Epidemiological Study of Depression (CES-D) instrument. Seventy-two patients (45%; 31 that elected operative and 41 nonoperative care) returned a completed questionnaire with usable data. Older age was the only significant predictor of choice for nonoperative treatment among survey responders. Arm-specific disability (DASH) correlated with the CES-D, PASS, and PCS scores, and the influence of...
BMC Musculoskeletal Disorders
Background The aim of the study was to evaluate patient reported outcome measures (PROM) before and after trapeziectomy with or without ligament reconstruction and tendon interposition for trapeziometacarpal joint arthritis with special focus on possible differences due to gender, age and surgical method. Methods Data from the Swedish quality registry for hand surgery (HAKIR) was analyzed preoperatively, 3 months and 1 year postoperatively for 1850 patients (mean age 63 years, 79% women). Results One year postoperatively, mean pain at rest was reduced from 50 to 12 of maximum 100. However, pain on load and weakness had not abated to the same extent (mean 30 and 34 of 100, respectively). The mean improvement in PROM did not differ between age groups or gender. The result was similar after trapeziectomy with ligament reconstruction and tendon interposition (86% of the patients) and simple trapeziectomy but few patients were operated with the latter method. Conclusion Pain on load and ...
The Journal of hand surgery, 2016
To determine whether simplification of the Eaton-Glickel (E-G) classification of trapeziometacarpal (TMC) joint arthrosis (eliminating evaluation of the scaphotrapezial [ST] joint) and information about the patient's symptoms and examination influence interobserver reliability. We also tested the null hypotheses that no patient and/or surgeon factors affect radiographic rating of TMC joint arthrosis and that no surgeon factors affect the radiographic rating of ST joint arthrosis. In an on-line survey, 92 hand surgeons rated TMC joint arthrosis and ST joint arthrosis separately on 30 radiographs (Robert, true lateral, and oblique views) according to the (modified) E-G classification. We randomly assigned 42 observers to review radiographs alone and also informed 50 of the patient's symptoms and examination. Information about symptoms and examination was randomized. Interobserver reliability was determined with the s* statistic. Because of the hierarchical data structure, cros...
Trapeziometacarpal Arthritis of the Thumb
Bhandari/Evidence-Based Orthopedics, 2011
Objective: Trapeziometacarpal (TM) joint arthritis is a common source of hand pain in patients presenting to the hand surgeon's clinic. Long-term data on the natural history of symptomatic TM arthritis is lacking. Methods: We identified 251 patients with symptomatic TM arthritis and performed a retrospective chart review which identified treatment modalities (including surgery) and long term outcomes which were assessed via a telephone survey. Results: We found that of the 251 patients who presented with symptomatic TM arthritis, the 114 patients who had surgery had less pain and disability in the long term than those patients who were treated conservatively with splinting or injection (average pain score 1.8 vs. 3.8). However, the majority of patients did not ultimately undergo surgery. Conclusions: Although patients fare better from a pain and function standpoint with surgery, surgery is not inevitable.
Death, Taxes, and Trapeziometacarpal Arthrosis
Clinical Orthopaedics and Related Research®, 2013
Background Hand surgeons treat trapeziometacarpal arthrosis as if everyone with the disease presents for treatment despite evidence that suggests that trapeziometacarpal arthrosis is a normal part of human aging for which-it seems safe to assume-most people never seek medical attention. Questions/purposes The aims of our study were (1) to confirm the prevalence of radiographic trapeziometacarpal arthrosis in a very large sample and to determine if age and sex are associated with (2) any radiographic evidence of trapeziometacarpal arthrosis; and (3) radiographic evidence of severe trapeziometacarpal arthrosis.
Osteotomy versus tendon arthroplasty in trapeziometacarpal arthrosis 17 patients followed for 1 year
Acta Orthopaedica, 1998
We evaluated 2 consecutive cohorts of patients with primary trapeziometacarpal arthrosis 1 year after either first metacarpal osteotomy or trapezial excision with abductor pollicis longus tendon arthroplasty. At follow-up, 4 of 7 patients treated with osteotomy had pain at rest and/or with light activities and were dissatisfied with the results of surgery, all 4 had advanced (stage 111) preoperative trape-Submitted 97-05-1 9. Accepted 98-01 -30 ziometacarpal arthrosis. 1 of 10 patients (5 having stage 111 arthrosis) treated with abductor pollicis longus arthroplasty had pain with light activities, and no patient was dissatisfied. Our findings indicate that first metacarpal osteotomy as a surgical option in trapeziometacarpal arthrosis should be limited to patients with early disease.