-
Lakartidningen May 2019
Topics: Algorithms; Carpal Tunnel Syndrome; Carpometacarpal Joints; De Quervain Disease; Diagnosis, Differential; Humans; Osteoarthritis; Sick Leave; Thumb
PubMed: 31192429
DOI: No ID Found -
Orthopaedics & Traumatology, Surgery &... Oct 2016Posttraumatic carpal and carpometacarpal dislocations represent a heterogeneous group of disorders resulting from high-energy wrist trauma. Perilunate injury is the most...
Posttraumatic carpal and carpometacarpal dislocations represent a heterogeneous group of disorders resulting from high-energy wrist trauma. Perilunate injury is the most common and best-known manifestation of carpal dislocation, typically occurring after hyperextension trauma. Other forms are very rare and have different causative mechanisms. Carpometacarpal (CMC) dislocations are also uncommon and may affect isolated or multiple CMC joints. These lesions are prone to wrist instability if not treated promptly. The aim of this article is to provide a systematic radiologic approach to the evaluation of wrist injury and to present two acute cases of rare CMC dislocations.
Topics: Accidents, Traffic; Adult; Bone Nails; Carpometacarpal Joints; Female; Humans; Joint Dislocations; Male; Metacarpophalangeal Joint; Middle Aged
PubMed: 27210506
DOI: 10.1016/j.otsr.2016.04.003 -
Cureus Apr 2022Objectives This study aims to determine the prevalence of the first carpometacarpal (CMC) joint osteoarthritis and Carpal Tunnel Syndrome (CTS) among dentists from...
Objectives This study aims to determine the prevalence of the first carpometacarpal (CMC) joint osteoarthritis and Carpal Tunnel Syndrome (CTS) among dentists from different specialties in Saudi Arabia and their association with gender, years of practice, and weekly working hours. Materials and Methods In this cross-sectional study, 361 dentists in Saudi Arabia have completed an online questionnaire of three parts: demographic and health data, the Thumb Disability Exam (TDX), and the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ). Univariate and multivariate analyses of logistic regression were performed to investigate the participants' predictors of the first CMC joint osteoarthritis and Carpal Tunnel Syndrome. The level of significance was set at α = 0.05 for all tests. Results Thumb disability was significantly associated with the female gender (aOR 2.21; 95 percent CI 1.31-3.56) and dentists aged 50 or older (aOR 9.63; 95 percent CI 1.05-88.47). The symptom severity scale (SSS) part of BCTQ was significantly associated with increased risk in the female gender (aOR 1.62; 95% CI 1.62-2.58). Limiting the clinical work to 10-20 hours per week showed a significant reduction in the odds of reporting CTS symptoms in SSS (aOR 0.44; 95% CI 0.21-0.90). CTS-related hand disability was more likely to be reported by the female gender (aOR 2.21; 95% CI 1.36-3.57) and less likely to be reported by endodontic specialists (aOR 0.15; 95% CI 0.04-0.58). Conclusion The female gender was significantly associated with first CMC joint osteoarthritis and CTS among dentists in Saudi Arabia. Other predictors were also identified in this cross-sectional study.
PubMed: 35530881
DOI: 10.7759/cureus.23876 -
Journal of Wrist Surgery Feb 2020The volume of the carpometacarpal joint of the thumb (TCMC) and its capacity to accommodate fluid injection is unknown. The purpose of the present study is to...
The volume of the carpometacarpal joint of the thumb (TCMC) and its capacity to accommodate fluid injection is unknown. The purpose of the present study is to assess the volume of the TCMC. Forty-two thumbs undergoing surgical treatment for symptomatic TCMCJ osteoarthritis (OA) were evaluated. Prior to the start of the surgical procedure saline was injected into the TCMC until resistance was felt and no further saline could be injected. The maximum volume (MaxVol) of injectate was measured and recorded. Mean MaxVol among all patients was 0.9 cc (range: 0.2-3.0 cc). There were 15 patients with 1 cc or more injected, the rest were less than 1 cc. The mean MaxVol for Eaton 2 thumbs was 1.5 cc, for Eaton 3 thumbs 0.9 cc, and for Eaton 4 thumbs 0.7 cc, with negative correlation between Eaton stage and MaxVol. TCMC has limited capacity for injected fluid. This is a Level II, diagnostic study.
PubMed: 32025349
DOI: 10.1055/s-0039-1693043 -
Orthopaedics & Traumatology, Surgery &... Dec 2020Intra-articular fractures and fracture-dislocations of the ulnar-sided carpometacarpal joints (US-CMC) are common and under-reported. Their diagnosis is often delayed or... (Review)
Review
BACKGROUND
Intra-articular fractures and fracture-dislocations of the ulnar-sided carpometacarpal joints (US-CMC) are common and under-reported. Their diagnosis is often delayed or incomplete, and there is no consensus as to the best treatment. The aim of this systematic literature review was to focus on the quality of existing data and to describe in detail the available evidence on the diagnosis and treatment of these lesions. Based on our findings, we will propose guidelines for improving the design of future studies on these lesions.
METHODS
This systematic literature review looked at all articles published between 1918 and 2019 on US-CMC fractures and fracture-dislocations. The quality of the articles was evaluated using the Quality Appraisal Tool devised by Moga et al. Information on the diagnostic and therapeutic methods were extracted along with epidemiological data, classifications, and clinical and radiological outcomes.
RESULTS
Of the 500 articles identified, 13 were included. According to the Quality Appraisal Tool, three of these articles had acceptable quality. While either radiographs or CT scans were used for the diagnosis, the radiographs were insufficient to precisely describe the lesions and guide the treatment. Conservative treatment or percutaneous surgical treatment was preferred for acute stable lesions without extensive fractures or comminution, while open surgical treatment was used most often in cases of unstable or sub-acute fractures and fracture-dislocations.
DISCUSSION
The current literature on this topic is made up of case series with a low level of evidence. CT is needed to assess and classify these lesions and select between conservative and surgical treatment. Unstable cases or those with delayed presentation should be treated with an open surgical approach. Based on our findings, we propose reporting guidelines for future studies on the treatment of US-CMC fractures and fracture-dislocations.
LEVEL OF EVIDENCE
III.
Topics: Carpometacarpal Joints; Fracture Dislocation; Fractures, Bone; Humans; Joint Dislocations; Ulna Fractures
PubMed: 33097451
DOI: 10.1016/j.otsr.2020.03.039 -
Journal of Wrist Surgery Aug 2021Thumb carpometacarpal joint (CMCJ) osteoarthritis is common and can lead to significant morbidity making it a condition frequently treated by hand surgeons when...
Thumb carpometacarpal joint (CMCJ) osteoarthritis is common and can lead to significant morbidity making it a condition frequently treated by hand surgeons when initial conservative measures fail. The surrounding ligamentous structures are complex and important to maintain thumb CMCJ stability. The aim of this study was to review the normal and arthritic anatomy of the thumb CMCJ, focusing on morphology and position of osteophytes and the gap between metacarpal bases, and the effect of these on intermetacarpal ligament integrity. This may be the sole ligament suspending the first metacarpal following trapeziectomy and could determine the need for further stabilization during surgery, avoiding potential future failures. Computed tomography (CT) scans of a normal cohort and those with arthritic changes who had undergone trapeziectomy following the scan were identified. The three-dimensional reconstructions were examined for osteophyte position on the saddle and the intermetacarpal distance. A total of 55 patients, 30 normal and 25 arthritic, were identified and studied. The most common anatomic position for osteophytes was the intermetacarpal ulnar aspect of the trapezium. The intermetacarpal distance increased by an average of 2.1 mm in the presence of the arthritic process. The findings point to an increase in the intermetacarpal distance, and hence lengthening of the ligament with potential damage, possibly secondary to osteophyte formation and wear. Further prospective research is required to determine whether using preoperative CT scanning to define osteophyte position and measure the intermetacarpal distance would predict probable damage to the ligament, hence providing an indication for stabilization and reconstruction in trapeziectomy surgery. This is a Level III, retrospective cohort study.
PubMed: 34381638
DOI: 10.1055/s-0041-1726310 -
Revista Brasileira de Ortopedia Oct 2021Carpometacarpal (CMC) injuries can easily be missed in more than half of the cases. Early diagnosis is crucial for treatment. Although the clinical aspect can lead the...
Carpometacarpal (CMC) injuries can easily be missed in more than half of the cases. Early diagnosis is crucial for treatment. Although the clinical aspect can lead the treating physician to suspect that anything is going wrong, appropriate radiographs, especially in the lateral view, are crucial for the diagnosis. The most common CMC fracture dislocations affects the 4 and 5 joints. Treatment will depend on the type of injury and on the degree of joint involvement. Reduction and fixation are usually required. When only one ray is affected, usually the 5 , closed reduction and fixation with Kirschner wires can be performed. In complex cases, open reduction and fixation are required, with Kirschner wires being the most commonly used materials. After the hardware removal, rehabilitation can be intensified. If an appropriate reduction has been achieved, satisfactory functional and radiological outcomes are expected.
PubMed: 34733423
DOI: 10.1055/s-0040-1712138 -
The Journal of Hand Surgery Oct 2022Our goals were to identify individuals who required surgery for thumb carpometacarpal (CMC) joint osteoarthritis (OA), determine if CMC joint OA clusters in families,...
PURPOSE
Our goals were to identify individuals who required surgery for thumb carpometacarpal (CMC) joint osteoarthritis (OA), determine if CMC joint OA clusters in families, define the magnitude of familial risk of CMC joint OA, identify risk factors associated with CMC joint OA, and identify rare genetic variants that segregate with familial CMC joint OA.
METHODS
We searched the Utah Population Database to identify a cohort of CMC joint OA patients who required surgery. Affected individuals were mapped to pedigrees to identify high-risk families with excess clustering of CMC joint OA. Cox regression models were used to calculate familial risk of CMC joint OA in related individuals. Risk factors were evaluated using logistic regression models. Whole exome sequencing was used to identify rare coding variants associated with familial CMC joint OA.
RESULTS
We identified 550 pedigrees with excess clustering of severe CMC joint OA. The relative risk of CMC joint OA requiring surgical treatment was elevated significantly in first- and third-degree relatives of affected individuals, and significant associations with advanced age, female sex, obesity, and tobacco use were observed. We discovered candidate genes that dominantly segregate with severe CMC joint OA in 4 independent families, including a rare variant in Chondroitin Sulfate Synthase 3 (CHSY3).
CONCLUSIONS
Familial clustering of severe CMC joint OA was observed in a statewide population. Our data indicate that genetic and environmental factors contribute to the disease process, further highlighting the multifactorial nature of the disease. Genomic analyses suggest distinct biological processes are involved in CMC joint OA pathogenesis.
CLINICAL RELEVANCE
Awareness of associated comorbidities may guide the diagnosis of CMC joint OA in at-risk populations and help identify individuals who may not do well with nonoperative treatment. Further pursuit of the genes associated with severe CMC joint OA may lead to assays for detection of early stages of disease and have therapeutic potential.
Topics: Carpometacarpal Joints; Chondroitin Sulfates; Cluster Analysis; Female; Genetic Predisposition to Disease; Humans; Osteoarthritis; Thumb
PubMed: 36184273
DOI: 10.1016/j.jhsa.2022.08.004 -
Systematic Review of Thumb Carpometacarpal Joint Hemiresection Interposition Arthroplasty Materials.Hand (New York, N.Y.) Sep 2022Osteoarthritis of the first carpometacarpal joint is a common condition. Various management options and surgical procedures have been described to treat symptomatic...
BACKGROUND
Osteoarthritis of the first carpometacarpal joint is a common condition. Various management options and surgical procedures have been described to treat symptomatic cases. Many systematic reviews examine aspects of thumb carpometacarpal joint osteoarthritis treatment, although none solely examines the outcomes of trapezial partial resection and interposition arthroplasty in stage II to III patients in detail, yet this technique is of growing interest as surgeons seek more nuanced, tailored approaches for osteoarthritis of the first carpometacarpal joint.
METHODS
A systematic review of the thumb carpometacarpal joint hemiresection and interposition arthroplasty was performed with pain assessment as a primary outcome measure and patient-reported outcome measures (PROMs) and reoperation rate as secondary outcome measures. A search was performed between 2004 and 2019 using MEDLINE, Embase, and PubMed. Preferred Reporting Items and Systematic Reviews and Meta-Analyses guidelines were used.
RESULTS
Twenty-nine articles met the inclusion criteria and were included in the final review. Pain relief and improved PROMs were described in all the articles using this technique with all the interposition materials. Materials such as polyurethane urea matrix and poly-l/d-lactide scaffold had higher complication rates. Revision rates varied and were highest with the polyurethane urea matrix.
CONCLUSIONS
This review shows that hemiresection interposition arthroplasty is a useful technique and provides symptomatic benefit in patients with Eaton-Littler stage II and III osteoarthritis. Revision surgery rates due to persistent pain and instability were higher with the use of implants. Larger and long-term studies of this technique using autologous or more bioinert materials and implants are required to assess duration of symptomatic benefit.
Topics: Arthroplasty; Carpometacarpal Joints; Humans; Osteoarthritis; Pain; Polyurethanes; Thumb; Urea
PubMed: 33307813
DOI: 10.1177/1558944720974124 -
Ugeskrift For Laeger Jul 2019Osteoarthrosis of the trapeziometacarpal joint is a common condition, especially in middle-aged women, and this review summarises the diagnosis and treatment modalities.... (Review)
Review
Osteoarthrosis of the trapeziometacarpal joint is a common condition, especially in middle-aged women, and this review summarises the diagnosis and treatment modalities. Many patients have few symptoms and may be treated conservatively with orthoses, nonsteroidal anti-inflammatory drugs and intra-articular steroid injections. In patients with more persistent symptoms, surgical treatment has generally shown good results. Several surgical procedures have been described, but at present, trapeziectomy is the preferred treatment. Total joint arthroplasty is possible and may provide faster rehabilitation and a better grip strength but at the expense of a relatively high risk of implant failure.
Topics: Arthroplasty; Carpometacarpal Joints; Female; Humans; Middle Aged; Osteoarthritis; Trapezium Bone
PubMed: 31280761
DOI: No ID Found