Effect of Extension Osteotomy of the 1st Metacarpal on Laxity of the Thumb Carpometacarpal Joint

2002 ◽  
Author(s):  
Matthew F. Koff ◽  
Niket Shrivastava ◽  
Amy E. Abbot ◽  
Benton E. Heyworth ◽  
Thomas R. Gardner ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Hand Function ◽  
Joint Stiffness ◽  
Joint Laxity ◽  
Carpometacarpal Joint ◽  
Thumb Carpometacarpal Joint ◽  
Common Solution ◽  
Clinical Literature ◽  
Thumb Carpometacarpal ◽  
Cmc Joint

Osteoarthritis (OA) of the human thumb carpometacarpal (CMC) joint is a debilitating disease. It has been proposed in the clinical literature that joint ligamentous laxity, or joint looseness, is a major etiological factor in OA of the CMC joint (Figure1) [1–4]. Previous investigations of laxity and stability of the human thumb CMC joint have been performed visually, with no quantitative measures of joint laxity recorded [5–7]. Surgical treatment has been a common solution to reduce the pain associated with CMC OA. One treatment, extension osteotomy of the 1st metacarpal, has been suggested not only to reduce the pain of OA, but also improve hand function [8], however, little is known about its biomechanical effects. A complete description of joint laxity requires that all physiological directions of motion be fully tested. A custom-designed, 4 degree of freedom tester was constructed and instrumented for displacement and load in the distraction-compression, dorsal-volar, pronation-supination, and radial-ulnar directions. The purpose of this study was to use this device to: 1) Measure the joint laxity and compliance of non-OA human thumb CMC joints and 2) Determine the effect that a simulated extension osteotomy has on joint laxity and joint stiffness. This study provides an accurate baseline for future comparisons with osteoarthritic, surgically corrected, and otherwise non-healthy CMC joints.

Simulated Osteotomy of the Trapezium Reduces Radial Subluxation and Improves Contact Pressure Distribution Across the Thumb Carpometacarpal Joint in Lateral Pinch

2010 ◽  
Author(s):  
Deana Mercer ◽  
Christina Salas ◽  
James Love ◽  
Letitia Lansing ◽  
Amanda Medoro ◽  
...  
Keyword(s):  
Joint Laxity ◽  
Carpometacarpal Joint ◽  
Contact Pressure Distribution ◽  
Thumb Carpometacarpal Joint ◽  
Thumb Carpometacarpal ◽  
Long Term Impact ◽  
Flexion And Extension ◽  
Cmc Joint ◽  
Over Time

Joint laxity and radial subluxation of the metacarpal on the trapezium have been associated with arthritis of the carpometacarpal (CMC) joint of the thumb. In normal flexion and extension of the thumb, the ligaments and the joint are minimally stressed. However, in opposition and lateral pinch (key pinch), the two surfaces rotate on each other, generating an unequal surface stress. Over time, the unequal stresses lead to an asymmetrical wear pattern. This leads to increased strain on the ligaments and may lead to subluxation over time.1 Surgical treatment of early arthritis of the CMC joint includes ligament reconstruction or first metacarpal extension osteotomy to decrease joint laxity. Once laxity exists, joint degeneration is accelerated.2 The long-term impact of painful CMC arthritis on activities of daily living can be debilitating.

A Device for Assessment of Hand and Wrist Coronal Plane Strength

2005 ◽  
Vol 127 (6) ◽  
pp. 998-1000 ◽  
Author(s):  
Mark Carl Miller ◽  
Manoj Nair ◽  
Mark E. Baratz
Keyword(s):  
Repeated Measures ◽  
Normative Data ◽  
Hand Function ◽  
Normal Subjects ◽  
Carpometacarpal Joint ◽  
Ulnar Deviation ◽  
Thumb Carpometacarpal Joint ◽  
Disk Size ◽  
Repeated Measures Analysis ◽  
Thumb Carpometacarpal

Diagnostic and rehabilitative assessments of hand function commonly omit measurement of twisting strength even though many activities of daily living require turning handles, lids, and objects of many sizes. A simple device to quantify twisting strength was designed and constructed to establish normative data and test hypotheses about hand function. The instrument is easy to use and includes an electronic torsional load cell and disks of several sizes. Tests were conducted on the dominant and nondominant hands of 64 normal subjects and 13 arthritic patients with arthritis of the thumb carpometacarpal joint. Hands were tested with disks ranging in diameter from 2.5to12.5cm. A three-way repeated measures analysis showed that gender (p<0.001), handedness (p<0.001), and disk size (p<0.001) had significant effects. There was no difference between radial and ulnar deviation strengths (p=0.365). The arthritic group had significantly reduced strength (p<0.02). Nine subjects were tested twice, with 1day between tests: no differences occurred between the first and second testing (p=0.930). The ability to distinguish the test groups with reproducible results proves that the device fulfills all basic requirements; continued testing and development are warranted.

PALMAR SUBLUXATION OF THE THUMB CARPOMETACARPAL JOINT FOLLOWING THE MEDIAN NERVE RECURRENT BRANCH INJURY

Hand Surgery ◽  
2010 ◽  
Vol 15 (01) ◽  
pp. 53-55
Author(s):  
Tomoya Matsuhashi ◽  
Norimasa Iwasaki ◽  
Kinya Nishida ◽  
Makoto Motomiya ◽  
Akio Minami
Keyword(s):  
Median Nerve ◽  
Carpometacarpal Joint ◽  
Thumb Carpometacarpal Joint ◽  
Thumb Carpometacarpal ◽  
Cmc Joint

To our knowledge, the combination of a palmar subluxation of the thumb carpometacarpal (CMC) joint with low median nerve deficit followed by the recurrent branch injury is extremely rare. We present a case of the subluxation of the thumb CMC joint with low median nerve deficit.

scholarly journals Surgical Treatment of Thumb Carpometacarpal Joint Arthritis: A Single Institution Experience from 1995–2005

Hand ◽  
2008 ◽  
Vol 3 (4) ◽  
pp. 304-310 ◽  
Author(s):  
Min J. Park ◽  
Greg Lichtman ◽  
Jennifer B. Christian ◽  
Jennifer Weintraub ◽  
James Chang ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Carpometacarpal Joint ◽  
Single Institution ◽  
Thumb Carpometacarpal Joint ◽  
Thumb Carpometacarpal ◽  
Joint Arthritis

scholarly journals Trapezium Fracture Associated with Thumb Carpometacarpal Joint Dislocation: A Report of Three Cases and Literature Review

2018 ◽  
Vol 2018 ◽  
pp. 1-9
Author(s):  
Sho Kohyama ◽  
Toshikazu Tanaka ◽  
Akira Ikumi ◽  
Yasukazu Totoki ◽  
Kosuke Okuno ◽  
...  
Keyword(s):  
Carpometacarpal Joint ◽  
Ligament Injuries ◽  
Short Term ◽  
Joint Dislocation ◽  
Thumb Carpometacarpal Joint ◽  
Trapezium Fracture ◽  
Thumb Carpometacarpal ◽  
Treatment Consensus ◽  
Cmc Joint

Isolated trapezium fracture in combination with thumb carpometacarpal (CMC) joint dislocation is extremely rare, and no treatment consensus exists. Herein, we report 3 successfully treated cases of isolated trapezium fracture with thumb CMC joint dislocation. While good short-term results have been reported in the literature, the possibility of substantial ligament injuries that can lead to future instability of the thumb CMC joint must be noted. In order to obtain an excellent long-term clinical result, we propose the consideration of the anatomical repair of the CMC joint in terms of both bony and ligamentous structures in cases where instability remains after fracture fixation.

scholarly journals Modified Eaton-Littler's Reconstruction for Traumatic Thumb Carpometacarpal Joint Instability: Operative Technique and Clinical Outcomes

2017 ◽  
Vol 07 (03) ◽  
pp. 191-198 ◽  
Author(s):  
Karthikeyan Iyengar ◽  
William Loh ◽  
Hosam Matar
Keyword(s):  
Clinical Outcomes ◽  
Outcome Measures ◽  
Joint Instability ◽  
Case Series ◽  
Strength Analysis ◽  
Carpometacarpal Joint ◽  
Thumb Carpometacarpal Joint ◽  
Thumb Carpometacarpal ◽  
Cmc Joint

Background Injuries to thumb carpometacarpal joint ligaments lead to instability. Eaton-Littler's ligament reconstruction traditionally uses a strip of flexor carpi radialis to stabilize the CMC joint. Study Description We have modified this technique to reproduce the direction of active action of the anterior oblique ligament by reconstructing both the volar and dorsoradial ligaments. In this prospective study, we evaluated patients with confirmed traumatic thumb CMC joint instability who underwent modified Eaton-Littler's reconstruction. Strength analysis, Michigan Hand Outcome Questionnaire, QuickDASH, and subjective outcome measures were collected pre- and postoperatively with minimum 3 years of follow-up. Eleven patients were included in the final analysis, with mean age of 29 years (range: 16–52) and average follow-up of 6.2 years (range: 3–11). There was a statistically significant improvement in all outcome measures. Clinical Relevance Our modified technique helps to simultaneously address both volar and dorsal ligaments and yields satisfactory clinical outcomes at medium term follow-up. Level of Evidence Level IV, case series.

scholarly journals 208 First and Second Metacarpal Arthrodesis - Salvage Procedure for Failed Thumb Carpometacarpal Joint Arthritis Surgery

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
G Manoharan ◽  
J Edakalathur ◽  
S Pickard
Keyword(s):  
Literature Search ◽  
Ligament Reconstruction ◽  
Salvage Procedure ◽  
Carpometacarpal Joint ◽  
Thumb Carpometacarpal Joint ◽  
Primary Procedure ◽  
Surgical Options ◽  
Thumb Carpometacarpal ◽  
Joint Arthritis ◽  
Cmc Joint

Abstract Aim There are various surgical options for the management of thumb carpometacarpal joint (CMCJ) arthritis. These include first metacarpal osteotomy, trapeziectomy with or without ligament reconstruction, CMCJ arthrodesis and arthroplasty. However, if these operations fail, the options for salvage are limited. The authors aim to offer ‘first and second metacarpal arthrodesis (FSMA)’ as a salvage procedure for failed first CMC joint surgeries. The authors also reviewed the literature on FSMA. Method Literature search Operative Technique Results Literature search Conclusions FSMA is a good salvage option for failed surgical treatment of thumb CMCJ arthritis. FSMA can also be utilised as a primary procedure for various indications.

Poor Patient-Reported Outcomes following Surgical Treatment of Eaton Grade 1 Osteoarthritis of the Thumb Carpometacarpal Joint

2021 ◽  
Author(s):  
Rasmus Wejnold Jørgensen ◽  
Anders Odgaard ◽  
Kiran Annette Anderson ◽  
Claus Hjorth Jensen
Keyword(s):  
Surgical Treatment ◽  
Carpometacarpal Joint ◽  
Interposition Arthroplasty ◽  
Chi Square ◽  
Thumb Carpometacarpal Joint ◽  
Poor Patient ◽  
Patient Reported ◽  
Thumb Carpometacarpal ◽  
Stage 1 ◽  
Radiographic Changes

Abstract Background Osteoarthritis of the thumb carpometacarpal joint (CMC-1 OA) is increasingly common with age. Conservative treatment with anti-inflammatory medication, thumb spica splinting, and steroid injection is recommended for early-stage OA, but some patients will continue to have refractory symptoms and surgery may be considered. We found it interesting to study outcomes of surgical treatment of cases with mild radiographic changes and yet symptoms severe enough to indicate surgery. The specific research question is, if there is a limit of radiographic changes, below which a poor patient-reported outcome (PRO) can be expected. Purpose In a retrospective cohort of patients with prospectively collected PROs, we intend to study the effect of the radiographic CMC-1 OA severity on the PRO improvement and satisfaction after interposition arthroplasty. Patients and Methods Radiographs of 347 patients, who had CMC-1 surgery, were retrospectively analyzed. Each rater independently assessed all radiographs classifying each according to the Eaton classification. All patients had surgery with CMC-1 interposition arthroplasty using three well-known techniques that all include a complete trapeziectomy. Comparison between stage 1 and stage 2–4 was done using Chi-square test and t-test. Results Patients with Eaton stage 1 had a mean improvement in Quick-DASH (Quick-Disability of the Arm, Shoulder, and Hand questionnaire) scores of 14.6 points. Patients with Eaton stage 2 to 4 had a mean improvement of 25.3 points. The difference between these two groups was 10.6 points (p = 0.009). Only 52% of patients with Eaton stage 1 OA were satisfied. However, 76% of patients with Eaton stage 2 to 4 were satisfied (p = 0.008, chi-square between stage 1 and stage 2–4). Conclusion Patients with Eaton stage 1 CMC-1 OA had poorer PROs, as compared with more advanced stages of OA, 6 months following surgical treatment with interposition arthroplasty. Based on our results, we advise against surgical treatment with interposition arthroplasty of the very mildest CMC-1 OA, regardless of the preoperative PROs.

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