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.

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.

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.

Results of 115 Rubis II reverse thumb carpometacarpal joint prostheses with a mean follow-up of 10 years

2017 ◽  
Vol 42 (6) ◽  
pp. 592-598 ◽  
Author(s):  
M. Dehl ◽  
M. Chelli ◽  
S. Lippmann ◽  
S. Benaissa ◽  
V. Rotari ◽  
...  
Keyword(s):  
Clinical Results ◽  
Carpometacarpal Joint ◽  
Level Of Evidence ◽  
Thumb Carpometacarpal Joint ◽  
The Mean ◽  
Thumb Carpometacarpal ◽  
Joint Prostheses ◽  
Clinical And Radiological Results

The aim of this study was to assess the clinical and radiological results of the Rubis II thumb carpometacarpal joint reverse prosthesis, at a mean follow-up of 10 years. Between 1997 and 2008, 253 prostheses were implanted in 199 patients; 115 were reviewed. The survival after a mean of 10 years was 89%. At the last follow-up, 70% of prostheses were painless; the others reported moderate or intermittent pain. The satisfaction rate was 98%. The mean opposition was 9 on the Kapandji scale; the mean QuickDASH score was 30. Wrist, key and tip pinch strengths were comparable with the non-operated side. Of the 115 implants, one was radiologically loose (1%) and 15 had suffered dislocations (13%), 12 of which were caused by an injury. Eleven thumbs had revision surgery. This study confirms that the good clinical results of the Rubis II prosthesis are maintained in the medium and long term, and represents a useful alternative to trapeziectomy for selected patients. Level of evidence: IV

Ligament reconstruction for the painful thumb carpometacarpal joint: A long-term assessment

1984 ◽  
Vol 9 (5) ◽  
pp. 692-699 ◽  
Author(s):  
Richard G. Eaton ◽  
Lewis B. Lane ◽  
J. William Littler ◽  
John J. Keyser
Keyword(s):  
Ligament Reconstruction ◽  
Carpometacarpal Joint ◽  
Thumb Carpometacarpal Joint ◽  
Thumb Carpometacarpal

A Device for Evaluating Laxity of the Thumb Carpometacarpal Joint

2000 ◽  
Author(s):  
Michael A. Soltz ◽  
Mathew F. Koff ◽  
Eric J. Balaguer ◽  
Robert J. Pawluk ◽  
Robert J. Strauch ◽  
...  
Keyword(s):  
Mechanical Properties ◽  
Biochemical Composition ◽  
Carpometacarpal Joint ◽  
Thumb Carpometacarpal Joint ◽  
Quantitative Measurements ◽  
Thumb Carpometacarpal ◽  
Surface Remodeling ◽  
Joint Congruence ◽  
Force Displacement

Abstract It has been proposed that ligamentous laxity promotes osteoarthritis of the thumb carpometacarpal joint. However, quantitative measurements of laxity for this joint have not been correlated with its incidence of osteoarthritis nor with other measures of degenerative changes such as joint congruence, surface remodeling, cartilage mechanical properties or biochemical composition. The goal of this study was to design and build a device for testing the laxity of the carpometacarpal joint, with the long-term aim of advancing our understanding of the etiology of osteoarthritis in this joint. This laxity tester has the ability to accurately measure the force-displacement response along the joint’s dorsal-volar, radial-ulnar, and distraction-reduction directions, as well as the torque-rotation response in pronation-supination. The compliance of the tester was evaluated and laxity curves were generated for a sample thumb carpometacarpal joint.

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.

Simple trapeziectomy versus trapeziectomy with flexor carpi radialis suspension: a 17-year follow-up of a randomized blind trial

2020 ◽  
pp. 175319342095296
Author(s):  
Adrian Brennan ◽  
Julia Blackburn ◽  
Jane Thomson ◽  
Jeremy Field
Keyword(s):  
Functional Outcomes ◽  
Ligament Reconstruction ◽  
Carpometacarpal Joint ◽  
Long Term Outcomes ◽  
Level Of Evidence ◽  
Thumb Carpometacarpal Joint ◽  
Thumb Carpometacarpal ◽  
Tendon Interposition

The purpose of this study was to investigate if there were any significant differences in the long-term outcomes of patients who participated in a randomized trial of trapeziectomy alone compared with trapeziectomy with ligament reconstruction and tendon interposition (LRTI). Sixty-five patients were invited for a follow-up visit at a mean of 17 years (range 15–20) postoperatively. Twenty-eight patients attended, who had 34 operations, 14 trapeziectomy alone and 20 with LRTI. There were no statistically significant differences between the two groups in terms of satisfaction with surgery or functional outcomes, with most measurements showing minimal or no differences in means between the two groups. There was no difference in the space between the metacarpal and scaphoid. Radial abduction was the only parameter that was significantly greater in the patients with simple trapeziectomy (median 79°) compared with trapeziectomy with LRTI (median 71°) ( p = 0.04). Even at 17 years there is no significant benefit of LRTI over trapeziectomy alone for thumb carpometacarpal joint osteoarthritis. Level of evidence: I

A LONG-TERM FOLLOW-UP OF SILICONE-RUBBER INTERPOSITION ARTHROPLASTY FOR OSTEOARTHRITIS OF THE THUMB CARPOMETACARPAL JOINT

Hand Surgery ◽  
2005 ◽  
Vol 10 (01) ◽  
pp. 77-82 ◽  
Author(s):  
Akio Minami ◽  
Norimasa Iwasaki ◽  
Keiji Kutsumi ◽  
Naoki Suenaga ◽  
Kazunori Yasuda
Keyword(s):  
Silicone Rubber ◽  
Normal Subjects ◽  
Long Term Results ◽  
Interposition Arthroplasty ◽  
Thumb Carpometacarpal Joint ◽  
Long Term Follow Up ◽  
Thumb Carpometacarpal ◽  
Cmc Joint

There are several surgical options for osteoarthritis (OA) of the thumb carpometacarpal (CMC) joint. This paper presents our long-term clinical and radiographic review of 12 thumbs in ten patients treated by partial trapezial excision and silicone-rubber interposition arthroplasty. The follow-up period averaged 15; three years with a ten-year minimum. Although the procedure provided early pain relief in most thumbs, all but two had mild to severe pain at follow-up. The average range of post-operative palmar abduction was 23°. The average post-operative grip strength was 9.5 kg. Both tip and key pinch between thumb and index finger averaged about 50% that of normal subjects. Dislocation of the implant occurred in two joints and breakages in five. Bony erosions around the implant, which we attributed silicone synovitis, were found in four thumbs. The indications for silicone-rubber interposition arthroplasty for OA of the thumb CMC joint should be severely restricted as these produced unsatisfactory long-term results.

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