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ABSTRACT Introduction Comparison of different surgical techniques to treat patients with rhizarthrosis or carpometacarpal osteoarthritis of the thumb. Materials and Methods A systematic review was conducted using three electronic databases. Randomized, controlled trials in patients who underwent surgery for the treatment of rhizarthrosis were included. The literature review followed the PRISMA protocol. Results A total of 15 articles involving a total population of 958 patients were selected. Seven different surgical techniques were compared. Conclusions We conclude that no procedure is superior to another in terms of pain, physical function, overall patient assessment, range of motion, or strength. Outcome measurements should be standardized to enable better comparison between surgical techniques. Level of evidence II, Systematic Review.
RESUMO Introdução Comparação de diferentes técnicas cirúrgicas em pacientes com rizartrose ou osteoartrite carpometacárpica do polegar. Materiais e Métodos A revisão sistemática foi conduzida em três bancos de dados eletrônicos. Foram incluídos estudos clínicos randomizados e controlados com pacientes submetidos ao tratamento cirúrgico para tratamento de rizartrose. A revisão da literatura seguiu o protocolo PRISMA. Resultados Foram selecionados 15 artigos, envolvendo uma população total de 958 pacientes. Foram comparadas sete técnicas cirúrgicas distintas. Conclusões Concluímos que nenhum procedimento é superior a outro em termos de dor, função física, avaliação geral do paciente, amplitude de movimento ou força. A mensuração dos desfechos obtidos devem ser padronizadas a fim de possibilitar melhor comparação entre as técnicas cirúrgicas assim como, permitir uma análise estatística fidedigna. Nível de Evidência II; Revisão Sistemática.
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Objective: As a minimal invasive surgery for the treatment of thumb carpometacarpal joint (trapeziometacarpal [TMC]) arthritis, we performed an arthroscopic synovectomy for Eaton stage II to IV arthritis.Patients and Methods: We included patients who were effectively treated with a corticosteroid injection, experienced recurrence of TMC pain, and had no major instability of the TMC. Surgery was performed in 17 female patients. Synovectomy was performed, when possible, using radiofrequency and a shaver. The mean follow-up period was 27.2 months.Results: Two patients required additional surgery; however, 15 patients were satisfied with the outcome. The mean visual analogue scale score improved from 8.8 preoperatively to 2.2 postoperatively.Conclusion: Arthroscopic synovectomy is indicated to be an effective treatment for stage II to IV TMC arthritis. The goal of this treatment was to relieve severe pain minimally invasively. Furthermore, if symptoms remain or reoccur, another curative procedure can be chosen.
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Introducción: El tratamiento de la artrosis trapeciometacarpiana encaminado a mejorar el dolor y mantener la movilidad del pulgar, comprende desde el tratamiento conservador hasta el quirúrgico, con múltiples técnicas quirúrgicas, como la interposición de Artelon®. El objetivo del trabajo es mostrar una serie de pacientes tratados con esta técnica.Materiales y métodos: Se evaluó una serie de casos operados con Artelon. Se clasificaron radiológicamente según Eaton y Littler y se evaluaron las variables de arcos de movilidad y de dolor según la escala visual análoga.Resultados: 12 pacientes fueron evaluados (14 casos), con edad promedio de 57 años y de ellos el 91% mujeres. El dolor preoperatorio en promedio era de 8 y el posoperatorio de 1. La movilidad posoperatoria fue buena en general, con una flexión-extensión de 32º y abducción de 33º. Se encontraron 2 complicaciones menores: en un paciente, aflojamiento del tornillo proximal colocado en el trapecio y, en el otro, una subluxación leve del metacarpiano sobre el trapecio. El 100%, de los pacientes, estaba satisfecho con la cirugía.Discusión: Se lograron buenos resultados en cuanto a movilidad y mejoría del dolor. Es un procedimiento relativamente sencillo, de corta duración y que ha mostrado buenos resultados pero no supera las técnicas de suspensión tendinosa. Es, en definitiva, otra herramienta más en la solución de la artrosis trapeciometacarpiana.
Subject(s)
Humans , Arthroplasty , Osteoarthritis , Wrist JointABSTRACT
PURPOSE: To investigate the clinical usefulness of hematoma distraction arthroplasty to treat advanced trapeoziometacarpal osteoarthritis of the thumb. MATERIALS AND METHODS: We studied 12 cases (1 male, 11 females) with osteoarthritis of the thumb that was managed with hematoma distraction arthroplasty using K-wire fixation. Of the 12 cases, 7 were Littler-Eaton stage III and 5 were Littler-Eaton stage IV. We investigated operation time, preoperative and postoperative visual analogue scale (VAS) score, preoperative and postoperative range of motion, grip power and radiologic changes. RESULTS: The mean patient age was 53.2 (39-61) years and the mean duration of follow-up was 19.5 (14-27) months. The average operation time was 52 minutes. The mean VAS scores at 6 and 12 months after the operation were 1.3 and 0.7, respectively. The range of motion and grip power of the finger improved postoperatively (15% in abduction, 18% in adduction, 25% in flexion, 14% in extension, 66% in grip power of the finger). On a simple 12-month postoperative radiologic exam, the interval between the scaphoid and first metacarpal bone had decreased 6.5 mm compared with the preoperative interval. CONCLUSION: The surgical treatment using hematoma distraction arthroplasty for trapeziometacarpal osteoarthritis is an effective method for pain relief, improvement of motion range and finger-grip power.
Subject(s)
Humans , Male , Arthroplasty , Fingers , Follow-Up Studies , Hand Strength , Hematoma , Joints , Osteoarthritis , Range of Motion, Articular , ThumbABSTRACT
La rizartrosis es la degeneración de la base del pulgar. Ésta lesiona la articulación metacarpofa-lángica y su síntoma más común es el dolor. El objetivo de éste estudio es describir la frecuencia sintomatológica compatible con rizartrosis y determinar los factores relacionados con su desa-rrollo en la población de fisioterapeutas de diferentes ciudades de Colombia.Para tal fin entre los meses de Noviembre y Diciembre de 2011, se aplicó una encuesta para identificar la sintomatolo-gía de la patología en una muestra de 59 fisioterapeutas en ejercicio asistencial de su profesión. El análisis de datos comprende dos componentes, uno descriptivo y otro correlacional, que se realizaron mediante el programa SPSS.La edad media de los participantes fue de 32 años y el 50% de la población ejerce como fisioterapeuta hace más de 6 años, trabaja más de 3 horas diarias y utiliza el pulgar en el 60% del tiempo laboral. 22 participantes reportan dolor pero solo el 1.7% de estos manifiesta dolor en la articulación trapeciometacarpiana. Adicionalmente, se encontró relación entre el dolor y los procedimientos de masaje, digitopresión y de agarres. Se concluye que la fisioterapia se puede considerar una profesión en riesgo para desarrollar sintomatología compatible con rizartrosis, siendo los esfuerzos de masaje, digitopresión y agarres, los que favo-recen su desarrollo.
Rhizarthrosis is the degeneration of the base of the thumb. It injuries the trapeziometacarpal joint and its most common symptom is pain.The objective of this study to describe the frequency of symptomatology compatible with rhizarthrosis and to determine the factors related to its development among the physiotherapist in different Colombian cities. For this purpose during the months of November and December in 2011 was applied a survey to identify the symptomatology of the pathology in a sample of 59 therapists in care exercise of their profession. The data analysis includes two components, a descriptive one and a correlational one, made using the SPSS software. The average age of the sample was 32 years and 50% of them has practiced the profession for more than 6 years, works more than 3 hours and uses the thumb 60% of their working time. 22 participants report pain but only 1.7% reports it in the trapeziometacarpal joint. Additionally, relationship was found between pain and massage procedures, digital pressure and holds. It was concluded that p-hysiotherapy can be considered as a profession with high risk to develop symptoms compatible with rhizarthrosis, being the massage efforts, digital pressure and holds the factors that promote its development.
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Humans , Signs and Symptoms , Hand , Physical Therapy Specialty , ThumbABSTRACT
PURPOSE: We evaluated clinical outcomes of the trapeziometacarpal arthrodesis as a treatment for trapeziom-etacarpal arthritis. MATERIALS AND METHODS: Nineteen patients that received trapeziometacarpal arthrodesis for Eaton & Litter stage III(n=18) and IV(n=1) arthritis were enrolled in this study. Mean age was 45.8(43~67) and mean follow up duration was 2.3 years(1~4 years). Posttraumatic arthritis and idiopathic arthritis were 9 and 10 cases, respectively. The assessment included a preoperative and postoperative Visual Analogue Scales (VAS) (0~10) and overall satisfaction with Roles & Maudsley score. Functional outcomes were assessed by measuring of grip and pinch strength and range of thumb motion. The evaluation also included postoperative complications. RESULTS: Mean preoperative VAS score was 6.6 points and improved to average 1.4 points postoperatively. Mean grip and pinch strength was improved from 12.1 kg to 26.5 kg and from 2.7 kg to 5.2 kg, respectively. The mean radial abduction arc of motion was 42.9 degrees. Metacarpophalangeal and thumb interphalangeal joint arc of motion was averaged 63.3 degrees and 73 degrees, respectively. Complications consisted of scaphotrapezoidal arthritis(n=1) and nonunion(n=1). CONCLUSION: The trapeziometacarpal arthrodesis could afford good functional results, pain relief in advanced arthritis patient.