Basal thumb arthritis: Treatment strategies for managing pain.

BACKGROUND: The carpometacarpal joint of the thumb is one of the joints most commonly affected by arthritis. The dominant hand is involved in 60-65% of cases, with a higher prevalence among women. The condition results in significant disability of the hand, which affects activities of daily living. Management is dependent on both the clinical stage of the disease and patient expectations and demands. OBJECTIVE: The aim of this article is to review the current non-operative and operative modalities in managing pain symptoms, and explore evidence for the use of these modalities. DISCUSSION: Basal thumb arthritis is a very common condition encountered by the general practitioner. Treatment must focus on functional expectations and demands of the patient, and individualised treatment plans need to be tailored to the patient. Hand therapy in addition to patient education and use of an orthosis has been shown to be very effective in management of the early stages of basal thumb arthritis. With more advanced disease, surgical modalities provide better symptomatic control.

Minimal Clinically Important Difference of Grip and Pinch Strength in Women With Thumb Carpometacarpal Osteoarthritis When Compared to Healthy Subjects.

PURPOSE: The primary objective of this study was to compare grip and pinch strength between women with carpometacarpal (CMC) osteoarthritis (OA) between affected and unaffected sides of the body in patients or dominant and nondominant sides in healthy subjects. The secondary aim was to establish the cutoff value scores for the minimal clinically important difference (MCID) for grip strength, tip, and tripod pinch. DESIGN: A prospective case-control study. METHODS: One hundred ten women participated in the study. The CMC OA group consisted of 57 patients, and the control group consisted of 53 healthy subjects. Grip strength, tip, and tripod pinch were assessed bilaterally. The two-way analysis of variance (ANOVA) was conducted to determine the differences between sides of the body and between the groups. FINDINGS: The post hoc analysis indicated that the patients in the CMC OA group indicated statistically significant lower scores on the grip and pinch strength (all, p < .001). The MCID from baseline score in this patient population was 0.84 kg for grip, 0.33 kg for tip, and 0.35 kg for tripod pinch for the affected right arm and 1.12 kg for grip, 0.23 kg for tip, and 0.30 kg for tripod pinch for the unaffected left side. CONCLUSIONS: Women with CMC OA have significantly decreased grip strength, tip, and tripod pinch as compared to their healthy counterparts and may experience functional consequences because of this limitation. CLINICAL RELEVANCE: Our study established the MCID for grip and pinch strength for individuals with CMC OA and their healthy counterparts.

Stability of the Basal Joints of the New Thumb After Pollicization for Thumb Hypoplasia.

PURPOSE: To investigate the presence or absence of union of the new trapezium to the retained metacarpal base after pollicization and to relate this to stability of the new trapezium and the new carpometacarpal joint. METHODS: Thirty-six patients (46 pollicizations) were assessed at clinical review. Mean time from surgery to review was 96 months (range, 9-260 mo). Clinical assessment measured range of motion (ROM) at the carpometacarpal joint, stability of the carpometacarpal joint, and extrinsic and intrinsic strength of both hands. Radiological review evaluated 3 parameters: bony union between the new trapezium and retained metacarpal base, stability of the new trapezium in relationship to the metacarpal base, and carpometacarpal joint stability. RESULTS: There was radiographic nonunion between the new trapezium and the retained metacarpal base in 8 (1 treated) of 46 pollicizations. Relative risk of instability of the new trapezium was 39 times more likely if nonunion was present. Nine pollicizations were unstable at the carpometacarpal joint, 8 in those with union and 1 with nonunion. Relative risk of instability was 1.4 times more likely for those with union. For patients with nonunion, ROM and grip strength variables were reduced but only grip strength reached statistical significance. In patients with carpometacarpal joint instability, ROM and grip strength variables were reduced but none of the variables reached statistical significance. CONCLUSIONS: This study suggests that when the surgeon is attempting to obtain union of the new trapezium to the retained metacarpal base, failure to do so results in a poorer thumb with a significantly increased risk of trapezial instability and decreased grip strength. There is a mildly increased risk of carpometacarpal joint instability with union, but significantly poorer function as a consequence of this has not been demonstrated. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.