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Physical Examination of the Hand
Published in J. Terrence Jose Jerome, Clinical Examination of the Hand, 2022
Thumb carpometacarpal (CMC) or scaphotrapezial-trapezoid joints (or both): Patients with CMC arthritis present with varied complaints of localized pain, or vague complaints such as throbbing or burning in the radial aspect of the hand. Advanced osteoarthritis often has adduction contracture thumb and a compensatory MCP joint hyperextension. These patients may show laxity of the joint in hyperextension. A grinding test and joint subluxation test evaluate thumb carpometacarpal joint arthritis. Grinding test: The examiner faces the patient and rests his/her hand on the examination table. Once the wrist is stabilized with the other hand, an axial load is applied to the thumb axis to elicit pain as well as crepitus seen in degenerative arthritis (Video 3.4).CMC subluxation test: The test is similar to the grinding test where the examiner gently forces the CMC joint to subluxate and note the pain and crepitus.
Surgery of the Wrist
Published in Timothy W R Briggs, Jonathan Miles, William Aston, Heledd Havard, Daud TS Chou, Operative Orthopaedics, 2020
Ramon Tahmassebi, Sirat Khan, Kalpesh R Vaghela
After inspecting for arthritic lesions and making an assessment of the extent of their effects, the surgeon can sequentially perform the following: Excision of the cartilage and the subchondral bone in the radioscaphoid and radiolunate joints and the intercarpal joints (scaphocapitate, lunocapitate and triquetrohamate) until the cancellous bone of each carpal bone is reached. To achieve this, a small burr (with irrigation), rongeur, curette or osteotome is sufficient.Temporary fixation using K-wires, trying if possible to align the central axis between radius, lunate, capitate and third metacarpal.Filling of any gaps or defects with bone graft of adequate quality and size. Bone from the distal radius may possibly be used but is often insufficient in terms of volume, and harvest may create a cortical defect that interferes with plate fixation.The third carpometacarpal joint must be considered. Ideally, this should also be at least partially excised and grafted so as to remove any movement and provide a continuous bridge of bone across the fusion mass.
A to Z Entries
Published in Clare E. Milner, Functional Anatomy for Sport and Exercise, 2019
The only carpometacarpal joint with any significant movement is that of the thumb – the first metacarpal. The movements permitted at this saddle joint are flexion and extension in the plane of the palm of the hand, abduction and adduction in a plane perpendicular to the palm of the hand, and opposition. The opposable thumb gives the hand its grasping ability by enabling the tip of the thumb to come into contact with the palmar surfaces of the fingers when they are slightly flexed. The ellipsoidal metacarpophalangeal joints, easily recognizable as the knuckles of the hand, also allow significant movement of the digits. This joint is capable of flexion and extension, abduction and adduction, and circumduction. Finally, the interphalangeal hinge joints of the fingers and thumb are capable of a large amount of flexion, enabling the hand to make a fist, and a little extension.
Psychological factors are more strongly associated with pain than radiographic severity in non-invasively treated first carpometacarpal osteoarthritis
Published in Disability and Rehabilitation, 2021
Lisa Hoogendam, Mark J. W. van der Oest, Jonathan Tsehaie, Robbert M. Wouters, Guus M. Vermeulen, Harm P. Slijper, Ruud W. Selles, Jarry T. Porsius
The patients’ records were searched for X-rays of the first carpometacarpal joint. If multiple X-rays were present, we selected the X-ray in which both the CMC-1 joint and the scaphotrapeziotrapezoid joint (STT) were most clearly visible. The Eaton-Glickel classification [32] ranges from stage I to stage IV. Stage III is defined as excessive CMC-1 degeneration and subluxation. Stage IV is defined as stage III with additional presence of STT OA. According to this classification, presence of STT OA indicates the most advanced stage of structural damage. Therefore, we used this feature as indication of radiographic severity of disease. The first 100 X-rays were independently scored by both a European Board-certified hand surgeon (G. V.) and a junior scientist (L.H.). The Intraclass Correlation Coefficient was 0.58 (95% CI 0.49–0.65). This is in agreement with the study by Dela Rosa et al. [33], who reported fair to moderate inter-observer agreement for the Eaton-Glickel classification, with similar agreement rates for stage I, III and IV. The scores of the junior scientist were used for all patients. Patients without an X-ray of the CMC-1 joint were excluded.
Patient-reported ‘treatment injuries’ after hand surgery. A review of 1321 claims submitted to the Norwegian system of patient injury compensation 2007–2017
Published in Journal of Plastic Surgery and Hand Surgery, 2021
Sunniva Martine Kolstad Addison, Lisa Sofie Albrigtsen, Ida Rashida Khan Bukholm, Hebe Désirée Kvernmo
Of 34.2% of the 609 diagnoses treated electively were accepted. Women predominated in relation to men (59.3 vs. 40.7%, p < .05). The mean age of the elective group was 50.8 years (SD 13.9). Age distribution was 29.6% in the 50–59 years group, 22.8% in the 40–49 years group and 19.4% in the 60–69 years group. The diagnosis ‘G56 – Mononeuropathies of upper limb’ dominated, accounting for 40% of the accepted claims for elective hand surgery (Table 2). ‘G56.0 – Carpal tunnel syndrome’ accounted for 86.9% of these and ‘G56.2 – Lesion of ulnar nerve’ for 10.7%. The second-largest elective diagnosis was ‘M18 – Arthrosis of first carpometacarpal joint’, accounted for 16%. ‘M65 – Synovitis and tenosynovitis’ accounted for 11.1% of accepted claims, but this diagnosis had the highest rate of acceptance for elective cases at 41.8%. ‘M 72 – Fibroblastic disorders’ accounted for 11% of accepted claims for elective hand surgery. ‘M72.0 – Palmar fascial fibromatosis [Dupuytren]’ accounting for 97.5% of this diagnosis, but at a low acceptance rate. 82.2% of elective cases were accepted based on ‘failure in treatment’ (Figures 2 and 3).
Trapeziectomy with LRTI or joint replacement for CMC1 arthritis, a randomised controlled trial
Published in Journal of Plastic Surgery and Hand Surgery, 2019
Rasmus D. Thorkildsen, Magne Røkkum
Numerous treatments exist for osteoarthritis of the carpometacarpal joint of the thumb, but no operation has been proven superior to another [1]. Trapeziectomy, first suggested by Gervis [2], was later modified with ligament reconstruction and/or tendon interposition. It is widely utilised and is the method that most other procedures are measured against [3]. Good pain relief and reasonable function for the majority of patients, in the both short and long terms, have been published [4,5]. Many surgeons still advocate some stabilisation technique [6]. Nonetheless, some shortening of the thumb ray invariably occurs and the rehabilitation period can be long [4,7]. Total joint replacements introduced in the 70’s have gradually evolved and non-randomised comparative studies, comparing modern, uncemented joint replacements to trapeziectomy with LRTI, suggest that they provide faster rehabilitation and better function in the short term [8–10]. Randomised controlled trials (RCT) have up until now yet to be published.