Matthew M Tomaino MD MBA

Department of Orthopaedics, Division of Hand, Shoulder and Elbow Surgery, University of Rochester Medical Center, 601 Elmwood Avenue, Box 665, Rochester, NY 14642, USA The thumb trapeziometacarpal (TM) joint is the second most commonly involved site of osteoarthritis in the hand, after the distal in-terphalangeal (DIP) joint, but its involvement potentially causes far more significant functional disability secondary to painful, weakened pinch and grip. Many treatment alternatives exist, and the...

Wendy Parker MD PhDa Steven L Moran MDab Kirsten B Hormel RNa Marco Rizzo MDa Robert D Beckenbaugh MDa

ADepartment of Orthopedic Surgery, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA bDivision of Plastic Surgery, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA Beginning with the introduction of soft-tissue arthroplasty, there have been multiple attempts to create an ideal and long lasting metacarpophalangeal (MP) joint arthroplasty design types have included hinged 1-5 , semiconstrained 6-8 , and unconstrained instrumentation 9-13...

Clinical outcomes

The author's evaluation of outcomes following the APL suspensionplasty has revealed a satisfaction rate and functional return equivalent to that witnessed following the LRTI procedure in countless patients. My therapists tell me that they see no difference between the LRTI and the APL technique. Evaluation of 23 thumbs in 22 patients at a minimum of 1 year after surgery shows that grip Fig. 3. Postoperative lateral radiograph shows arthroplasty space 1 year following surgery. Fig. 3....

Thumb Metacarpophalangeal Arthritis Arthroplasty or Fusion211

Ramirez The human thumb assumes 50 of the workload of the human hand, and is therefore the most important digit. As such, the thumb has a propensity for the development of osteoarthritis. Moreover, the thumb is also often diseased, in anywhere from 68 to 80 of patients who have rheumatoid arthritis. Much attention over the years has been given to the carpalmetacarpal joint of the thumb, whereas the metacarpophalangeal (MP) joint of the thumb remains largely...

Degenerative and Post Traumatic Arthritis Affecting the Carpometacarpal Joints of the Fingers

Division of Orthopaedic Surgery, The University of Alabama, Birmingham School of Medicine, 930 Faculty Office Tower, 510 20th Street South, Birmingham, AL 35294-3409, USA CMC joint fractures and fracture dislocations involving the fingers are relatively common injuries that infrequently result in chronic disability. Persistent pain and dysfunction, usually manifesting as diminished grip strength, typically result from late instability and secondary joint degeneration from missed or maltreated...

References

Vitallium cap arthroplasty of metacarpophalangeal and interpalangeal joints of fingers. Bull Hospital Joints Dis 1940 1 79-89. 2 Brannon EW, Klein G. Experiences with a finger-joint prosthesis. J Bone Joint Surg Am 1959 41-A 87-102. 3 Flatt A. Restoration of rheumatoid finger-joint function interim report on trial of prosthetic replacement. J Bone Joint Surg Am 1961 43A 753-74. 4 Beevers DJ, Seedhom BB. Metacarpophalangeal joint prostheses. A review of the clinical results of past...

History

The advent of small-joint arthroscopic technology has allowed us to apply the concept of minimally invasive surgery to smaller joints, including the wrist, ankle, and now the smaller joints of the hand. Yung-Cheng Chen's classic paper in 1979 1 on arthroscopy of the wrist and finger joints discussed the feasibility of performing small-joint arthroscopic procedures using the Watanabe No. 24 arthroscope as early as 1970 however, within that paper there was no mention of arthroscopy of the thumb...

Discussion

Clinical assessment and radiographic studies used to be the only tools available for the selection of treatment modalities for thumb CMC arthritis 28,29 . Eaton and Glickel proposed a staging system for this disease that has been widely applied 17 . Later, Bettinger and coworkers 30 described the trapezial tilt as an instrument to predict further progression of the disease. They found that in advanced Stages (Eaton III and IV) the trape-zial tilt was high (50 + 4 normal 42 + 4 ). Barron and...

Suspensionplasty for Basal Joint Arthritis Why and How171

Abductor pollicis longus suspensionplasty is a simple, effective treatment alternative for basal joint arthritis. Use of a suspensionplasty technique acknowledges our current understanding of forces involved during pinch and grip, as well as the role of normal lig-amentous anatomy. The primary rationale for performing suspensionplasty revolves around resisting the sagittal plane collapse that will occur when the thumb is loaded during pinch. In the absence of a volar-based suspension of the...

Charles S Day MD MBAab Miguel A Ramirez BSab

ADepartment of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, E CC2, Boston, MA 02215, USA hHarvard Medical School, 260 Longwood Avenue, Boston, MA 02115, USA The human thumb assumes 50 of the workload of the human hand 1 , and is therefore the most important digit. As such, the thumb has a propensity for the development of osteoarthritis. Moreover, the thumb is also often diseased, in anywhere from 68 to 80 of patients who have rheumatoid arthritis (RA) 1,2 ....

Peter M Murray MDab

ADepartment of Orthopaedic Surgery, Mayo Clinic College of Medicine, 200 1st Street SW, Rochester, MN 55905, USA bDepartment of Orthopaedic Surgery, Division of Education, Mayo Clinic, 4500 San Pablo Road, In 1940, Burman reported the use of a Vi-tallium cap for proximal interphalangeal joint (PIPJ) arthroplasty 1 . This and other early digital implants used concepts similar to those used in the highly successful implant arthroplasty of the lower extremity. In 1959, Brannon and Klein 2 from...

Steven Z Glickel MDab Salil Gupta MDb

ADepartment of Orthopedic Surgery, Columbia University College of Physicians and Surgeons, 622 West 168 Street, New York, NY 10032, USA bC.V. Starr Hand Surgery Center, St. Luke's-Roosevelt Hospital Center, 1000 Tenth Avenue, Eaton and Littler 1 described the staging system for basal joint disease that has remained most widely used for the past 30 years. That staging system is based upon the true lateral radiograph of the thumb and defines the degree of involvement of the carpometacarpal (CMC)...

Trapeziometacarpal Arthroscopy A Classification and Treatment Algorithm

AMiami Hand Center, 8905 SW 87th Avenue, Miami, FL 33176, USA bDepartment of Small Joint Arthroscopy, DaVinci Learning Center, Miami, FL, USA Osteoarthritis of the thumb trapeziometacarpal joint is a common clinical problem as well as a perplexing challenge, because of a myriad of treatment options. The fact that so many different surgical options exist for this condition attests to the fact that none of them has an optimal success rate. Or perhaps it may be that the majority of treatment...

John D Mahoney MD Roy A Meals MD

Combined Orthopaedic and Plastic Surgery Hand Service, University of California, Los Angeles, 100 UCLA Medical Plaza, 305, Los Angeles, CA 90024, USA Primary osteoarthritis of the carpometacarpal joint of the thumb is a common problem, especially in women beyond the fifth decade. Patients usually present with activity-related pain at the base of the thumb. The usual first line of treatment may include activity modification, pain-relieving medications, splinting, and possibly corticosteroid...

Thumb Mp Fusion

MP arthritis of the thumb is a potentially debilitating disorder whose treatment is relative successful for the surgeon who thoroughly evaluates the entire thumb axis, because involvement of other joints will dictate the most appropriate treatment. Fusion is generally successful, and very little variability in results exists between methods. This treatment option is also supported by most of the existing literature on this topic 5,7,12,14 . Osteotomy type, whether flat or chevron, makes no the...

Treatment of posttraumatic arthrosis

Fifth Cmc Fracture Dislocation

Patients who present with symptomatic post-traumatic CMC arthrosis generally complain of pain over the involved joint aggravated by gripping, shaking hands, and occupation-specific or sports-specific activities. A percentage of these patients present simply to determine the cause for their intermittent discomfort, but a number of others have daily, bothersome complaints. Frequently subtle instability is present on examination and may be a significant contributing factor. First line treatment is...

Arthrodesis

For years, arthrodesis has been the gold standard in treating isolated end-stage MP arthritis, whether inflammatory or post-traumatic arthropathies 25 . Arthrodesis is able to provide effective pain relief as well as restore stability to the joint, even in the setting of severe arthritis. 1,3,7,10,25 . The key to why MP fusion in the thumb is so successful lies in the relatively negligible loss of motion that results from MP fusion. The functional goal of the thumb is to be able to oppose to at...

Trapeziometacarpal Arthroscopy A Classification and Treatment Algorithm153

Indications for arthroscopy of the trapeziometacarpal joint of the thumb remain poorly understood. Arthroscopic assessment of the carpometacarpal joint allows direct visualization of all components of the joint, including synovium, articular surfaces, ligaments, and the joint capsule. It also allows for the extent of joint pathology to be evaluated and staged with intraoperative management decisions made based on this information. A proposed arthroscopic classification for basal joint...