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In this narrative review, we explore developments in the field of computational musculoskeletal model personalization using the Physiome and Musculoskeletal Atlas Projects. Model geometry personalization; statistical shape modeling; and its impact on segmentation, classification, and model creation are explored. Examples include the trapeziometacarpal and tibiofemoral joints, Achilles tendon, gastrocnemius muscle, and pediatric lower limb bones. Finally, a more general approach to model personalization is discussed based on the idea of multiscale personalization called scaffolds. [ABSTRACT FROM AUTHOR]

Background: Osteoarthritis in the thumb base (trapeziometacarpal joint, CMC-1 joint) is prevalent, particularly among middle-aged and elderly women, causing significant disability. Conservative treatments, including steroid injections, have been questioned for their efficacy, prompting exploration into alternative therapies such as platelet-rich plasma (PRP) injections. This randomized, double-blinded, controlled trial aims to evaluate the effectiveness of high-concentration PRP (platelet-rich plasma) injection compared to saline (placebo) in reducing pain and disability in patients with thumb base osteoarthritis. Methods: Patients meeting inclusion criteria will be randomized and blinded, with injections administered under sterile conditions and radiological guidance. With a planned sample size of 90 patients recruited from the Department of Hand Surgery at Södersjukhuset, Stockholm, the study will assess pain relief and functional improvement at 3, 6, and 12 months post-injection. The primary outcome measure is pain on load (numerical rating scale) at 6 months, with secondary outcomes including patient-reported outcomes, key pinch, grip strength, abduction of the thumb, and time to intervention within 1 year. Statistical analyses will employ non-parametric tests, chi-square tests, and generalized estimating equations to compare outcomes between the PRP and placebo groups. Discussion: The study aims to provide evidence regarding the efficacy of high-concentration PRP injections for thumb base osteoarthritis. If PRP proves superior to saline in reducing pain and improving function, it could offer a promising alternative treatment. Conversely, if PRP does not demonstrate significant benefits over placebo, its use for this condition is not justified. This study seeks to address the current gap in evidence regarding the efficacy of PRP injections for thumb base osteoarthritis. Trial registration: The study has been approved by the Swedish Ethical Review Authority (2023–06860-01 and 2024–01238-02) and is registered on ClinicalTrials.gov (NCT06193499) 2024–01-04. [ABSTRACT FROM AUTHOR]

Introduction: Osteoarthritis of the first carpometacarpal joint is a common pathology of the hand, which may show an increasing prevalence in Germany due to the demographic development. In recent years, not only the current gold standard - the resection arthroplasty of the thumb saddle joint - has been used, but also therapeutic thumb saddle joint arthroscopy. In addition to the patient's clinical complaints, radiographic diagnostics have been used to decide on treatment, although it has not been proven whether there is a correlation between imaging and clinical complaints. Materials and methods: Between 2020 and 2022, 20 articular surfaces of the thumb saddle joint undergoing resection arthroplasty for symptomatic basal thumb osteoarthritis were prospectively examined, mapped and compared with preoperative conventional radiographs. Results: The evaluation of the corresponding articular surfaces showed a higher cartilage destruction at the articular surfaces of the trapezium compared to the first metacarpal. No correlation was found between the stage of osteoarthritis and the Eaton-Littler classification. Conclusions: Overall, there is a patient-specific heterogeneity of the cartilage damage of the articular surface of the trapezium bone, as well in the metacarpal bone I base in relation to the radiographic diagnosis. Furthermore, an inhomogeneity of the radiographic stage of osteoarthritis of the carpometacarpal joint according to Eaton and Littler in relation to the intraoperatively assessed cartilage damage. The statistical significance of the surgically assessed cartilage damage in relation to the conventional radiographs could not be demonstrated. Thus, the treatment of symptomatic osteoarthritis of the carpometacarpal joint should primarily address the patient's individual complaints. The radiographic classification according to Eaton and Littler can be used as an additional factor to decide on the surgical procedure but should not delay the therapeutic treatment. Level of evidence: III. [ABSTRACT FROM AUTHOR]

The multidirectional biomechanics of the thumb carpometacarpal (CMC) joint underlie the remarkable power and precision of the thumb. Because of the unconfined nature of thumb CMC articulation, these biomechanics are largely dictated by ligaments, notably the anterior oblique ligament (AOL) and the dorsoradial ligament (DRL). However, the rotational and translational stabilizing roles of these ligaments remain unclear, as evidenced by the variety of interventions employed to treat altered pathological CMC biomechanics. The purpose of this study was to determine the effects of sectioning the AOL (n = 8) or DRL (n = 8) on thumb CMC joint biomechanics (rotational range‐of‐motion [ROM] and stiffness, translational ROM) in 26 rotational directions, including internal and external rotation, and in eight translational directions. Using a robotic musculoskeletal simulation system, the first metacarpal of each specimen (n = 16) was rotated and translated with respect to the trapezium to determine biomechanics before and after ligament sectioning. We observed the greatest increase in rotational ROM and decrease in rotational stiffness in flexion directions and internal rotation following DRL transection and in extension directions following AOL transection. The greatest increase in translational ROM was in dorsal and radial directions following DRL transection and in volar directions following AOL transection. These data suggest the AOL and DRL play complementary stabilizing roles, primarily restraining translations in the direction of and rotations away from the ligament insertion sites. These findings may inform future interventions or implant designs for pathological CMC joints. [ABSTRACT FROM AUTHOR]

The aim of this Delphi study was to provide a diagnostic and treatment algorithm for patients with persistent or recurrent symptoms after trapeziometacarpal joint resection arthroplasty. Three Delphi rounds were conducted in which surveys were sent to 182 experienced hand surgeons worldwide. Responses were received from 140 participants. A consensus threshold was set at 67% agreement. Diagnostic tools and treatment approaches for six common revision scenarios achieved consensus. Radiographs are appropriate as primary (97%) and CT scans as secondary (76%) diagnostic tools. For scaphometacarpal impingement, 67% of respondents agreed that revision interposition is appropriate, with 93% recommending autologous tendon for the interposition. Additional suspension was considered appropriate by 68% of the participants. The diagnostic and treatment algorithm can help the surgeon to identify the reason for persistent symptoms after trapeziometacarpal joint resection arthroplasty and to choose an appropriate treatment strategy. Level of evidence: V [ABSTRACT FROM AUTHOR]

Thumb carpometacarpal arthroplasty has become a widely used standard technique in the surgical treatment of thumb carpometacarpal osteoarthritis. One of the most critical steps during this procedure is proper surgical exposure of the trapezium and the base of the first metacarpal to allow for prosthesis implantation. This article introduces a surgical technique in which a roll constructed from gauze sponges tightly wrapped with medical tape facilitates several steps in thumb carpometacarpal arthroplasty. While performing a dorsoradial approach to the thumb carpometacarpal joint, this cost-effective tool is perfectly tailored to the joint's unique anatomy. It aids in precise hand positioning and ensures optimal exposure of the trapezium and base of the first metacarpal, which is crucial for accurate cup and stem preparation as well as for unimpeded prosthesis implantation. [ABSTRACT FROM AUTHOR]

Background: This study aimed to investigate the effect of thumb metacarpal osteotomy on dorsal subluxation of the carpometacarpal (CMC) joint and compare the effects of early and advanced osteoarthritis (OA). Methods: We retrospectively reviewed 42 thumbs of 37 patients who underwent metacarpal osteotomy with a postoperative extension angle of 90° or more between January 2018 and October 2021 and were followed up for more than 2 years. The thumbs were classified into two groups: early OA (Eaton stage I or II) and advanced OA (Eaton stage III). We measured the reduction ratio, which was defined as the ratio of improvement in dorsal subluxation, at 3 months and 1 year postoperatively, and at the latest follow-up. We statistically compared the reduction ratio between the two groups and investigated the factors affecting the reduction ratio using correlation analysis. Results: The reduction ratio was significantly higher in the early OA group than in the advanced OA group at 3 months after surgery, whereas no significant difference was found between the two groups at 1 year after surgery and at the latest follow-up. A significant positive correlation was detected between the reduction ratio and the postoperative extension angle. Conclusions: First metacarpal osteotomy reduces dorsal subluxation in both early- and advanced-stage CMC OA. This procedure yields immediate marked reduction in early-stage OA, while improvement of the subluxation progressed gradually in advanced-stage OA. Level of Evidence: Level IV (Therapeutic) [ABSTRACT FROM AUTHOR]

Background: This retrospective study compares the outcomes of trapeziectomy and Weilby suspensionplasty procedure versus implant arthroplasty using the TOUCH® prosthesis for basilar thumb arthritis in an Asian population. Methods: A total of 15 consecutive thumbs in 13 patients were included in this study. Six patients (2 male, 4 female, mean age of 62 years old) underwent trapeziectomy and Weilby suspensionplasty procedure. Seven patients (4 male, 3 female, mean age 63 years old) underwent implant CMCJ arthroplasty using the TOUCH® prosthesis. Data collected include demographics, severity of arthritis on plain radiographs of the thumb basilar joint, length of follow-up, pre- and postoperative pain levels, Kapandji thumb opposition score, grip and pinch strength and the time taken to return to work. Results: Patients in the trapeziectomy and Weilby suspensionplasty group had a mean follow-up of 4.5 months, while those in the TOUCH® implant arthroplasty group had a mean follow-up of 14 months. TOUCH® implant arthroplasty patients showed significantly higher grip strengths at 3 months post-surgery and a shorter return to work. There were no differences in pinch strength at 3 months, pinch or grip strength at 6 months or pain scores. Complications included prolonged scar hypersensitivity in two patients who underwent the Weilby suspensionplasty and a dislocated TOUCH® implant cup in one patient. Conclusions: Our study suggests that in the short term, CMCJ implant arthroplasty with the TOUCH® prosthesis produces results comparable to trapeziectomy and Weilby suspensionplasty. Level of Evidence: Level III (Therapeutic) [ABSTRACT FROM AUTHOR]

Family physicians are well-positioned to provide injections for patients who have pain due to hand and finger conditions, especially when initial treatments such as splinting and nonsteroidal anti-inflammatory drugs are ineffective. Corticosteroid injections can offer pain relief; however, potential risks such as infection, cartilage damage, and skin depigmentation should be discussed. Techniques and procedures for injections vary. Corticosteroid injections for ste-nosing flexor tenosynovitis (trigger finger) can be performed with or without ultrasound guidance. To maximize benefits of corticosteroid injection for carpometacarpal joint osteoarthritis, topical nonsteroidal anti-inflammatory drugs and other conservative treatment modalities should be used concurrently. Because of the risks of disease recurrence and adverse effects, corticosteroid injections for palmar fibromatosis should be approached with caution in the context of shared decision-making. [ABSTRACT FROM AUTHOR]

Summary A 1‐month‐old Paint filly was diagnosed with a latero‐distal luxation of the fourth carpal bone associated with avulsion fractures of the third and fourth carpal bones and rupture of intercarpal ligaments based on clinical, radiography and computed tomography examination. A carpometacarpal (CMC) joint arthrodesis was performed using a lateral 3.5 mm 5‐hole Locking Compression Plate (LCP) T‐plate and a medial 3.5 mm 5‐hole narrow LCP plate associated with mediocarpal arthroscopic exploration. An external coaptation was maintained for 6 weeks. No complication was reported and the filly was full loading the day after surgery. Radiographical follow‐up was available 6 and 14 weeks after surgery showing an intact construct and stable fixation with a complete fusion of the lateral part of the carpometacarpal joint at 14 weeks postoperatively. The filly was sound on pasture without angular deformity 4 months after surgery. Luxation of the fourth carpal bone was successfully stabilised using two LCP plates, leading to complete soundness and preservation of middle carpal joint motion. [ABSTRACT FROM AUTHOR]

Background: Numerous anatomical features of the first carpometacarpal (CMC I) joint have been investigated as potential predispositions for CMC I osteoarthritis (OA). Even though load transmission through the CMC I joint—and, therefore, the development of osteoarthritis—is believed to be influenced by the geometry of the first metacarpal (MC I) bone, there is no common definition of the MC I axes. Methods: CT scans of twenty healthy volunteers and pre- and postoperative CT scans of six patients with CMC I OA undergoing Wilson osteotomy were analyzed. We proposed a calculation method based on anatomical landmarks for the proximal joint surface axis (PA) angle and the definition of an anatomical (AA) and a mechanical (MA) longitudinal axis. We hypothesized that for an MC I extension osteotomy to be effective, the AA and MA need to be aligned surgically. Results: To align AA and MA, an average correction angle of 22.60° (SD 2.53°) at 1 cm and 26.73° (SD 2.55°) at 1.5 cm distal to the CMC I joint line is required. Conclusions: The hereby proposed method for patient-specific calculation of the correction can be used to improve the surgical technique. [ABSTRACT FROM AUTHOR]

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Background: Arthroscopic debridement is increasingly being utilised in patients with early-stage first carpometacarpal joint (FCMCJ) arthritis but has limited supportive evidence. This systematic review evaluates the literature, and reports on outcomes and adverse events following this procedure. Methods: An electronic literature search of PubMed, Embase, Medline and Cochrane Central, looking for studies describing outcomes following arthroscopic debridement in FCMCJ arthritis, was performed in November 2022. Studies where bony resection or interposition was performed as adjuncts were excluded. Reported outcomes included visual analogue scores (VAS) for pain; Disabilities of Arm, Shoulder and Hand (DASH) scores; pinch and grip strength; complications and re-operations. Results: Out of a total of 90 studies revealed from the search, only two studies were eligible for inclusion, with a cohort of 34 patients. Following arthroscopic debridement for FCMCJ osteoarthritis, the mean VAS improved by four units, mean DASH by 22 points, grip strength by 4.5 kg and pinch strength by 2 kg at mean follow-up of 18 months. The pooled complication and re-operation rates were 8.8% and 23.5%, respectively. Conclusions: There is a lack of evidence supporting the utility of FCMCJ arthroscopy and debridement in the management of patients with early arthritis. Although the limited evidence suggests that there may be some therapeutic benefit, further large-scale prospective studies need to be performed before making conclusive recommendations. Level of Evidence: Level III (Therapeutic) [ABSTRACT FROM AUTHOR]

To date, no clinical test provides specific objective information on the integrity of key ligamentous support of the trapeziometacarpal (TMC) joint. To examine the potential of the TMC joint screw home torque mechanism (SHTM) in estimating the integrity of the posterior ligament complex in older adult population. Cross-sectional laboratory-based study. Twenty cadaver hands presenting with various degrees of TMC joint degradation ranging from none to severe osteoarthritis (OA) were radiographed in multiple positions to establish their degeneration status, joint mobility, and amount of dorsal subluxation at rest and with the application of the SHTM. Comparisons and correlations between degeneration status, joint mobility, subluxation reduction and ligament status obtained from dissection were calculated. No significant statistical correlation was demonstrated with the subluxation reduction ratio of the SHTM and the combined ligament complex value however, a moderate negative correlation was found with dorsal central ligament injury at 21 Nm (τ b = −0.46, p < 0.05) and 34 Nm (τ b = −0.45, p < 0.05). A statistically significant reduction of radial subluxation of the TMC joint was observed between the subluxation at rest (M = 5.2, SD = 1.9) and subluxation with SHTM of 21 Nm (M = 4.4, SD = 2.4), t (19) = 3.2, p = 0.01, 95% CI [0.3, 1.4] and subluxation with SHTM of 34 Nm (M = 4.3, SD = 2.6), t (19) = 2.6, p = 0.02, 95% CI [0.2, 1.5]. Our results did not support the SHTM as indicator of the TMC posterior ligament complex integrity however, it demonstrated 100% stabilization effect with non-arthritic TMC population. • SHTM was not a clear indicator of TMC joint posterior ligament complex integrity. • DCL damage was moderately correlated with a decline in subluxation reduction. • SHTM demonstrated positive stabilization results with non-arthritic population. • Decreased radial abduction may suggest more significant joint degradation. [ABSTRACT FROM AUTHOR]

Purpose: This study compared clinical outcomes depending on the fixation modality in patients who underwent arthrodesis surgery for Eaton-Littler stage III trapeziometacarpal (TM) joint arthritis between 2009 and 2022. Methods: In total, 39 patients with 44 hands (five patients had surgery on both hands) were selected. Depending on the operative fixation instruments, patients were divided into two groups: group 1, surgery with 25-gauge interosseous wiring and Kirschner wire or headless screw fixation; group 2, surgery with only multiple headless screws for fixation. Bone union was achieved at 62 days after surgery in group 1 and 75 days in group 2 (p=0.165). Results: The preoperative mean visual analogue scores improved during the postoperative outpatient follow-up period in both groups (group 1, from 4.0 preoperatively to 1.0 at the final follow-up; group 2, from 5.0 preoperatively to 2.0 at the final follow-up). Mean grip strength and pinch strength increased after surgery. One patient (4.8%) experienced nonunion in group 1, whereas nonunion occurred in four patients (17.4%) in group 2. This difference was not statistically significant. Four patients in group 1 and no patients in group 2 underwent fixation instrument removal after sound union. Conclusion: Adequate stability can be achieved during arthrodesis by combining interosseous wiring and other implants or multiple headless compression screws, resulting in successful outcomes for patients with Eaton-Littler stage III degenerative TM arthritis. [ABSTRACT FROM AUTHOR]

Background: Thumb carpometacarpal joint (CMC) osteoarthritis is the most symptomatic hand arthritis but the long-term healthcare burden for managing this condition is unknown. We sought to compare total healthcare cost and utilisation for operative and nonoperative treatments of thumb CMC arthritis. Methods: We conducted a retrospective longitudinal analysis using a large nationwide insurance claims database. A total of 18,705 patients underwent CMC arthroplasty (trapeziectomy with or without ligament reconstruction tendon interposition) or steroid injections between 1 October 2015 and 31 December 2018. Primary outcomes, healthcare utilisation and costs were measured from 1 year pre-intervention to 3 years post-intervention. Generalised linear mixed effect models adjusted for potentially confounding factors such as the Elixhauser comorbidity score with propensity score matching were applied to evaluate the association between the primary outcomes and treatment type. Results: A total of 13,646 patients underwent treatment through steroid injections, and 5,059 patients underwent CMC arthroplasty. At 1 year preoperatively, the surgery group required $635 more healthcare costs (95% CI [594.28, 675.27]; p < 0.001) and consumed 42% more healthcare utilisation (95% CI [1.38, 1.46]; p < 0.0001) than the steroid injection group. At 3 years postoperatively, the surgery group required $846 less healthcare costs (95% CI [−883.07, −808.51], p < 0.0001) and had 51% less utilisation (95% CI [0.49, 0.53]; p < 0.0001) annually. Cumulatively over 3 years, the surgical group on average was $4,204 costlier than its counterpart secondary to surgical costs. Conclusions: CMC arthritis treatment incurs high healthcare cost and utilisation independent of other medical comorbidities. At 3 years postoperatively, the annual healthcare cost and utilisation for surgical patients were less than those for patients who underwent conservative management, but this difference was insufficient to offset the initial surgical cost. Level of Evidence: Level III (Therapeutic) [ABSTRACT FROM AUTHOR]

Purpose: Hamate fractures are infrequent and often overlooked wrist injuries. Our objective is to present the Shish-Kebab method, a surgical approach utilized in the treatment of intra-articular Hamate body fractures occurring concurrently with fourth metacarpal base fractures and dislocations. Methods: This study was conducted at a single-center using a prospective design. It included patients aged 16–65 with Kim Type IIB fractures affecting the dominant side. Patients with the same features of fracture and carpometacarpal (CMC) instability findings were divided into two groups according to the success of the closed reduction procedure. In the conservative group (8 patients), all fractures and instability findings were successfully resolved with closed reduction and a short arm plaster cast. The surgical group (8 patients), comprising those requiring open reduction and internal fixation, underwent the application of the 'shish kebab' method. Results: At the 6th and 12th week follow-ups, no significant differences were observed between the groups concerning pVAS and QuickDash scores. However, upon examining the QuickDash scores, a statistically significant difference emerged between the 6th and 12th weeks within both the conservative (p = 0.017) and surgical (p = 0.012) groups in the intragroup analysis. Grip strength, measured as 83.78% of the contralateral side in the surgical group and 79.51% in the conservative group, did not exhibit a statistically significant difference (p = 0.462). Conclusion: In the management of Hamate body intra-articular fractures and accompanying fourth metacarpal base fracture dislocations, good clinical results can be achieved with the 'Shish–Kebab' method in cases where closed reduction is unsuccessful. [ABSTRACT FROM AUTHOR]

Background: Total joint arthroplasty as a surgical treatment option for trapeziometacarpal joint arthritis is recently revived. The aim of this study is to report on mid- and long-term results of the Elektra (single-mobility) and Moovis (dual-mobility) prosthesis for treatment of primary thumb carpometacarpal joint arthritis. Methods: In this retrospective, monocentric, descriptive cohort study, 31 prostheses were evaluated that were implanted by a single surgeon in 26 patients between 2009 and 2019. Indication for surgery was trapeziometacarpal joint osteoarthritis (Eaton/Littler Stage II and III). Clinical and radiological follow-up was performed at a minimum of 24 months. The postoperative assessment included range of motion, pain, strength as well as functional scores (DASH, MHQ). Implant survival and complications were the primary endpoints. Results: 10 Elektra and 21 Moovis prostheses were implanted between 2009 and 2019 with a mean follow-up of 74.2 months in the Elektra and 41.4 months in the Moovis group. The average patients' age at surgery was 64 years. Postoperative pain levels (VAS 0–10) were below 2 at rest and under stress in both groups. Grip/pinch strength and range of motion showed results comparable to the contralateral hand. Opposition was excellent with an average Kapandji index of 9.6 in both groups. Elektra achieved slightly better functional scores in the DASH and MHQ score. Satisfaction was high in both groups, and 96% of the patients would recommend the procedure. Metacarpophalangeal hyperextension > 15° was seen in 3 patients per group preoperatively and was corrected to < 5° post-surgery. 3 Elektra prostheses were revised due to cup loosening and dislocation for cup and/or neck replacement or secondary trapeziectomy. 1 Moovis prosthesis was revised with an exchange of the neck to a larger size due to restricted movement. After the mean follow-up of 7.9 years in Elektra and 3.5 years in MOOVIS, cumulative survival was 68.6% vs. 95.2%, respectively. Conclusions: In this mid- to long-term retrospective analysis, total joint arthroplasty in primary trapeziometacarpal joint arthritis results in low pain levels, excellent mobility and clinical function. Patient satisfaction is overall high. While revision due to cup loosening occurred more often in patients with single-mobility implants, no cases of dislocation or loosening of components were observed in the dual-mobility group. Trial registration: The study was conducted in accordance with the Declaration of Helsinki, and approved by the Ethics Committee of the Medical Faculty of Heidelberg University, reference number S-150/2020. [ABSTRACT FROM AUTHOR]

(1) Background: Dislocations of the trapeziometacarpal joint (TMC) are uncommon in children and adolescents. Only a few isolated cases are reported in the literature. Therapeutic guidance is minimal and inconclusive. (2) Methods: The authors present four patients treated for this unusual lesion. We evaluated the evolution according to treatment, age, patient activity, and quickDASH. Despite the clear limitation of the small number of patients, it is relevant to try to better understand this lesion and its evolution. A systematic review of the literature was also conducted. (3) Results: This is the largest published series of TMC dislocations in children and adolescents. Patients included a 12-year-old girl treated conservatively with a poor quickDASH; a 9-year-old girl treated surgically with the Eaton–Littler technique for a new dislocation with a partially modified quickDASH; a 13-year-old boy with two necessary closed reductions for a new dislocation and a very good final quickDASH; and a 12-year-old boy treated with closed reduction and percutaneous fixation with excellent final results with quickDASH. (4) Conclusions: In the absence of scientific evidence, conservative treatment and ligament reconstruction did not provide good functionality. In contrast, closed reduction with percutaneous fixation provided excellent results. Therefore, the authors would recommend closed reduction and percutaneous needle fixation as an elective method to treat TMC dislocations in pediatric and adolescent patients. [ABSTRACT FROM AUTHOR]

Exercise-based interventions are a common management strategy in patients with thumb carpometacarpal joint osteoarthritis (CMCJ OA); however, their exact effect on or the use of an optimal training programme for reducing pain and disability remains unclear. Our purpose was to evaluate the effectiveness of exercise-based interventions compared with other conservative interventions in patients with CMCJ OA. We performed a systematic review and meta-analysis based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Fourteen randomised clinical trials with 1280 patients were finally included. Exercise-based interventions present statistically and clinically better outcomes in reducing pain intensity (mean difference [MD]: −21.91; 95% confidence interval [CI]: −36.59, −7.24; p = 0.003) and wrist disability (MD: −8.1, 95% CI: −4.6, −11.5; p = 0.02) compared with no treatment at short-term follow-up. Proprioceptive exercises have statistically and clinically better outcomes compared with standard care only in pain intensity at very short-term (standardised mean difference [SMD]: −0.76; 95% CI: −1.30, −0.21; p = 0.007) and short-term (SMD: −0.93; 95% CI: −1.86, −0.01; p = 0.049) follow-up and statistically better results in wrist disability at very short-term (SMD: −0.94; 95% CI: −1.68, −0.21; p = 0.01) follow-up. No differences were found between the comparators at mid- and long-term follow-up. Low to moderate certainty of evidence suggests that exercise-based interventions can provide clinically better outcomes compared with no treatment in patients with thumb CMCJ OA, at least in the short term. [ABSTRACT FROM AUTHOR]

Accurate proprioception in the thumb carpometacarpal (CMC) joint is necessary during activities such as performing fine manipulative tasks, such as coin handling, opening doors, using keys, and pressing control buttons. The primary aim of the present study was to examine the test-retest reliability of CMC joint position sense (JPS) in healthy subjects. The secondary aim was to determine the most reliable JPS testing position for the thumb CMC joint. This was a cross-sectional study of a convenience sample of healthy adults. Three thumb positions (20°, 30°, and 40° of thumb abduction) were measured twice on the same day by a single rater using a universal goniometer. The absolute error in degrees between each position and reposition was calculated. The intraclass correlation coefficient (2,1) was calculated for relative reliability. The standard error of the measurement was calculated. Sixty-four healthy adults (mean age 27.8 years, standard deviation = 8.7) were assessed. The intraclass correlation coefficients were poor (−0.08 to 0.22), and the standard error of the measurement was 1.4° for all positions. The joint position reproduction test for JPS using goniometry demonstrated poor test-retest reliability and acceptable measurement error in healthy adults. • Joint position sense (JPS) error is the most widely used clinical measure of proprioception. • Intraclass correlation coefficient values of the JPS testing of the thumb demonstrated poor (0.04-0.40) test-retest reliability. • JPS testing demonstrated acceptable measurement error in healthy adults. [ABSTRACT FROM AUTHOR]

• Improvements in disability scores were clinically relevant with both programs. • Mobility improved by 29% and pain was reduced by 57% in the combined program. • Strength improved in both groups but with a greater effect size in combined program. • Improvements in disability, pain, mobility and strength were maintained 1-month later. Thumb carpometacarpal osteoarthritis (CMC OA) greatly affects post-menopausal women. It is characterized by pain and functional deficits that limit the performance of activities of daily life and affect quality of life. Analyze the effects of 4/weeks strength training, with and without proprioceptive neuromuscular facilitation (PNF) on the disability among post-menopausal women with thumb CMC OA. Secondly, analyze the effects on pain, mobility, and strength. Superiority randomized clinical trial. 42 women were randomly allocated to strength training program (SEG, n = 21) and to a strength training plus PNF therapy program (PNFG, n = 21). The Disability (disabilities of the arm, shoulder and hand questionnaire), pain (visual analogue scale), mobility (Kapandji Test), and hand strength were evaluated pre, post intervention (at 4 weeks) and follow-up (at 8 weeks). Disability was significantly reduced in both groups after intervention, but reduction was statistically superior in PNFG (between-group mean difference [MD] = -16.69 points; CI = -21.56:-11.82; P <.001; d = 2.14). Similar results were observed for secondary outcomes: pain (MD = -2.03; CI = -2.83:-1.22; P <.001; d = 1.58), mobility (MD = 0.96; CI = 0.52:1.38; P <.001; d = 1.40) and strength (grip: MD = 3.47kg; CI = 1.25:5.69; P =.003; d = 0.97, palmar: MD = 0.97kg; CI = 0.14:1.80; P =.024; d = 0.72, tip: MD = 1.12kg; CI = 0.41:1.83; P =.003; d = 0.99 and key pinch: MD = 0.85kg; CI = 0.001:1.70; P =.049; d = 0.62). These improvements were maintained at follow-up. The combination of PNF exercises and strength training is more effective for reducing disability pain and improve mobility and strength in post-menopausal women with CMC OA than a programme based solely on strength. [ABSTRACT FROM AUTHOR]

Joint effusion is diagnostically important. The canine carpal joint effusion, which is sometimes difficult to detect clinically, has received less attention in diagnostic ultrasound (US) studies. The aim of the present study was to provide a description of the morphological appearance of the canine carpal joint cavities and recesses using US, radiography, helical computed tomography (CT) and three‐dimensional volume rendering technique (3D‐VRT) images and to prove the applicability of musculoskeletal US for the detection of artificial carpal joint effusion in dogs. The understanding of the characteristics of these structures in normal patients is essential in the diagnosis. Twenty‐eight clinically and radiologically unremarkable canine carpal cadavers of different breeds were examined, representative images were selected and anatomical structures were labelled. The canine carpal joint cavities and in particular its recesses had a complex appearance with a basic structure found in all dogs: Antebrachiocarpal joint: dorsoproximal antebrachiocarpal recess, dorsodistal antebrachiocarpal recess, medial antebrachiocarpal recess, lateral antebrachiocarpal recess and five palmar antebrachiocarpal recesses. Middle carpal joint: two dorsal middle carpal recesses, medial common middle carpal and carpometacarpal recess, lateral common middle carpal and carpometacarpal recess, four palmar middle carpal recesses. The carpometacarpal joint had dorsal and palmar funnel‐shaped and irregular, finely tubular extensions, the most prominent ran dorsal to metacarpal III, the maximum distal end represented the proximal metacarpal diaphysis. All recesses presented ultrasonographically as a generalized anechogenic to hypoechoic filled continuation of the articular capsule with an indistinct peripheral hypoechogenic to isoechogenic fine capsule, the synovial‐connective tissue interface was difficult to identify. The novel results of this study provide the first morphological description of the ultrasonographic, radiographic and computed tomographic arthrographic appearance of the canine carpal joint cavities and recesses with different injection volumes. The canine carpal joint cavities and in particular its recesses had a complex appearance with a basic structure found in all dogs. The applicability of musculoskeletal US to visualize an artificial carpal effusion has been demonstrated. The results of this study, and in particular US, give the practitioner an advantage in visualizing joint effusion and assist in the decision to perform arthrocentesis. [ABSTRACT FROM AUTHOR]

The aim of this prospective and randomized study is to analyze and compare the outcomes of two surgical techniques for trapeziometacarpal joint osteoarthritis (Eaton-Littler grade III and IV). 52 consecutive patients underwent surgical intervention by two different surgical techniques and checked for subjective outcomes (DASH, NPRS), objective outcomes (ROM, opposition test, grinding test, pulp pinch, hand grip) and radiographic outcomes. Surgical time was calculated. 26 patients underwent suspension arthroplasty using abductor pollicis longus tendon interposition (Ceruso procedure) and 26 patients underwent arthroplasty using suspension tenoplasty of the flexor radialis carpi (Altissimi procedure). Both techniques were performed by a single surgeon and showed good and satisfactory results, with best outcome reported in Altissimi procedure regarding DASH and ROM (p = 0.011 and p = 0.012, respectively), with reduced surgical time (about 6 min less, p = 0.03). The proximal shift between scaphoid and the base of first metacarpal did not influence the final results of the cases treated. This study provides evidence that trapeziectomy in combination with both tendon suspension arthroplasty and tendon interposition are two surgical procedures useful to solve advanced basal joint arthritis. Patients who underwent suspension tenoplasty without tendon interposition seemed to be generally more satisfied with significantly better symptomatic and functional outcomes. • This is the first prospective randomized study comparing outcomes of trapeziectomy plus tenoplasty with so many measures. • Both surgical procedures appear useful to solve advanced basal joint arthritis at 4.5 years of follow-up. • Suspension tenoplasty without tendon interposition could offer better functional results with reduced operating times. [ABSTRACT FROM AUTHOR]

Simple Summary: Carpometacarpal and tarsometatarsal instabilities are rare diseases in dogs as compared to subluxations of the other joints of the carpus and the tarsus. Arthrodesis, skeletal external fixator use and ligament reconstruction are the most common surgical procedures for this pathology; however, high complication rates have been reported. This case report describes a novel procedure for the treatment of valgus instability of the carpometacarpal and tarsometatarsal joints using ultra-high-molecular-weight polyethylene suture (Isolock Intrauma®). The clinical and radiological findings are reported and a detailed description of the surgical technique is provided. The long-term outcomes reported in this study suggest that using a medial joint reinforcement system can be an easy, safe and effective treatment for joint instability. This case report describes a novel procedure using the Isolock Intrauma® implant system for treating medial instability of the carpometacarpal and tarsometatarsal joints, as demonstrated in in two dogs. A 9-year-old spayed female Spanish greyhound presented with a non-weight-bearing right hindlimb following a trauma. The clinical and radiological findings confirmed medial tarsometatarsal instability consistent with valgus deviation of the tarsus and the opening of the joint line on the medial aspect from the first to the third tarsometatarsal joints. A 4-year-old female Drahthaar presented with a non-weight-bearing left forelimb, swelling of the carpus and valgus instability. Radiological examination revealed a widening of the spaces between the intermedioradial carpal bone, second carpal bone and metacarpal bone II, confirming the medial carpometacarpal instability. In both cases, the Isolock system, an implant including ultra-high-molecular-weight polyethylene suture (UHMWPE), was used to reinforce the medial joint structures. Minor short-term complications were observed, such as swelling of the tarsal surgical site and hyperextension of the carpus, but these resolved spontaneously. No lameness or major complications were reported five months postoperatively. Carpometacarpal and tarsometatarsal instabilities are rare diseases in dogs as compared to subluxations of the other joints of the carpus and tarsus. There are no previous reports regarding the use of a UHMPWE implant for the treatment of these rare joint injuries, though the present case report suggests the validity and efficacy of the Isolock Intrauma® implant for restoring carpal and tarsal stability and preserving joint mobility. [ABSTRACT FROM AUTHOR]

Summary: A 10‐year‐old Connemara mare presented with persistent 3/5 (AAEP) right forelimb lameness following a traumatic incident whilst hunting, which was localised to the proximal metacarpal and distal carpal regions with diagnostic anaesthesia. Radiography revealed non‐specific moderately increased mineral opacity at the proximomedial margin of the third metacarpus, dorsal to the enthesis of the proximal suspensory ligament. However, subsequent computed tomography (CT) performed under general anaesthesia, identified an incomplete, dorsal ‐ obliquely orientated third metacarpal fracture arising from the interosseous space between the third and second metacarpi, also involving the carpometacarpal joint. Using CT guidance, internal surgical fixation was performed under the same anaesthetic episode and resulted in a shortened post‐operative recovery period with a successful return to previous athletic function. Surgical fixation can be performed using cross‐sectional imaging guidance to optimise recovery and facilitate a positive outcome. [ABSTRACT FROM AUTHOR]

The management of complications after surgery for basal thumb arthritis is sometimes challenging, and there are no clear recommendations on how to evaluate and manage patients with residual symptoms. The aim of the present article was to review the most common complications after surgery for basal thumb arthritis, with an emphasis on resection arthroplasty, joint replacement and joint fusion. In addition, possible management strategies for the different types of complications will be highlighted. [ABSTRACT FROM AUTHOR]

Aim: Polymers and metals, such as polyethylene (PE) and cobalt chrome (CoCr), are common materials used in thumb-based joint implants, also known as CMC (Carpometacarpal) arthroplasty. The purpose of this review was to investigate the reported failure modes related to wear debris from these type of materials in CMC implants. The impact of wear debris on clinical outcomes of CMC implants was also examined. Potential adverse wear conditions and inflammatory particle characteristics were also considered. Method: A literature search was performed using PRISMA guidelines and 55 studies were reviewed including 49 cohort studies and 6 case studies. Of the 55 studies, 38/55 (69%) focused on metal-on-polyethylene devices, followed by metal-on-metal (35%), and metal-on-bone (4%). Results: The summarized data was used to determine the frequency of failure modes potentially related to wear debris from metals and/or polymers. The most commonly reported incidents potentially relating to debris were implant loosening (7.1%), osteolysis (1.2%) and metallosis (0.6%). Interestingly the reported mechanisms behind osteolysis and loosening greatly varied. Inflammatory reactions, while rare, were generally attributed to metallic debris from metal-on-metal devices. Mechanisms of adverse wear conditions included implant malpositioning, over-tensioning, high loading for active patients, third-body debris, and polyethylene wear-through. No specific examination of debris particle characterization was found, pointing to a gap in the literature. Conclusion: This review underscores the types of failure modes associated with wear debris in CMC implants. It was found that failure rates and adverse wear conditions of CMC implants of any design are low and the exact relationship between wear debris and implant incidences, such as osteolysis and loosening remains uncertain. The authors note that further research and specific characterization is required to understand the relationship between debris and implant failure. [ABSTRACT FROM AUTHOR]

Joint replacement arthroplasty for the treatment of thumb osteoarthritis is gaining popularity as recent studies have demonstrated better pinch and grip strength and faster rehabilitation. Our aim was to identify early complications in modern implant designs using a multicenter study. A total of 381 patients who underwent thumb carpometacarpal replacement surgery in six participating hospitals were enrolled. The complications included were fractures, dislocations, infections, tendon and nerve injuries, and complex regional pain syndrome. Major complications were defined as a failure to implant the prosthesis, revision surgery to remove the implant, and any other need for further surgical intervention. The secondary outcomes were any other complications treated non-surgically and the timing of the complications. Eleven procedures failed, and these patients were treated with trapeziectomies. Twelve other patients required repeat surgical interventions. Minor adverse events occurred in 25.4% of the cases, and transient irritation of the superficial radial nerve and De Quervain tendinopathy were the most prevalent complications. Although this cohort depicted the learning curves of multiple surgeons, our study demonstrated low short-term failure rates. An inability to achieve primary stability of the cup in the trapezium was the leading cause of failure. Dislocations and other major complications with modern implants were very few. [ABSTRACT FROM AUTHOR]

Measurement of treatment outcomes and change in health status over time is a critical component of clinical practice and research for people with osteoarthritis. Numerous clinical tools are used to assess the structures and function of the thumb in persons with thumb carpometacarpal osteoarthritis however their psychometrics have not yet been systematically explored. The purpose of this study was to explore the psychometric properties of clinical tools used in persons with non-surgical thumb carpometacarpal osteoarthritis to objectively measure thumb structures and function, evaluate the quality of such studies, and subsequently make clinical and future research recommendations. Systematic review. A systematic search and screening was conducted across nine databases. Original research published between 2002 and 2022 that involved the assessment of psychometric properties (validity, reliability, precision, responsiveness, sensitivity, specificity, and minimal clinically important difference) of clinical tools were included. Sample characteristics, methods, and psychometric findings from each study were compiled. The methodological quality of included studies was evaluated using the COnsensus‐based Standards for the selection of health Measurement Instruments' checklist. Two independent researchers screened articles and assessed methodological quality and when not in agreement, a third party was consulted. Eleven studies were included in the review. The mean age of all participants in the studies was 69 years of age. The study designs included prospective case–control, prospective cohort, and cross-sectional to determine the psychometric properties of the measurements and tools. The included studies examined techniques to assess range of motion, strength, and pain-pressure thresholds, and screen for arthritis (ie, provocative tests). The intermetacarpal distance method, Kapandji index, pain-pressure threshold test, and pain-free grip and pinch dynamometry demonstrate excellent reliability and acceptable precision. Metacarpal extension, adduction, and pressure-shear provocative tests have superior sensitivity and specificity and the extension and adduction tests have excellent reliability. Other assessments included in the review yielded less robust psychometric properties. Studies were of variable methodological quality spanning from inadequate to very good. Based on the available literature on the psychometric properties of assessments of body structures and functions in persons with non-operative thumb carpometacarpal osteoarthritis, we offer a limited set of recommendations for use when screening for arthritis symptomology and measuring hand strength, thumb mobility, and pain thresholds. Additional psychometric research is needed in these domains as well as in dexterity, sensation, and objective measures of hand function. Future research should employ best practices in psychometric research. • There is a limited volume of body structure and function assessments with established psychometric properties in non-operative thumb carpometacarpal osteoarthritis. • The methodological quality of ∼60% psychometric studies on body structure and function assessments in non-operative thumb carpometacarpal osteoarthritis is less than "adequate." • Based on the current psychometric evidence, a limited set of clinical assessments of body structures and functions is proposed. • High-quality psychometric research on body structure and function assessments in non-operative thumb carpometacarpal osteoarthritis is needed. [ABSTRACT FROM AUTHOR]

This article discusses a rare case of isolated tuberculosis of the wrist joint without pulmonary involvement. The patient, a 26-year-old male, presented with a swollen and painful left wrist joint and limited mobility. Laboratory tests and imaging confirmed the diagnosis of tuberculosis of the wrist joint. The patient received antituberculosis drug treatment and underwent lesion resection surgery, resulting in a successful recovery. The article emphasizes the importance of timely diagnosis and treatment to prevent hand deformity and severe hand dysfunction. [Extracted from the article]

It has been suggested that boxing glove design alters thumb position increasing the risk of injury. The purpose of this study was to determine the effects of boxing glove design on thumb joint angles when making a fist. Ten experienced fighters participated in this study. A DEXA scan was used to produce an x-ray image of thumb position for all conditions (no gloves and 10-oz boxing gloves). Mean values for dependent measures were compared using a paired-sample T test and an alpha of 0.05. The carpometacarpal (CMC) joint angle was significantly different between no glove (14.1 ± 6.54°) and boxing glove (34.2 ± 7.60°) at p ≤ 0.001. The metacarpophalangeal (MP) joint angle was significantly different between no glove (132.6 ± 12.74°) and boxing glove (149.40 ± 8.15°) at p ≤ 0.001. The IP joint angle was not significantly different between no glove (135.50 ± 19.12°) and boxing glove (144.40 ± 17.39°) at p = 0.269. The perpendicular distance from the second metacarpal of the hand to the center of the MP joint was significantly different between no glove (0.48 ± 0.54 cm) and boxing glove (1.84 ± 0.29 cm) at p ≤ 0.001. Use of a boxing glove resulted in abduction of the thumb away from the hand and increased CMC and MP joint angles that were significantly different in relation to making a fist without a glove. Information from this study may provide insight into the high rate of thumb injury and provide insight for future boxing glove design. [ABSTRACT FROM AUTHOR]

Objective: To determine interobserver agreement and reliability of different radiological parameters in the assessment of fracture-dislocation of the 4th and 5th carpometacarpal joints (FD CMC 4–5) and associated hamate fracture on radiographs. Materials and methods: A retrospective, consecutive case series of 53 patients diagnosed with FD CMC 4–5. Emergency room diagnostic radiology images were reviewed by four independent observers. The reviews included assessment of radiological patterns and parameters in relation to CMC fracture-dislocations and associated injuries previously described in the literature, to analyze their diagnostic power (specificity and sensitivity) and reproducibility (interobserver reliability). Results: Among 53 patients, mean age 35.3 years, dislocation of the 5th CMC joint was present in 32/53 (60%) of patients, mostly (11/32 [34%]) associated with 4th CMC dislocation and base of 4th and 5th metacarpal fracture. The most common presentation of hamate fracture, in 4/18 (22%), was associated with combined 4th and 5th CMC dislocation and base of metacarpal fracture. Computed tomography (CT) was performed in 23 patients. Performing CT scan was significantly associated with hamate fracture diagnosis (p < 0.001). Interobserver agreement was slight (0–0.641) for most of the parameters and diagnoses. Sensitivity ranged from 0 to 0.61. Overall, the described parameters had low sensitivity. Conclusion: Radiological parameters described for assessment of fracture-dislocation of the 4th and 5th CMC joints and associated hamate fracture have a slight interobserver agreement index in plain X-ray and low sensitivity for diagnostic assessment. These results suggest the need for emergency medicine diagnostic protocols that include CT scan for such injuries. ClinicalTrials.gov identifier: NCT04668794 [ABSTRACT FROM AUTHOR]

In fruit cultivation, viticulture requires the longest working hours in extended arm postures, much of which is carried out in standing postures to accumulate fatigue on arms, shoulders, and legs: a tough working environment. In this study, we propose a power assist system to assist its users in their extended arm work while they move in vineyards. The proposed system largely consists of a mobile robot, a power assist device for work, and a control system. The mobile robot is structured with a tracked vehicle for rough terrain arranged on its left and right sides so that the users can sit between the two vehicles and be assisted by the power assist device for work installed on it. The power assist device for work with a single linear actuator utilizing a linkage mechanism has the function to retain users' hand attitude angles while assisting the flexion and extension movements of their shoulder, elbow, and carpometacarpal joints. Then, we verify by simulations the effects that the arrangement and lengths of links will have on the carpometacarpal joints' trajectories as well as on the hand attitude angles. Finally, in order to check the effectiveness of the proposed power assist device for work, we conducted the evaluation experiments for assumed grape-harvesting work and gibberellin treatments. As a result, we proved its work assisting effects from the muscle activity states as well as its applicability to other kinds of work by altering its linkage structure and hand support part. [ABSTRACT FROM AUTHOR]

To investigate the determinants of hand strength in patients with hand osteoarthritis (OA). Pinch and cylinder grip strength were measured in 527 patients with hand OA diagnosed by their treating rheumatologist from the Hand OSTeoArthritis in Secondary care (HOSTAS) study. Radiographs of hands (22 joints) were scored 0–3 (scaphotrapeziotrapezoid and first interphalangeal joints 0–1) on osteophytes and joint space narrowing following the Osteoarthritis Research Society International atlas. The first carpometacarpal joint (CMC1) was scored 0–1 for subluxation. Pain was assessed with the Australian/Canadian Hand Osteoarthritis Index pain subscale, and health-related quality of life with the Short Form-36. Regression analysis served to investigate associations of hand strength with patient, disease, and radiographic features. Hand strength was negatively associated with female sex, age, and pain. Reduced hand strength was associated with reduced quality of life, although less after adjusting for pain. Radiographic features of hand OA were associated with reduced grip strength when solely adjusted for sex and body mass index, but only CMC1 subluxation in the dominant hand remained significantly associated with pinch grip adjusted additionally for age (−0.511 kg, 95% confidence interval −0.975; −0.046). Mediation analysis showed low and not significant percentages of mediation of hand OA in the association between age and grip strength. Subluxation of CMC1 is associated with reduced grip strength, whereas associations with other radiographic features seem to be confounded by age. In the relationship between age and hand strength, radiographic hand OA severity is not an important mediator. [ABSTRACT FROM AUTHOR]

Background Steroid injection and splinting, which are commonly recommended nonsurgical treatments in adults with trigger finger, have been demonstrated to effectively relieve pain and improve function. However, to our knowledge, there have been no direct comparisons of pain relief and function improvement with splinting alone, steroid injection alone, or a combination of splinting and steroid injection in patients with this diagnosis. Question/purpose Are there differences in pain reduction and functional improvement in adults with trigger finger treated with splinting alone, steroid injection alone, and a combination of splinting and steroid injection at 6, 12, and 52 weeks after the intervention? Methods Between May 2021 and December 2021, we treated 165 adult patients for trigger finger at an academic university hospital. Based on prespecified criteria, all patients we saw during that period were eligible, but 27% (45 of 165) were excluded because they had received a previous local corticosteroid injection (n = 10) or they had concomitant carpal tunnel syndrome (n = 14), first carpometacarpal joint arthritis (n = 3), osteoarthritis of the hand (n = 6), de Quervain disease (n = 3), multiple-digit trigger finger (n = 6), or pregnancy during the study period (n = 3). After screening, 120 patients were randomized to receive either splinting (n = 43), steroid injection (n = 40), or splinting plus steroid injection (n = 37). Patients were randomly assigned to the different treatments using computer-generated block randomization (block of six). Sequentially numbered, opaque, sealed envelopes were used in the allocation concealment process. Both the allocator and the outcome assessor were blinded. Splinting involved the patient wearing a fixed metacarpophalangeal joint orthosis in the neutral position at least 8 hours per day for 6 consecutive weeks. Steroid injection was performed using 1 mL of 1% lidocaine without epinephrine and 1 mL of triamcinolone acetonide (10 mg/mL) injected directly into the flexor tendon sheath.No patientswere lost to follow-up or had treatment failure (that is, the patient had persistent pain or triggering with the trigger finger treatment and requested additional medical management including additional splinting, steroid injection, or surgery) at 6 or 12 weeks after the intervention, and at 52 weeks, there was no difference in loss to follow-up among the treatment groups. An intention-totreat analysis was performed with all 120 patients, and a perprotocol analysis was conducted with 86 patients after excluding patients who were lost to follow-up or had treatment failure. Primary outcomes evaluated were VAS pain reduction and improvement in Michigan Hand Outcomes Questionnaire (MHQ) scores at 6, 12, and 52 weeks after the intervention. The minimum clinically important difference (MCID) values were 1 and 10.9 for the VAS and MHQ, respectively. Results There were no clinically important differences in VAS pain scores among the three treatment groups at any timepoint, in either the intention-to-treat or the per-protocol analyses. Likewise, there were no clinically important differences in MHQ scores at any timepoint in either the intention-to-treat or the per-protocol analyses. Conclusion Splinting alone is recommended as the initial treatment for adultswith trigger finger because therewere no clinically important differences between splinting alone and steroid injection alone in terms of pain reduction and symptom or functional improvement up to 1 year. The combination of steroid injection and splinting is disadvantageous because the benefits in terms of pain reduction and symptom or functional improvement are not different from those achieved with steroid injection or splinting alone. Level of Evidence Level I, therapeutic study. [ABSTRACT FROM AUTHOR]

We compared the short-term recovery of patients treated with trapeziometacarpal joint (TMJ) implant arthroplasty versus resection-suspension-interposition (RSI) arthroplasty. Implant patients (n = 147) had a better 3-month postoperative brief Michigan Hand Outcomes Questionnaire (MHQ) score (mean 82) compared to RSI patients (n = 127), who had a mean score of 69. Key pinch strength at 3 months was also higher in the implant group compared to the RSI group (6.8 kg vs. 3.1 kg). At 1 year, both groups had similar brief MHQ scores, but key pinch remained higher in the implant group (7.0 kg vs. 3.9 kg [RSI]). After implant arthroplasty, employed patients returned to work after a mean of 44 days, which was significantly faster than the 84 days for RSI patients. Patients after TMJ implant arthroplasty recover significantly faster in the first 3 postoperative months compared to RSI patients. However, 1-year postoperative outcomes are similar for both cohorts, with key pinch strength remaining higher for patients with TMJ implant arthroplasty. Level of evidence: II [ABSTRACT FROM AUTHOR]

Objective: To provide complete anatomical and ultrasonographic description of tendons and ligaments at the palmar (plantar) aspect of the cannon and phalangeal regions of the one‐humped camel. Design: Forty‐two (21 fore and 21 hind) clinically normal camel cadavers' limbs disarticulated at the carpal and tarsal joints and three clinically normal mature camels were included in the study. Six cadaver limbs (three fore and three hind) were dissected, and another six limbs specimens (three fore and three hind) were frozen at −20° for 1 week then sectioned transversely with an electric band saw at different distances distal to the carpometacarpal and tarsometatarsal joints. The ultrasonographic study was carried out on the live camels and 30 cadaveric limbs. The shape, echogenicity and measurements (thickness, width and cross‐sectional area) of superficial digital flexor tendon (SDFT), deep digital flexor tendon (DDFT), suspensory ligament (SL), and sesamoidean ligaments were recorded and the differences in values between live animals and cadaveric specimens were statistically analysed. Results: The shape and echogenicity of SDFT, DDFT, and SL, varied between proximal, middle, and distal thirds of the cannon bone and the phalangeal region. There was no significant difference between live animal and cadaveric specimens. Conclusion: This study provided complete description of tendons and ligaments at the palmar (plantar) aspect of the cannon and phalangeal region of the one humped camel. The data obtained serves as a reference guide for practicing veterinarians and for future studies on injury to ligaments and tendons of camel's distal extremity. [ABSTRACT FROM AUTHOR]

While the literature is abundant on hand therapy assessment and treatment of nonsurgical thumb carpometacarpal (CMC) osteoarthritis (OA), clarity and uniformity are meager, making it a desirable diagnosis to establish expert consensus. This study aimed to ascertain if consensus exists for the assessment and treatment of nonsurgical management of thumb CMC OA in the hand therapy clinical setting. This was a consensus paper via the modified Delphi approach. A modified Delphi method was used to determine consensus among an expert panel, including hand therapists and hand surgeons, via two online surveys. A consensus paper steering committee (from the American Society of Hand Therapist's research division) designed the surveys and analyzed responses. Consensus was established as 75% agreement among the expert panel. Demographic information was collected from the expert panel. The expert panel included 34 hand therapists and seven hand surgeons. The survey response rates were 93.6% for the first survey and 90.2% for the second survey. Consensus recommendations were classified according to the World Health Organization categorization. These included evaluating the body structures for clinical signs/clinical testing and body functions for pain, range of motion for palmar abduction, radial abduction, opposition, and thumb metacarpal phalangeal flexion/extension, and grip and tripod pinch strength. Further consensus recommendations were for the assessment of function using a region-specific, upper extremity patient-reported outcome measure (activity and participation), environmental factors, outcome expectation, and illness perception within the patient's unique environmental and social contexts. Treatment recommendations included the use of an orthosis during painful activities, a dynamic stability program (stable C posture, release of tight adductors, and strengthening of stabilizers), patient education, joint protection techniques, adaptive equipment, and functional-based intervention. The findings describe the consensus of a group of experts and provide a clinical reference tool on the hand therapy assessment and treatment of nonsurgical thumb CMC joint OA. • A consensus paper using a modified Delphi process to determine consensus on non-surgical assessment and treatment of thumb CMC OA. • Assessment recommendations: evaluate clinical signs/testing, pain, thumb range of motion grip and tripod pinch, a region-specific PROM, environmental factors, outcome expectation, and illness perception. • Treatment: orthosis during painful activities as needed, a dynamic stability program, patient education, joint protection techniques, adaptive equipment, and functional based intervention. • Findings provide a clinical reference tool on hand therapy assessment and treatment of non-surgical CMC joint OA. [ABSTRACT FROM AUTHOR]

We present two cases of isolated post-traumatic osteoarthritis in the middle carpometacarpal joint. [ABSTRACT FROM AUTHOR]

Background: Carpal conformation is an important factor in relation to joint soundness. The equine carpometacarpal joint (CMCJ) was reported to have variations in its three palmaromedial articulations. Lacking one or more of these articulations has not been radiographically evaluated in Thoroughbred (TB) and Standardbred (SB) racehorses. Aim: The study aimed to identify the prevalence of the variation in the palmaromedial articulation of the carpometacarpal joint (PM-CMCJ) in TB and SB horses. Additionally, to detect the probability of having each of the three articulations within and between the breeds. Finally, to establish an anatomical description for the different patterns of the articulations in these horses. Methods: 313 dorsopalmar radiographs from 174 horses (117 TB and 57 SB) were used. Three articulations at PM-CMCJ were evaluated based on their presence or absence: the articulations between the second and third carpal bones (C2-C3), the second carpal-second metacarpal (C2-Mc2), and the second and third metacarpal (Mc2-Mc3) bones. The probability of each articulation was determined in the breeds. Depending on the presence/absence of one or more of these articulations in each horse, each group of horses that had the same patterns of articulation was gathered into one category. Results: Prevalence of variation in articulations of PM-CMCJ was identified in about 28% of the horses. SB showed a higher variation than TB throughout the comparisons. C2-C3 articulation was significantly the most common articulation, especially in TB (98%). The most common pattern of articulations (73%) was found in category I, which had three articulations whereas three horses grouped in category VI had no palmaromedial articulations. Conclusion: The variations in the articulations of PM-CMCJ in TB and SB racehorse might show a breed association. C2-C3 articulation was considerably the most frequent feature and category I was the common pattern of articulations in PM-CMCJ. The potential clinical effects of the varied patterns of the articulations require investigation. [ABSTRACT FROM AUTHOR]

Osteoarthritis (OA) is a common disease of the first carpo-metacarpal (CMC I) joint. Biomechanical factors promoting OA are the shape of the CMC I-joint, being a biconcave-convex saddle joint with high mobility and the increased instability caused by joint space narrowing, ligamentous laxity, and direction of force transmission of the abductor pollicis longus (APL) tendon during adduction. The closing wedge osteotomy of the base of the first metacarpal is joint preserving treatment option. We combine this closing wedge osteotomy with a ligamentoplasty to stabilize the joint. In this manuscript, we provide a detailed description of the indication, discuss biomechanical aspects and the surgical technique in detail. [ABSTRACT FROM AUTHOR]

Hand Osteoarthritis (HOA) is a frequently occurring musculoskeletal disease that impacts health. Diagnostic criteria often incorporate osteophytes documented through imaging procedures. Radiographic imaging is considered the gold standard; however, more sensitive and safer methods like ultrasound imaging are becoming increasingly important. We conducted a population-based cross-sectional study to examine the prevalence, grade, and pattern of osteophytes using high-resolution ultrasound investigation. Factory workers were recruited on-site for the study. Each participant had 26 finger joints examined using ultrasonography to grade the occurrence of osteophytes on a semi-quantitative scale ranging from 0–3, where higher scores indicate larger osteophytes. A total of 427 participants (mean age 53.5 years, range 20–79 years) were included, resulting in 11,000 joints scored. At least one osteophyte was found in 4546 out of 11,000 (41.3%) joints or in 426 out of 427 (99.8%) participants, but only 5.0% (553) of the joints showed grade 2 or 3 osteophytes. The total osteophyte sum score increased by 0.18 per year as age increased (p < 0.001). The distal interphalangeal joints were the most commonly affected, with 61%, followed by the proximal interphalangeal joints with 48%, carpometacarpal joint 1 with 39%, and metacarpophalangeal joints with 16%. There was no observed impact of gender or workload. In conclusion, ultrasound imaging proves to be a practical screening tool for osteophytes and HOA. Grade 1 osteophytes are often detected in the working population through ultrasound assessments and their incidence increases with age. The occurrence of grade 2 or 3 osteophytes is less frequent and indicates the clinical presence of HOA. Subsequent evaluations are imperative to ascertain the predictive significance of early osteophytes. [ABSTRACT FROM AUTHOR]

Background: Carpometacarpal (CMC) osteoarthritis (OA) of the thumb is a painful condition that affects over 15% of individuals above the age of 30 and up to 30% of post-menopausal women. Dry needling (DN) has been found to reduce pain and disability in a variety of neuromusculoskeletal conditions; however, DN in the management of CMC OA has not been well studied. Methods: Consecutive patients with clinical and radiographic evidence of CMC OA were treated with DN. The primary outcome measure was pain using the Numerical Pain Rating Scale (NPRS) at 12 weeks. Secondary outcome measures were the Upper Extremity Functional Index (UEFI-20) and the Global Rating of Change (GROC) scale. Outcome measures were collected at baseline, 4 weeks, 8 weeks, and 12 weeks. Results: Nine patients were treated for six sessions of periosteal DN over 3 weeks. Compared to baseline, statistically significant and clinically meaningful improvements were observed in thumb pain (NPRS mean difference: 2.6; p = 0.029) and function (UEFI-20 mean difference: 21.3; p = 0.012) at 12 weeks. Conclusion: Statistically significant and clinically meaningful within-group improvements in thumb pain and function were observed at 12 weeks following six sessions of periosteal DN treatment. DN may be a useful intervention in the management of patients with CMC OA of the thumb. [ABSTRACT FROM AUTHOR]

Since weight limitation on prosthetic hands limits their actuator numbers, designers cannot bio-mimic human hand. Therefore, optimization is required in order to develop prosthetic hands that could mimic the human hand performance as close as possible despite limitations. Hence, the objective function is to correlate the configuration of prosthetic hands to their performance in terms of their ability to grasp various objects like the human hand. The assessment was done by evaluating an accessible workspace and a grasp quality index. Forward kinematics was implemented to grade the workspace. Grasp ability was measured using the volume of the grasp wrench space, one of the grasp quality indexes. The grasp quality cannot rate prosthetic hands solely. As a result, techniques including randomization and grasp taxonomy were employed. Further, the function was applied to specify the importance of each finger and the Degree of Freedom (DOF) of the human hand. The results show that the most significant finger is the thumb. The most crucial DOFs are the abduction movement of the thumb's carpometacarpal (CMC) joint and the index's metacarpophalangeal (MCP) joint. Finally, the optimized configuration is proposed using the Taguchi method. [ABSTRACT FROM AUTHOR]

J Hand Surg Eur. 2019, 44: 263-8. 12 Yao J.Chapter 8: Dislocations and ligament injuries of the digits. In order to assess the ligament, the MCP joint must be flexed passively before stressing the ligament; this may readily be demonstrated on oneself. [Extracted from the article]

Background: Trapeziometacarpal osteoarthritis is the second most frequent degenerative hand disease and is the most functionally debilitating. The condition presents in 66% of women over 55. Motor imagery (MI) training post-surgery could help reduce rehabilitation times. Method: It is an experimental, prospective, longitudinal, parallel arm randomised clinical trial. Participants were women over 50 years old on the surgical waiting list. The experimental group will undergo MI training during the 3-week post-surgical immobilisation period. The control group will receive standard rehabilitation treatment. Outcomes will be assessed four times throughout the study using the Disabilities of the Arm, Shoulder and Hand questionnaire, the Cochin Hand Function Scale questionnaire, the Visual Analogue Scale, goniometry, baseline pinch gauge, circumferential measurement (cm), the Modified Kapandji Index and the Kinaesthetic and Visual Imagery questionnaire. Discussion: Early MI could improve hand function leading to improvements in recovery times. Trial registration: Clinical Trials registration: NCT03815734. Ethics Committee approval: 17155. Project funded in 2021. [ABSTRACT FROM AUTHOR]

• Patients with TMO can experience moderate to severe pain, disability, disturbed emotional well-being, limited quality of life, and reduced work productivity. • Pain frequency and magnitude of disability accounted for 59.0% of the variance in TMO pain intensity while sex, pain intensity, depression, and education explained 60.1% of the variance in magnitude of disability. • The greater the intensity of the pain and the magnitude of the disability, the more the hand therapist should be attentive to depressive symptoms (eg, feelings of worry or despair). • Education in ergonomic principles and assistive devices are provided to only a small proportion of the participants (20%); since the efficacy of these interventions has been soundly demonstrated, they should be more broadly offered. • Since pain experience is unique to each individual, patients with TMO should benefit from interventions most suited to their specific needs from a biopsychosocial perspective. Trapeziometacarpal osteoarthritis (TMO) is one of the most prevalent and painful forms of hand osteoarthritis. This study aimed at (1) describing the TMO pain experience, (2) identifying biopsychosocial factors associated with pain intensity and disability, and 3) documenting the use of non-surgical management modalities. Cross-sectional. Participants who presented for care for TMO were recruited from 15 healthcare institutions. They completed a questionnaire addressing sociodemographic, pain, disability, psychological well-being, quality of life (QoL), productivity, and treatment modalities employed. Multivariable regression analyses identified biopsychosocial factors associated with pain intensity and magnitude of disability. Among our 228 participants aged 62.6 years, 78.1% were women. More than 80% of the participants reported average pain of moderate to severe intensity in the last 7 days. Nearly 30 % of them scored clinically significant levels of anxiodepressive symptoms. The participants' norm-based physical QoL score on the SF-12v2 was 41/100. Among the 79 employed respondents, 13 reported having missed complete or part of workdays in the previous month and 18 reported being at risk of losing their job due to TMO. Factors independently associated with more intense pain included higher pain frequency and greater disability, accounting for 59.0% of the variance. The mean DASH score was 46.1 of 100, and the factors associated with greater magnitude of disability were higher pain intensity, greater levels of depression, female sex, and lower level of education, explaining 60.1% of the variance. Acetaminophen, oral non-steroid anti-inflammatory drugs, cortisone injections, orthoses, hand massage/exercises, and heat/cold application were the most frequently employed modalities. Most participants never used assistive devices, ergonomic techniques, and psychosocial services. Patients with TMO can experience severe pain, disability, disturbed emotional well-being, limited QoL and reduced productivity. As disability is associated with TMO pain, and depressive symptoms with disability, reducing such modifiable factors should be one of the clinicians' priorities. [ABSTRACT FROM AUTHOR]

• Standard therapy for CMC osteoarthritis with and without a stabilization home exercise program decreases pain and improves function over the course of a year. • Individuals with CMC osteoarthritis may benefit from individualized stabilization, stretching and strengthening exercises. • The role of exercise including optimal exercise selection and dosage is still under investigation. Randomized, interventional trial with 1 year follow-up. Though recommended, evidence is lacking to support specific exercises to stabilize and strengthen the first carpometacarpal (CMC) joint for cases of osteoarthritis (OA). To determine in a naturalistic setting, whether standard treatment plus a home exercise program (ST+HEP) is more effective than standard treatment (ST) alone in improving Quick Disabilities of Arm, Shoulder and Hand (qDASH) scores, and secondarily, in other patient-centered (pain, function) and clinical outcomes (range of motion, strength). A total of 190 patients from a hand therapy practice in northwestern PA were enrolled by informed consent and randomized into ST or ST+HEP groups. Average age was 60 years, most were female (78%) with sedentary occupations most common (36%). ST group received orthotic interventions, modalities, joint protection education and adaptive equipment recommendations, while the ST+HEP group received a home exercise program in addition to ST for 6-12 months. Follow-up occurred at 3, 6, and 12 months. Outcomes included grip strength, pinch strength, range of motion (ROM), qDASH, Patient Specific Functional Scale (PSFS) and pain ratings. At the 6 month mark, all subjects could change groups if desired. Efficacy data analysis included both parametric and non-parametric tests. The threshold for statistical significance was 0.05 and adjusted for multiple comparisons. Repeated measures ANOVA failed to show a statistically significant difference in strength and ROM assessments between treatment groups over the 12 month follow-up (P ≥.398). Differences between groups did not exceed 13%. Both the ST and ST+HEP groups evidenced improvement over time in most patient-focused assessments (P ≤.011), including improvements exceeding reported clinically important differences in pain with activity and PSFS scores. Scores for these measures were similar at each follow-up period (P ≥.080) in each group. The presence of CTS exerted no effect on outcomes; longer treatment time was weakly related to poorer qDASH and PSFS scores initially. Of those enrolled, 48% of subjects completed the study. The addition of a high-frequency home exercise program did not improve clinical or patient-centered outcomes more so than standard care in our sample however, study limitations are numerous. Both groups had decreased pain with activity and improved PSFS scores, meeting the established minimally clinically important difference (MCID) of each at 6 and 12 months. Adherence with the home program was poor and/or unknown. [ABSTRACT FROM AUTHOR]