Aims. In the treatment of basal thumb osteoarthritis (OA), intra-articular autologous fat transplantation has become of great interest within recent years as a minimally invasive and effective alternative to surgical intervention with regard to pain reduction. This study aims to assess its long-term effectiveness. Methods. Patients diagnosed with stage one to three OA received a single intra-articular autologous fat transplantation. Fat tissue was harvested from the abdomen and injected into the trapeziometacarpal (TMC) joint under radiological guidance, followed by one week of immobilization. Patients with a minimum three-year post-procedure period were assessed for pain level (numerical rating scale), quality of life (Mental Health Quotient (MHQ)), the abbreviated version of the Disabilities of Arm, Shoulder and Hand questionnaire (QuickDASH)), and grip and pinch strength, as well as their overall impression of the treatment. Wilcoxon tests compared data from pre-intervention, and at one and three years post-intervention. Results. Out of 136 treated joints, the study involved 87 patients (37 patients were loss to follow-up, and 12 patients (9%) who underwent resection arthroplasty) with a median follow-up of 4.9 years (IQR 5.4 to 5.9). Pain, both at rest and during stress, significantly improved at one year and remained stable through three years. Sex, age, and stage of disease were not associated with postoperative pain levels. Patient-reported outcome measures for QuickDASH and MHQ improved up to at least three years post-treatment. Patients reported high satisfaction and willingness to recommend the procedure. Grip and pinch strength did not significantly change over time. Conclusion. The data show that autologous fat transfer has a longer-lasting effect in two-thirds of re-examined patients. If patients had an initial positive response, the pain-reducing effect lasted for at least three years. Therefore, this minimally invasive approach can offer a valuable treatment alternative for basal thumb OA

Osteoarthritis of the trapezometacarpal joint is a common form of arthritis. At present, there is a significant void between conservative and operative managements. Viscosupplementation is occasionally considered as an in-between therapy.

We aimed to compare the therapeutic benefit of a single intra-articular injection of Sodium Hyaluronate (SH; Ostenil®mini) to a single intra-articular injection of Methylprednisolone Acetate (MA; Depomedrone) in the management of rhizarthrosis (TMOA; Trapezometacarpal Osteoarthritis).

A retrospective review was performed over a 12 month period. We reviewed 25 patients who had received a single injection of viscosupplementation (SH) performed with fluoroscopic guidance and had been followed up at 12 weeks. These patients were compared with 21 patients who had received a single steroid injection (MA) and had been followed up at 12 weeks.

Of the SH group, 52% (n = 13) reported some benefit from the injection. The MA group reported an 86% (n=18) benefit from the injection.

We found that a single injection of viscosupplementation (SH) is effective in relieving pain and improving function in about half of patients with rhizarthrosis (TMOA). The efficacy of a single steroid injection (MA), however, was superior with a far greater proportion of patients reporting analgesic and functional benefits.

Objectives. Little is known about tissue changes underlying bone marrow lesions (BMLs) in non-weight-bearing joints with osteoarthritis (OA). Our aim was to characterize BMLs in OA of the hand using dynamic histomorphometry. We therefore quantified bone turnover and angiogenesis in subchondral bone at the base of the thumb, and compared the findings with control bone from hip OA. Methods. Patients with OA at the base of the thumb, or the hip, underwent preoperative MRI to assess BMLs, and tetracycline labelling to determine bone turnover. Three groups were compared: trapezium bones removed by trapeziectomy from patients with thumb base OA (n = 20); femoral heads with (n = 24); and those without (n = 9) BMLs obtained from patients with hip OA who underwent total hip arthroplasty. Results. All trapezium bones demonstrated MRI-defined BMLs. Compared with femoral heads without BMLs, the trapezia demonstrated significantly higher bone turnover (mean . sd. 0.2 (0.1) versus 0.01 (0.01) µm. 3. /µm. 2. /day), mineralizing surface (18.5% (13.1) versus 1.4% (1.3)) and vascularity (5.2% (1.1) versus 1.2% (0.6)). Femoral heads with BMLs exhibited higher bone turnover (0.3 (0.2) versus 0.2 (0.1) µm. 3. /µm. 2. /day), a higher mineralization rate (26.6% (10.6) versus 18.6% (11.9)) and greater trabecular thickness (301.3 µm (108) versus 163.6 µm (24.8)) than the trapezia. Conclusion. Bone turnover and angiogenesis were enhanced in BMLs of both the thumb base and hip OA, of which the latter exhibited the highest bone turnover. Thus, the increase in bone turnover in weight-bearing joints like the hip may be more pronounced than less mechanically loaded osteoarthritic joints demonstrating BMLs. The histological changes observed may explain the water signal from BMLs on MRI. Cite this article: M. Shabestari, N. J. Kise, M. A. Landin, S. Sesseng, J. C. Hellund, J. E. Reseland, E. F. Eriksen, I. K. Haugen. Enhanced angiogenesis and increased bone turnover characterize bone marrow lesions in osteoarthritis at the base of the thumb. Bone Joint Res 2018;7:406–413. DOI: 10.1302/2046-3758.76.BJR-2017-0083.R3

Aim of the study: The evaluation of denervation efficiency in the treatment of the arthritis of the base of the thumb. Material and method. Between 2001– 2004, 15 patients were surgically treated for arthritis of the basis of the thumb. There were all females of an average age of 53 years. In all patients the procedure was done ambulatory under local anesthesia. After completing a protocol form, regarding pain motion and power of the thumb, an incision was made at the level of the wrist crease extended from the level of FCR to the level of the 2nd extensor compartment. Through this incision the articular branches which conform the studies of Wilhem and Fusche supply the 1st CMC joint were divided. A supplementary incision for the first intermetacarpal space was made. The patients were free to return to their activities the third postoperative day and they were reviewed after 3, 6, 12, 24 months by an independent doctor. Their data were also recorded conform the protocol. Results: Twelve patients out of 15 had excellent improvement of their strength. Pinch and grip power was doubled. Mobility of the thumb according to Kapanji scale was improved in all cases. Pain was reduced in 65% average. The patients were satisfied from the operation. There was one patient with poor improvement and two patients who never shown up at the follow-up. As the last were at the beginning of our learning curve we think that could have a less satisfactory result. Discussion: The method is simple with minimal impact to the patient activity or life. It gives good results in 65% –75% and leaves further operative procedures possible. Although there not enough data yet for this procedure and our number of cases is small with short follow-up we believe that it is a nice procedure, it satisfies both the patient and the surgeon regarding the overall improvement of mobility and pain

Musculoskeletal disorders have been recognised as common occupational risks for all orthopaedic surgeons. The nature of tasks performed by hip surgeons often requires both forceful and repetitive manoeuvres, potentially putting them at higher risk of musculoskeletal injuries compared to other orthopaedic sub-specialities. This study aimed to investigate the prevalence of musculoskeletal conditions among hip surgeons and evaluate the association between their workplace and lifestyle factors and musculoskeletal health. An online questionnaire consisting of 22 questions was distributed to UK-based consultant hip surgeons via email and social media platforms. This survey was completed by 105 hip surgeons. The mean age of the respondents was 49 years (range 35–69), with an average of 12 years (range 1–33) in service. 94% were full-time and 6% worked part-time. 49% worked at a district general hospital, 49% at a tertiary centre and 4% at a private institution. 80% were on the on-call rota and 69% had additional trauma commitments. 91% reported having one or more, 50% with three or more and 13% with five or more musculoskeletal conditions. 64% attributed their musculoskeletal condition to their profession. The most common musculoskeletal conditions were base of thumb arthritis (22%), subacromial impingement (20%), degenerative lumbar spine (18%) and medial or lateral epicondylitis (18%). 60% stated that they experienced lower back pain. Statistical analysis showed that being on the on-call rota was significantly (P<0.001) associated with a higher musculoskeletal burden. Regular resistance and/or endurance training and BMI<30 were statistically significant protective factors (P<0.001). Over the last few decades, most of the hip-related literature has focused on improving outcomes in patients, yet very little is known about the impact of hip surgery on the musculoskeletal health of hip surgeons. This study highlights a high prevalence of musculoskeletal conditions among UK-based hip surgeons. Hip surgeons have a pivotal role to play in the ongoing recovery of elective orthopaedics services. There is a pressing need for the identification of preventative measures and improvement in the surgical environment of our hip surgeons

The October 2015 Wrist & Hand Roundup360 looks at: Base of thumb arthritis – steroids not a waste of time; De Quervain’s tenosynovitis and steroids; Use your therapy time wisely!; Excision osteotomy for the carpometacarpal joint?; CORDLESS at five years?; Arthroscopy again of no benefit?; Distal radius stirring up trouble again!; Scaphoid arthroscopy under the spotlight

Aims. The objective of this systematic review was to describe trapeziectomy outcomes and complications in the context of osteoarthritis of the base of the thumb after a five-year minimum follow-up. Methods. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to guide study design, and 267 full-text articles were assessed for eligibility. After exclusion criteria application, 22 studies were included, involving 728 patients and 823 trapeziectomies. Outcomes included pre- and postoperative clinical and radiological characteristics. Complications and revisions were recorded. Results. All the studies reported good results regarding pain and range of motion at the last follow-up of 8.3 years (5 to 22); the mean satisfaction rate was 91% (84% to 100%). It was difficult to assess the impact on metacarpophalangeal joint motion in extension with contrary results. The key pinch returned to its preoperative values, whereas tip pinch showed a modest improvement (+14%), with a mild improvement found in grip strength (+25%) at the last follow-up. The mean progressive trapezial collapse was 48% (0% to 85%) and was not correlated with pain, grip strength, or satisfaction. The most represented complications were linked to tendons or nerves affected during additional procedures to stabilize the joint (11.6%; n = 56). Mechanical complications included symptomatic scapho-M1 impingement (3.1%; n = 15/580), leading to nine surgical revisions out of 581 trapeziectomies. Meta-analysis was not possible due to study heterogeneity and limited data. Conclusion. After a minimum five-year follow-up, trapeziectomy achieved high patient satisfaction and pain relief. However, strength seemed to be deteriorating with detrimental consequences, but this did not correlate with trapezial collapse. The issues related to underestimating mechanical complications and varying degrees of success should be highlighted in the information given to patients. Evidence-based analyses should help the surgeon in their decision-making. Cite this article: Bone Jt Open 2021;2(3):141–149

The August 2015 Wrist & Hand Roundup360 looks at: Scaphoid screws out?; Stiff fingers under the spotlight; Trigger finger: is complexity needed?; Do we really need to replace the base of the thumb?; Scapholunate ligament injuries and their treatment: a missed research opportunity?; Proximal row carpectomy versus four-corner arthrodesis

Introduction. Rolando type base of thumb metacarpal fractures are potentially debilitating injuries, which can be difficult to manage because of their inherent instability. Malunion is associated with stiffness, pain and weakness of pinch grip. We aimed to assess the outcome of a simple technique for the treatment of this fracture using the principle of ligamentotaxis, with a static, 2-pin external fixator spanning the trapeziometacarpal joint. We present the results and functional outcomes of this technique. Methods. A consecutive series of 8 patients (7 males, 1 female) with Rolando type intra-articular fractures of the base of the first metacarpal was retrospectively reviewed. All cases were performed by the senior author using a static, 2-pin Mini-Hoffman external fixator. Case notes and radiographs were reviewed, and patients' functional outcome assessed using the Quick Disability of Arm, Shoulder and Hand (Quick DASH) scoring system. Mean age of the group was 32.8 years (range 18.1-52.3 years). Mean follow-up was 2.7 years (range 3.5 months to 6.0 years). Results. The mean delay between injury and surgery was 6.6 days (range 1-11). The mean time to frame removal was 28 days (range 15-41). There were 3 cases of superficial pin site infection all of which were treated satisfactorily with oral antibiotic therapy. Follow-up radiographs did not demonstrate any significant joint incongruity or malunion in any case. The mean Quick DASH score was 8 (range 0-23). Mean scores for the work and sport components were 10 (range 0-25) and 3 (range 0-6) respectively. Conclusion. The results of this study demonstrate that this simple method reliably gives excellent hand and thumb function with minimal impact upon work, sport or recreational activities. We recommend the use of spanning trapeziometacarpal external fixation for intra-articular fractures of the base of the first metacarpal

Aims

Osteoarthritis (OA) affecting the thumb carpometacarpal joint (CMCJ) is a common painful condition. In this study, we aimed to explore clinicians’ approach to management with a particular focus on the role of specific interventions that will inform the design of future clinical trials.

Purpose. Osteoarthritis of the trapezio-metacarpal joint (TMJ or basal thumb joint) is a common condition causing significant disability. A range of non-operative and operative management options can be used for its treatment. One of the most common conservative treatments is a steroid injection into the joint. To confirm correct placement of the steroid it is preferable to use X-ray image intensification. Few previous studies have audited effectiveness, particularly with the use of radiological guidance. Methods. This clinical observational study prospectively reviewed the longevity of benefit of steroid injections into the TMJ. They were followed up until the analgesic effects ceased with a questionnaire including visual analogue scores. The clinical improvement was compared with the degree of radiological osteoarthritis (Eaton grade). Seventy-seven patients were recruited with a median age of 62 years and injected with steroid and local anaesthetic under radioscopic guidance. Results. Nearly half of the patients had a 3-month improvement. Two-thirds benefited for at least 2 months. One in six patients had a 6-month benefit, with some patients still improved 2 years after injection. Previously injected patients had a reduced duration of benefit compared to their previous injection. Effectiveness was not affected by Eaton grade. We had no complications except pain during injection. Conclusion. This study demonstrates that there are potentially significant benefits to be gained from steroid injections into the TMJ. We believe the outcome is improved by using radiological guidance and by adding local anaesthetic. Based on this study we recommend steroid injections in all degrees of TMJ osteoarthritis

Introduction: Trapeziectomy is a well established surgical procedure for the treatment of osteoarthritis of the carpo-metacarpal joint (CMCJ) o the thumb. The complications have been recognised in the past, but there has been limited literature describing the management and prognosis of long term complications following Trapeziectomy. Aim: The purpose of our study was to describe our experience in management and prognosis of patients with long term complications associated with Trapeziectomy with particular references to residual pain and sensory branch of radial nerve (SBRN) paraesthesia. Methods: 118 trapeziectomy procedures were performed in 103 patients for primary osteoarthritis of the CMCJ of thumb during the period of January 2000 – December 2005 at a single centre performed or supervised by a single surgeon (senior author). The data was obtained from the case notes retrospectively. The average follow up period was 12 months. The short term and long term complications and their management were recorded and analysed in detail. Results: Long term complication rate was 23.7% (28 cases) which included 15 patients (12.7 %) complaining of residual pain at the base of the thumb, 6 patients (5.1%) had symptoms related to superficial branch of radial nerve and 2 patients (1.7%) had FCR rupture. Steroid injection was more successful than physiotherapy or splinting in majority of the patients with residual pain. Superficial branch of radial nerve symptoms resolved with time. However persistent symptoms were treated suceesfully by desensitization therapy. Conclusion: Trapeziectomy is a fairly benign operation, but the complications are more than expected and the patients must be warned to expect long term complications. Most of the postoperative problems can be effectively managed non-operatively and the prognosis remains good in majority of the cases. Patients must be reassured to expect full recovery with time

The February 2015 Wrist & Hand Roundup360 looks at: Toes, feet, hands and transfers… FCR Tendonitis after Trapeziectomy and suspension, Motion sparing surgery for SLAC/SNAC wrists under the spotlight, Instability following distal radius fractures, Bilateral wrist arthrodesis a good idea?, Sodium Hyaluronate improves hand recovery following flexor tendon repair, Ultrasound treatments for de Quervain’s, Strategies for treating metacarpal neck fractures.

The June 2015 Wrist & Hand Roundup360 looks at: Collagenase and Dupuytren’s disease – a genuine alternative to surgery?; iPad PROMise?; Should we learn how to do endoscopic carpal tunnel release?; Two-week radiographs a relic of the past?; Bible? Aspirate or excise?; Patient expectations and trapeziometacarpal osteoarthritis; Splintage in the treatment of sagittal band incompetence and extensor tendon subluxation

The December 2014 Wrist & Hand Roundup360 looks at: ultrasound for carpal tunnel diagnosis; where we are at with management of undisplaced scaphoid fractures; ARPE for thumb metacarpals?; extravasation injuries in the hand and wrist; research and practice in hand surgery; and physio ineffective in hand osteoarthritis