Trapeziometacarpal osteoarthritis

Trapeziometacarpal osteoarthritis
Other namesCarpometacarpal (CMC) osteoarthritis (OA) of the thumb, osteoarthritis at the base of the thumb, basilar (or basal) joint arthritis, rhizarthrosis.
Osteoarthritis of the trapeziometacarpal joint
SpecialtyPlastic surgery

Trapeziometacarpal osteoarthritis (TMC OA) also known as osteoarthritis at the base of the thumb, thumb carpometacarpal osteoarthritis, basilar (or basal) joint arthritis, or as rhizarthrosis.[1] This joint is formed by the trapezium bone of the wrist and the metacarpal bone of the thumb. This is one of the joints where most humans develop osteoarthritis with age.[2] Osteoarthritis is age-related loss of the smooth surface of the bone where it moves against another bone (cartilage of the joint).[1][3] In reaction of this process the joint bones thicken at the surface, resulting in subchondral sclerosis. Also bony outgrowths, called osteophytes, are formed at the joint margins.[4]

The main symptom is pain, particularly with gripping and pinching.[4][5] This pain is often described as weakness, but true weakness is not a part of this disease. People may also note a change in shape.[4][5] Some people choose surgery, but most people find they can accommodate trapeziometacarpal arthritis.

Signs and symptoms

The symptom that brings people with TMC OA to a doctor is pain.[5] Pain is typically experienced with gripping and pinching. People experiencing pain may describe it as weakness.[5]

There may be fullness at the TMC joint.[6] This area may be tender, meaning it is painful when pressed. There may also be hyperextension of the metacarpophalangeal joint. The thumb metacarpal deviates the middle of the hand (adduction).[7] Also a grinding sound, known as crepitus, can be heard when the TMC joint is moved, more so when axial pressure is applied.[8]

Causes

TMC OA is an expected part of aging in men and women equally.[2]

A population-based study of radiographic signs of pathophysiology in 3595 people assessed in a research-related comprehensive health examination found no association with physical workload.[9] A study of people seeing a hand specialist for symptoms unrelated to TMC OA demonstrated no relationship of radiographic TMC OA to hand activity.[10]

Studies that compare people presenting with TMC symptoms to people without symptoms are sometimes interpreted as indicating that activities can contribute to the development of TMC OA. A more accurate conclusion may be that hand use is associated with seeking care for symptoms related to TMC OA.[11]

Ligamentous laxity is often associated with TMC OA, but this is based on rationale rather than experimental evidence.[12]

Obesity may be related to TMC OA.[13]

Anatomy

The TMC joint is a synovial joint between the trapezium bone of the wrist and the metacarpal bone at the base of the thumb. This joint is a so-called saddle joint (articulatio sellaris), unlike the CMC joints of the other four fingers which are ellipsoid joints.[14] This means that the surfaces of the TMC joint are both concave and convex.

Its shape provides the TMC joint a wide range of motion. Movements include:[15]

  • Flexion
  • Extension
  • Abduction
  • Adduction
  • Opposition
  • Reposition
  • Circumduction

The TMC joint is stabilized by 16 ligaments.[16] Of these ligaments, the deep anterior oblique ligament, also known as the palmar beak ligament, is considered to be the most important stabilizing ligament.[17]

Showing the bones of the hand

Diagnosis

TMC OA is diagnosed based on symptoms and signs.[5] Radiographs can confirm the diagnosis and the severity of TMC OA. Other diagnoses in this region include scaphotrapezial trapezoid arthritis and first dorsal compartment tendinopathy (De Quervain syndrome) although these are usually easy to distinguish.[6]

Classification

TMC OA severity was classified by Eaton and Littler which can be simplified as follows:[18][19]

Stage 1:

  • slight widening of the joint space
  • < 1/3 subluxation of the joint (in any projection)

Stage 2:

  • Osteophytes, < 2 mm in diameter, are present. (usually adjacent to the volar or dorsal facets of the trapezium)

Stage 3:

  • Osteophytes, > 2 mm in diameter, are present (usually adjacent to the volar and dorsal facets of the trapezium)
  • Slight joint space narrowing

Stage 4:

  • Narrow joint space
  • Concomitant scaphotrapezial arthritis

A simpler classification is no arthritis, some arthritis, and severe arthritis.[20] This omits the potentially contradictory details of the Eaton/Littler classification and keeps scaphotrapezial arthrosis separate.

Treatment

Conservative

There is moderate quality evidence that manual therapy and therapeutic exercise improves pain in patients with thumb CMC OA at both short- and intermediate-term follow-up, and low to moderate quality evidence that magneto therapy improves pain and function at short-term follow-up. There is moderate evidence that orthoses (splints) can improve hand function at long-term follow-up. There is very low to low-quality evidence that other conservative interventions provide no significant improvement in pain and in function at short- and long-term follow-up. Some of the commonly performed conservative interventions performed in therapy have evidence to support their use to improve hand function and decrease hand pain in patients with CMC OA. [21] Patients with CMC OA of the thumb should initially be treated conservatively. Conservative treatment is equal to any non-surgical treatment and includes splinting, manual therapy, therapeutic exercises, magneto therapy, laser, NSAID medication and injections with corticosteroids.[22]

Manual therapy

Manual therapy is another commonly used treatment modality in which the joints or muscles of patients are manipulated with the intention of restoring the range of motion of the joint or increasing the flexibility of the muscles around the joint. Intervention techniques:

  • Kaltenborn Mobilization Technique[23]
  • Maitland's Mobilization[24]
  • Neurodynamic Techniques[25][26][27]
Kaltenborn mobilization technique

The specific Kaltenborn mobilization of posterior-anterior gliding with distraction in grade 3 of the CMC joint; the Convex/Concave Rule was applied in each case. In brief, Kaltenborn described these mechanics in terms of the convex-concave rule; the direction of decreased joint gliding in a hypomobile joint and, thus, the appropriate treatment can be deduced by this rule. With movement of a concave joint partner, the glide occurs in the same direction. The form of the joint surface has been considered to induce its gliding/sliding movement; a female (concave) joint surface glides in the same direction as the bone movement, whereas a male (convex) surface glides in the opposite direction of the bone movement. Traction is the technique that distracts 1 articular surface perpendicular to the other, and the glide technique describes the translational gliding of 1 articular surface parallel to the other. Traction in grade 3 has been defined as an additional force, which is applied in the parallel axis. This results in surrounding soft tissues and joint stretching, separating the joint surfaces.[23][28]

Neural mobilization technique

Nerve mobilization aims to glide a nerve by alternating moving at least two joints to increase in nerve strain due to nerve bed elongation at one joint (e.g., wrist extension) is simultaneously counterbalanced by a decrease in nerve bed length at an adjacent joint (e.g., elbow flexion).[29] The nerve mobilization technique for the median nerve consists of alternating the combination of elbow extension (which increases tension on the median nerve) and wrist flexion (which decreases tension on the median nerve) movement with the combination of elbow flexion (decreasing tension) and wrist extension (increasing tension) movement.[29] The radial nerve mobilization involves alternating the following 2 movements: shoulder depression applied simultaneously with elbow flexion and wrist flexion and ulnar deviation wrist extension; and shoulder elevation simultaneously with elbow extension, wrist extension. These movements can be alternated at a rate of approximately 2 seconds per cycle (1 second into extension and 1 second into flexion). Speed and amplitude of movement is adjusted to ensure that no pain was produced. At each session, the technique can be applied 3 times for 3 min separated by 1-min rest periods.[27]

Surgery

If conservative treatment does not reduce the complaints of patients, surgical treatment is indicated.[7] This might be the case when pain persists or when functional disability remains present after conservative treatment.

There are several surgical options to treat CMC OA of the thumb.[30] The aim of the treatment is not to cure the disease but to minimize the complaints and symptoms of patients.

Because many different expert opinions about the surgical treatment exist, there are many varieties of surgery, even within one type of surgery. However, there are four types of surgical techniques that are most commonly used.[30] These techniques can be categorized as follows:

  • Trapeziectomy
  • Arthrodesis
  • Joint replacement
  • Metacarpal osteotomy

Throughout the years many clinical trials have been carried out, investigating which surgical technique is superior. The levels of evidence of these studies vary from case reports up to randomized controlled trials and systematic reviews. Most studies focused on levels of pain, strength of the thumb, thumb mobility, satisfaction and complications.

No significant evidence has been found to claim that one of the four treatments is superior to one of the others in both short- and long-term effect.[30] Further investigation is needed, but until new evidence is found, investigators advice to carry out the most simple treatment with the least amount of complications. This means that the trapeziectomy is the most recommended surgical procedure for now.[30]

Showing the forces after trapeziectomy

Types of trapeziectomy

The principle of this procedure is the removal of the trapezium bone. It was originally described by Gervis in 1949 [24]. Because half of the carpometacarpal joint is removed, the complaints of patients caused by OA are usually gone.

Four main varieties within this procedure are performed:[31]

  • Trapeziectomy
  • Trapeziectomy with tendon interposition (TI)
  • Trapeziectomy with ligament reconstruction (LR)
  • Trapeziectomy with a combination of ligament reconstruction and tendon interposition (LRTI)

Claims have been made that one of these procedures is superior to the others, but there is no scientific evidence to support these statements.[32]

When pain, grip strength and key and tip pinch strengths were examined, investigators could not find a significant difference between the different procedures.[32]

Investigators suggest that the trapeziectomy without any interposition or reconstruction is preferred. It is a simpler procedure then the trapeziectomy with TI or LR and it tends to have fewer complications than the trapeziectomy with LRTI.[30][32]

Trapeziectomy is considered a good surgical option to treat stage II to IV of CMC OA of the thumb.[32]

Trapeziectomy

The most simple form out of the four variations is the trapeziectomy alone, also referred as the simple trapeziectomy.[31] During this procedure, the trapezium bone is removed without any further surgical adjustments.The trapezium bone will be removed through an approximately three centimeter long incision along the lateral side of the thumb. To preserve surrounding structures, the trapezium bone will be removed through fragmentation of the bone (the bone will therefore be broken into pieces).

An empty gap is left by the trapeziectomy and the wound is closed with sutures. Despite this gap, no significant changes in function of the thumb are reported.[30] After the surgery, the thumb will be immobilized with a cast.

Trapeziectomy with TI

Some physicians still believe that it is better to fill the gap left by the trapeziectomy. They assume that filling the gap with a part of a tendon is preferable in terms of function, stability and position of the thumb. They are afraid that leaving a gap might result in complications such as shortening or subluxation of the thumb.

During trapeziectomy with TI, a tendon interposition is performed.[33] A longitudinal strip of the palmaris longus tendon is separated. If this tendon is absent (which is the case in 13% of the population), half of the flexor carpi radialis tendon (FCR) can be used.

The tendon is then formed into a circular shape and placed in the gap, where it will be stabilized by sutures.[7]

Trapeziectomy with LR

Another technique used to assumable restore stability of the thumb, is a ligament reconstruction after a trapeziectomy is performed. The thought is that ligament reconstruction provides more stability to the thumb after removal of the trapezium bone.[34]

During this procedure the anterior oblique ligament is reconstructed using the FCR tendon. There is a wide variety in techniques to perform this LR, but they all have a similar goal.

Arthrodesis of the thumb
Trapeziectomy with LRTI

Some physicians suppose that combining LR with TI results in an even better stabilised thumb.

Like the name already suggests, this procedure includes a combination of a trapeziectomy with a LR as well as a TI.[35]

Arthrodesis

Arthrodesis of the CMC1 joint is a surgical procedure in which the trapezium bone and the metacarpal bone of the thumb are secured together. Because the joint is fixed, and therefore can not be moved, the complaints of the patient are mainly gone.During the surgery the two bones will be fixated using K-wires. The use of plates and screws has also been described. The thumb will be positioned in a way it can still perform a pinch grip. Because of the fixation, the two bones will fuse together. This will occur usually within four to six weeks.

However, this technique has some disadvantages.[30] The palm of the hand is unable to be flattened, making it difficult to wear gloves or put your hand in a pocket. Because the stress on the CMC1 joint is now divided over the other joints, those joints are more likely to be damaged.[36]

Nevertheless, this procedure can be used in patients with stage II and III CMC OA as well as in young people with posttraumatic OA.[30]

Joint Replacement

There are several prostheses available for use although they have not been widely successful. The goal is to create a stable artificial joint by replacing the old affected joint with new material. Newer prostheses tend to have better results than older ones.[30] Prostheses come in many varieties, such as spacers or resurfacing prostheses.

The total CMC1 joint replacement is a newer arthroplasty which has developed into a cemented and a non-cemented design. The cement acts as a binding factor for fixation of the prosthesis to the host bone. The non-cemented procedure is a good option to treat stage II and III OA and could be better on short-term than the trapeziectomy with LRTI. However, on the longer term, literature indicates the contrary.[30]

Overall, joint replacements are related to long-term complications such as subluxation, fractures, synovitis (due to the material used) and nerve damaging.[37] In many cases revision surgery is needed to either remove or repair the prosthesis. Also note that usage of a joint replacement is heavy in costs.

The quality of the prostheses is improving and there is reason to believe this will have a positive effect on outcome in the years to follow.[30]

Osteotomy of the thumb

Metacarpal osteotomy

The aim of this procedure is to change the pressure distribution on the CMC1 joint, so it can function without further damaging the joint. That is why a successful osteotomy requires a CMC1 joint of reasonable condition. Therefore, the metacarpal osteotomy should be limited to patients with a stage I-II CMC OA.[38]

An osteotomy is a surgical procedure wherein bone fragments are modified by cutting the bone.

During this procedure an abduction osteotomy of the proximal end of the first metacarpal bone is performed. An incision is made over the radial border of the first metacarpal bone. A wedged shape bone fragment is removed, causing the distal part of the metacarpal bone to tilt towards its desired position.[39] Postoperative, the thumb of the patient is immobilized using a thumb-cast.

Possible complications are non-union of the bone, persistent pain related to unrecognized CMC or pantrapezial disease and radial sensory nerve injury.[38]

Complications

The most common complication after surgery is pain persisting in the thumb. Over long term, there is pain relief, but on short term, patients experience pain from the surgery itself. The main complaint is a burning sensation or hypersensitivity over the incision. Some patients develop a complex regional pain syndrome. This is a syndrome of chronic pain with changes of temperature and colour of the skin.

Other general complications include radial nerve damage and postoperative wound infection.

After arthrodesis, non-union, in which fusion of the trapezium bone with the metacarpal bone fails, occurs in 8% to 21% of the cases.[30]

Subluxation of a prosthesis is a complication where the prosthesis is mobile and is partially dislocated. When the prosthesis is fully dislocated it is called a luxation. Both are painful and need revision surgery so the prosthesis can be repaired or removed.[40] When using a prosthesis over a longer period of time, there is a chance of breaking the prosthesis itself. This is due to mechanical wear.

Prostheses might also cause a reaction of the body against the artificial material they are made of, resulting in local inflammation.

Epidemiology

CMC OA is the most common form of OA affecting the hand.[2] Dahaghin et al. showed that about 15% of women and 7% of men between 50 and 60 years of age suffer from CMC OA of the thumb.[41] However, in about 65% of people older than 55 years, radiologic evidence of OA was present without any symptoms.[41] Armstrong et al. reported a prevalence of 33% in postmenopausal women, of which one third was symptomatic, compared to 11% in men older than 55 years.[2] This shows CMC OA of the thumb is significantly more prevalent in women, especially in postmenopausal women, compared to men.

References

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  2. 1 2 3 4 Becker, SJ, Briet, JP, Hageman, MP, Ring, D (2013). "Death, taxes, and trapeziometacarpal arthrosis". Clinical Orthopaedics and Related Research. 471 (12): 3738–3744. doi:10.1007/s11999-013-3243-9. PMID 23959907.
  3. ↑ Kihara H (April 1992). "[Anatomical study of the normal and degenerative articular surfaces on the first carpometacarpal joint]". Nippon Seikeigeka Gakkai Zasshi (in Japanese). 66 (4): 228–39. PMID 1593195.
  4. 1 2 3 North ER, Eaton RG (March 1983). "Degenerative joint disease of the trapezium: a comparative radiographic and anatomic study". J Hand Surg Am. 8 (2): 160–6. doi:10.1016/s0363-5023(83)80008-2. PMID 6833724.
  5. 1 2 3 4 5 Burton R. I. (1973). "Basal joint arthrosis of the thumb". Orthop. Clin. North Am. 4 (347): 331–8. doi:10.1016/S0030-5898(20)30797-5. PMID 4707436.
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  7. 1 2 3 Ghavami A, Oishi SN (May 2006). "Thumb trapeziometacarpal arthritis: treatment with ligament reconstruction tendon interposition arthroplasty". Plast. Reconstr. Surg. 117 (6): 116e–128e. doi:10.1097/01.prs.0000214652.31293.23. PMID 16651933. S2CID 6741548.
  8. ↑ Carr M. M., Freiberg A. (1994). "Osteoarthritis of the thumb: Clinical aspects and management". Am. Fam. Physician. 50 (995): 995–1000. PMID 7942418.
  9. ↑ Haara, Mikko M.; Heliövaara, Markku; Kröger, Heikki; Arokoski, Jari P. A.; Manninen, Pirjo; Kärkkäinen, Alpo; Knekt, Paul; Impivaara, Olli; Aromaa, Arpo (July 2004). "Osteoarthritis in the carpometacarpal joint of the thumb. Prevalence and associations with disability and mortality". The Journal of Bone and Joint Surgery. American Volume. 86 (7): 1452–1457. doi:10.2106/00004623-200407000-00013. ISSN 0021-9355. PMID 15252092.
  10. ↑ Wilkens, Suzanne C.; Tarabochia, Matthew A.; Ring, David; Chen, Neal C. (May 2019). "Factors Associated With Radiographic Trapeziometacarpal Arthrosis in Patients Not Seeking Care for This Condition". Hand (New York, N.Y.). 14 (3): 364–370. doi:10.1177/1558944717732064. ISSN 1558-9455. PMC 6535938. PMID 28918660.
  11. ↑ Fontana, Luc; Neel, Stéphanie; Claise, Jean-Marc; Ughetto, Sylvie; Catilina, Pierre (April 2007). "Osteoarthritis of the thumb carpometacarpal joint in women and occupational risk factors: a case-control study". The Journal of Hand Surgery. 32 (4): 459–465. doi:10.1016/j.jhsa.2007.01.014. ISSN 0363-5023. PMID 17398355.
  12. ↑ Doerschuk SH, Hicks DG, Chinchilli VM, Pellegrini VD (May 1999). "Histopathology of the palmar beak ligament in trapeziometacarpal osteoarthritis". J Hand Surg Am. 24 (3): 496–504. doi:10.1053/jhsu.1999.0496. PMID 10357527.
  13. ↑ Haara, Mikko M.; Heliövaara, Markku; Kröger, Heikki; Arokoski, Jari P. A.; Manninen, Pirjo; Kärkkäinen, Alpo; Knekt, Paul; Impivaara, Olli; Aromaa, Arpo (July 2004). "Osteoarthritis in the Carpometacarpal Joint of the Thumb: Prevalence and Associations with Disability and Mortality". JBJS. 86 (7): 1452–1457. ISSN 0021-9355.
  14. ↑ Sobotta Anatomy, 14th ed., Elsevier, ISBN 9780702034831
  15. ↑ Gray’s Anatomy for Students, second edition, Elsevier, ISBN 9780443069529
  16. ↑ Bettinger PC, Linscheid RL, Berger RA, Cooney WP, Kai-Nan A (1999). "An anatomic study of the stabilizing ligaments of the trapezium and trapeziometacarpal joint". J Hand Surg Am. 24 (4): 786–798. doi:10.1053/jhsu.1999.0786. PMID 10447171.
  17. ↑ Pellegrini VD, Olcott CW, Hollenberg G (March 1993). "Contact patterns in the trapeziometacarpal joint: the role of the palmar beak ligament". J Hand Surg Am. 18 (2): 238–44. doi:10.1016/0363-5023(93)90354-6. PMID 8463587.
  18. ↑ Tomaino, M. M. Thumb basal joint arthritis. In D. P. Green et al. (Eds.), Green’s Operative Hand Surgery, 5th Ed. New York: Churchill Livingstone, 2005. Pp. 461–485.
  19. ↑ Eaton RG, Glickel SZ (November 1987). "Trapeziometacarpal osteoarthritis. Staging as a rationale for treatment". Hand Clin. 3 (4): 455–71. doi:10.1016/S0749-0712(21)00761-7. PMID 3693416.
  20. ↑ Sodha, Samir; Ring, David; Zurakowski, David; Jupiter, Jesse B. (December 2005). "Prevalence of osteoarthrosis of the trapeziometacarpal joint". The Journal of Bone and Joint Surgery. American Volume. 87 (12): 2614–2618. doi:10.2106/JBJS.E.00104. ISSN 0021-9355. PMID 16322609.
  21. ↑ Bertozzi, L; Valdes, K; Vanti, C; Negrini, S; Pillastrini, P; Villafañe, JH (5 January 2015). "Investigation of the effect of conservative interventions in thumb carpometacarpal osteoarthritis: systematic review and meta-analysis". Disability and Rehabilitation. 37 (22): 2025–2043. doi:10.3109/09638288.2014.996299. PMID 25559974. S2CID 25470932.
  22. ↑ Valdes, Kristin; Marik, Tambra (October 2010). "A Systematic Review of Conservative Interventions for Osteoarthritis of the Hand". Journal of Hand Therapy. 23 (4): 334–351. doi:10.1016/j.jht.2010.05.001. PMID 20615662.
  23. 1 2 Villafañe JH, Silva GB, Diaz-Parreño SA, Fernandez-Carnero J (October 2011). "Hypoalgesic and motor effects of kaltenborn mobilization on elderly patients with secondary thumb carpometacarpal osteoarthritis: a randomized controlled trial". J Manipulative Physiol Ther. 34 (8): 547–56. doi:10.1016/j.jmpt.2011.08.005. PMID 21899891.
  24. ↑ Villafañe JH, Silva GB, Fernandez-Carnero J (February 2012). "Effect of thumb joint mobilization on pressure pain threshold in elderly patients with thumb carpometacarpal osteoarthritis". J Manipulative Physiol Ther. 35 (2): 110–20. doi:10.1016/j.jmpt.2011.12.002. PMID 22257943.
  25. ↑ Villafañe JH, Bishop MD, Fernández-de-Las-Peñas C, Langford D (March 2013). "Radial nerve mobilisation had bilateral sensory effects in people with thumb carpometacarpal osteoarthritis: a randomised trial". J Physiother. 59 (1): 25–30. doi:10.1016/S1836-9553(13)70143-7. PMID 23419912.
  26. ↑ Villafañe JH, Silva GB, Fernandez-Carnero J (September 2011). "Short-term effects of neurodynamic mobilization in 15 patients with secondary thumb carpometacarpal osteoarthritis". J Manipulative Physiol Ther. 34 (7): 449–56. doi:10.1016/j.jmpt.2011.05.016. PMID 21875519.
  27. 1 2 Villafañe JH, Silva GB, Bishop MD, Fernandez-Carnero J (March 2012). "Radial nerve mobilization decreases pain sensitivity and improves motor performance in patients with thumb carpometacarpal osteoarthritis: a randomized controlled trial". Arch Phys Med Rehabil. 93 (3): 396–403. doi:10.1016/j.apmr.2011.08.045. PMID 22218138.
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  29. 1 2 Coppieters MW, Alshami AM (Jul 2007). "Longitudinal excursion and strain in the median nerve during novel nerve gliding exercises for carpal tunnel syndrome" (PDF). J Orthop Res. 25 (7): 972–80. doi:10.1002/jor.20310. PMID 17415752. S2CID 6639758.
  30. 1 2 3 4 5 6 7 8 9 10 11 12 Vermeulen, Guus M.; Slijper, Harm; Feitz, Reinier; Hovius, Steven E.R.; Moojen, Thybout M.; Selles, Ruud W. (2011). "Surgical Management of Primary Thumb Carpometacarpal Osteoarthritis: A Systematic Review". The Journal of Hand Surgery. 36 (1): 157–169. doi:10.1016/j.jhsa.2010.10.028. ISSN 0363-5023. PMID 21193136.
  31. 1 2 Gervis W.H. (1949). "Excision of the trapezium for osteoarthritis of the trapeziometacarpal joint". J Bone Joint Surg. 31B (4): 537–539. doi:10.1302/0301-620X.31B4.537.
  32. 1 2 3 4 Gangopadhyay S, McKenna H, Burke FD, Davis TR (March 2012). "Five- to 18-year follow-up for treatment of trapeziometacarpal osteoarthritis: a prospective comparison of excision, tendon interposition, and ligament reconstruction and tendon interposition". J Hand Surg Am. 37 (3): 411–7. doi:10.1016/j.jhsa.2011.11.027. PMID 22305824.
  33. ↑ Weilby A (1988). "Tendon interposition arthroplasty of the first carpo-metacarpal joint". J Hand Surg Br. 13 (4): 421–425. doi:10.1016/0266-7681(88)90171-4. PMID 3249143.
  34. ↑ Blank J, Feldon P (1997). "Thumb metacarpophalangeal joint stabilization during carpometacarpal joint surgery". Atlas Hand Clin. 2: 217–225.
  35. ↑ Burton RI, Pellegrini VD (May 1986). "Surgical management of basal joint arthritis of the thumb. Part II. Ligament reconstruction with tendon interposition arthroplasty". J Hand Surg Am. 11 (3): 324–32. doi:10.1016/s0363-5023(86)80137-x. PMID 3711604.
  36. ↑ Mureau MA, Rademaker RP, Verhaar JA, Hovius SE (September 2001). "Tendon interposition arthroplasty versus arthrodesis for the treatment of trapeziometacarpal arthritis: a retrospective comparative follow-up study". J Hand Surg Am. 26 (5): 869–76. doi:10.1053/jhsu.2001.26659. PMID 11561240.
  37. ↑ Wajon A, Vinycomb T, Carr E, Edmunds I, Ada L (February 2015). Wajon A (ed.). "Surgery for thumb (trapeziometacarpal joint) osteoarthritis". Cochrane Database Syst Rev (2): CD004631. doi:10.1002/14651858.CD004631.pub4. PMC 6464627. PMID 25702783. (Retracted, see doi:10.1002/14651858.cd004631.pub5)
  38. 1 2 Atroshi I, Axelsson G, Nilsson EL (June 1998). "Osteotomy versus tendon arthroplasty in trapeziometacarpal arthrosis: 17 patients followed for 1 year". Acta Orthop Scand. 69 (3): 287–90. doi:10.3109/17453679809000932. PMID 9703405.
  39. ↑ Hobby JL, Lyall HA, Meggitt BF (May 1998). "First metacarpal osteotomy for trapeziometacarpal osteoarthritis". J Bone Joint Surg Br. 80 (3): 508–12. doi:10.1302/0301-620x.80b3.8199. PMID 9619947.
  40. ↑ Weilby A, Søndorf J (March 1978). "Results following removal of silicone trapezium metacarpal implants". J Hand Surg Am. 3 (2): 154–6. doi:10.1016/s0363-5023(78)80064-1. PMID 632545.
  41. 1 2 Dahaghin S, Bierma-Zeinstra SM, Ginai AZ, Pols HA, Hazes JM, Koes BW (May 2005). "Prevalence and pattern of radiographic hand osteoarthritis and association with pain and disability (the Rotterdam study)". Ann. Rheum. Dis. 64 (5): 682–7. doi:10.1136/ard.2004.023564. PMC 1755481. PMID 15374852.
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