Trapeziometacarpal Joint Osteoarthritis

Trapeziometacarpal Joint Osteoarthritis Diagnosis and Treatment Simona Odella 123 Trapeziometacarpal Joint Osteoarthritis Simona Odella Trapeziometacarpal Joint Osteoarthritis Diagnosis and Treatment Simona Odella Istituto Ortopedico Gaetano Pini Milan Italy ISBN 978-3-319-44334-8 ISBN 978-3-319-44336-2 (eBook) https://doi.org/10.1007/978-3-319-44336-2 Library of Congress Control Number: 2018940446 © Springer International Publishing AG, part of Springer Nature 2018 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Printed on acid-free paper This Springer imprint is published by the registered company Springer International Publishing AG part of Springer Nature. The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland Preface Trapeziometacarpal arthritis is a common disease in female population over 50 years old. Thirty-two percent of people over the age of 50 years have radiological evidence of trapeziometacarpal joint osteoarthritis. In a population aged over 80 years, radiographic evidence of trapeziometacarpal osteoarthritis is as high as 91%, but despite a very high prevalence of radiographic osteoarthritis, particularly in the elderly population, the presence of radiological findings does not correlate well with symptoms. Often radiological advanced arthritis does not correlate with an important pain and functional limitation; instead initial radiological stages can be painful causing weakness and impairment in daily activities. It can happen that two persons with the same radiological findings may experience a high degree of pain and disability. As a result, trapeziometacarpal osteoarthritis is frequently treated based on symptoms rather than radiological investigation. Conservative therapy is always the first choice. Only in case of failure and per- sistence of pain and dysfunction at the base of the thumb, surgery could be considered as a possible solution. There are many different surgical procedures to treat thumb osteoarthritis: some of these are trapeziectomy with ligament reconstruction and tendon interposition (LRTI), trapeziectomy, trapeziectomy with ligament reconstruction, trapeziectomy with interpositional arthroplasty (IA), Artelon joint resurfacing, arthrodesis and Swanson joint replacement, partial trapeziectomy, partial trapeziectomy with pyro- carbon or PLDLA bioabsorbable interposition spacer, metacarpal osteotomy, and other different techniques. In literature a systematic review has failed to identify any additional benefit in terms of pain, physical function, patient global assessment, strength, and adverse events of any procedure over another. There is no evidence that the shortening of the thumb, after simple trapezium excision, can cause pain or worse functional results [1]. The aim of this book is to give an overview of the anatomy of the thumb, the possible reasons that lead to the trapeziometacarpal joint degeneration and of the possible solution in case of thumb osteoarthritis, considering conservative treatments and surgical options; in both cases the aim is to decrease pain, increase strength, and improve physical function. There is no evidence that a technique can give better results than another, and many different options have to be considered in any single case to give the correct v vi Preface indication. It is important to evaluate anatomical condition (trapezium bone stock, trapezium ipoplasia, joint instability), radiological stage, age of the patient, and functional demand before choosing the surgical technique. Milan, Italy Simona Odella Reference 1. Wajon A, Vinycomb T, Carr E, Edmunds I, Ada L (2015) Surgery for thumb (trapeziometacarpal joint) osteoarthritis. Cochrane Database Syst Rev (2):CD004631. https://doi. org/10.1002/14651858.CD004631.pub4 Contents 1 Anatomy of the Trapeziometacarpal Joint �� 1 1.1 Dorsoradial Ligament (DRL) �� 4 1.2 Posterior Oblique Ligament (POL) . 4 1.3 Superficial Anterior Oblique Ligament (sAOL) . 4 1.4 Deep Anterior Oblique Ligament (dAOL) �� 5 1.5 Ulnar Collateral Ligament (UCL) . 5 1.6 Intermetacarpal Ligaments �� 6 1.7 The Flexor Carpi Radialis and the Flexor Carpi Radialis Groove . 6 References �� 7 2 Physical and Radiological Evaluation �� 9 2.1 Physical Evaluation . 9 2.2 Radiographic Evaluation . 10 References �� 14 3 Etiopathology. 15 References �� 20 4 Non-surgical Treatment . 23 4.1 Pharmacological Therapy . 24 4.1.1 Drug Treatment in the Early Stages �� 25 4.1.2 Intra-articular Injection . 26 4.2 TMC Infiltration Technique �� 26 4.2.1 Non-pharmacologic Treatments �� 30 4.3 Orthoses �� 31 4.4 Physical Therapy . 33 4.4.1 Physiotherapy Treatment �� 33 4.4.2 Education Programme . 35 References �� 37 5 Portals in the Arthroscopy of the Wrist and of the Small Joints . 41 5.1 Dorsal Portals �� 46 5.1.1 Portal 1/2 . 46 5.1.2 Portal 3/4 . 46 5.1.3 Portal 4/5 . 47 vii viii Contents 5.1.4 Portal 6R . 47 5.1.5 Portal 6U . 47 5.2 Medio-carpal Radial (MCR) Portal �� 48 5.2.1 Midcarpal Ulnar Portal (MCU) . 48 5.2.2 Anterior Portals . 49 5.2.3 Volar Radial Portal (VR) . 49 5.2.4 Ulnar Volar Portal (VU) �� 49 5.3 Portals to STT . 51 5.3.1 STT Portal . 51 5.4 Trapezium-Metacarpal Portals �� 51 5.4.1 Trapezium-Metacarpal Radial Portal (TMR, Also Called 1R) . 51 5.4.2 Trapezoidal-Metacarpal-Ulnar Portal (TMU, Also Called 1U) �� 51 5.5 Radio-ulnar Distal (RUD) Articulation Portals . 52 5.5.1 Radio-ulnar Distal Lower (RUDL) Portal . 52 5.5.2 Proximal Lower Radio-ulnar Portal (PLRUP) �� 52 References �� 52 6 Trapeziometacarpal Joint Arthrosis: Arthroscopic Treatment . 55 6.1 The Trapeziometacarpal Joint Arthrosis . 55 6.2 Anatomy of the Trapeziometacarpal Joint �� 55 6.3 Classification . 57 6.4 Surgical Technique Brief . 58 6.5 Errors and Complications . 61 Conclusions �� 62 References �� 62 7 Surgical Approaches and Techniques . 65 7.1 Algorithm of Treatment �� 69 7.2 Technique Description �� 70 7.3 Surgical Approaches and Techniques: Interposition Implants and TM Joint Fusion �� 70 7.3.1 Prosthesis Design �� 72 7.3.2 Surgical Technique �� 72 7.3.3 Surgical Technique �� 76 7.3.4 Surgical Technique �� 90 7.3.5 Open Surgical Technique �� 90 7.4 Surgical Approaches: Arthroplasty Without Interposition Implants . 92 References ��

Load more