BACKGROUND: 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.
OBJECTIVE: 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.
METHODS: This was a consensus paper via the modified Delphi approach.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.

BACKGROUND: Intra-articular fractures and fracture-dislocations of the ulnar-sided carpometacarpal joints (US-CMC) are common and under-reported. Their diagnosis is often delayed or incomplete, and there is no consensus as to the best treatment. The aim of this systematic literature review was to focus on the quality of existing data and to describe in detail the available evidence on the diagnosis and treatment of these lesions. Based on our findings, we will propose guidelines for improving the design of future studies on these lesions.
METHODS: This systematic literature review looked at all articles published between 1918 and 2019 on US-CMC fractures and fracture-dislocations. The quality of the articles was evaluated using the Quality Appraisal Tool devised by Moga et al. Information on the diagnostic and therapeutic methods were extracted along with epidemiological data, classifications, and clinical and radiological outcomes.
RESULTS: Of the 500 articles identified, 13 were included. According to the Quality Appraisal Tool, three of these articles had acceptable quality. While either radiographs or CT scans were used for the diagnosis, the radiographs were insufficient to precisely describe the lesions and guide the treatment. Conservative treatment or percutaneous surgical treatment was preferred for acute stable lesions without extensive fractures or comminution, while open surgical treatment was used most often in cases of unstable or sub-acute fractures and fracture-dislocations.
CONCLUSIONS: The current literature on this topic is made up of case series with a low level of evidence. CT is needed to assess and classify these lesions and select between conservative and surgical treatment. Unstable cases or those with delayed presentation should be treated with an open surgical approach. Based on our findings, we propose reporting guidelines for future studies on the treatment of US-CMC fractures and fracture-dislocations.
METHODS: III.

暂无摘要。

The most important complications of trapeziometacarpal arthroplasty are dislocation and component loosening. Incorrect cup position is often a contributing factor. Intra-operative guidelines to optimize cup orientation have recently been described. We evaluated the functional and radiological outcome of 50 Maïa® trapeziometacarpal prostheses that were implanted according to these guidelines. The minimum follow-up was 56 months. No constrained cups were used. Functional outcome was good to excellent. No spontaneous dislocations occurred. No radiological signs of loosening were observed. There was one case of premature wear. The survival rate was 96% (95% confidence interval 85 to 99%) at a mean of 65 months, with two prosthesie removed for posttraumatic trapezial fractures. This study shows that correct implant position can lead to reliable medium-term results after trapeziometacarpal joint arthroplasty.
METHODS: IV.