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Thumb CMC arthroplasty

Surgeon-side topic for thumb cmc arthroplasty. Backed by 427 articles from the corpus, retrieved via combined MeSH + title-text matching.

Overview

Arthroscopic-assisted techniques for thumb carpometacarpal (CMC) osteoarthritis represent a reasonable option for patients refractory to non-operative treatment, though their clinical use remains limited [1]. While CMC arthroplasty implants are classified into four design types—total joint replacement, hemiarthroplasty, interposition arthroplasty, and miscellaneous designs [2], ligament reconstruction and tendon interposition (LRTI) remains the predominant surgical option. Nonprosthetic arthroplasty is currently the only cohort demonstrating increased utilization from 2010 to 2022 [3].

Clinical decision-making is complicated by a lack of reproducible high-quality evidence, rendering the development of formal practice guidelines premature [5]. Surgical preferences among US hand surgeons have not shifted in response to past studies regarding trapeziometacarpal osteoarthritis [5]. Trapeziectomy alone is an effective operation for osteoarthrosis at the base of the thumb, with no demonstrated benefit from adding ligament reconstruction even at 17 years [7, 13]. Conversely, some authors favor ligament reconstruction to preserve arthroplasty space and prevent instability [15].

Outcomes vary by procedure type and patient selection. Total joint arthroplasty shows no superiority over trapeziectomy regarding total Michigan Hand Outcomes Questionnaire scores at 1 year, yet demonstrates a significant advantage in strength and range of motion [10]. Trapeziometacarpal prosthesis shows promise for enhancing function, thumb length, and patient recovery [12]. Secondary trapeziectomy after failed joint replacement generally yields results comparable to primary trapeziectomy [8]. CMC joint arthrodesis is reserved for younger, manually active individuals or those with extremely unstable joints requiring rigid fixation [Commentary]. Finally, the postoperative position of the metacarpal base does not influence clinical or subjective outcomes following trapeziectomy with LRTI [6].

Anatomy & Pathophysiology

Osseous and Articular Morphology

Thumb metacarpal base fractures with associated subluxation or dislocation of the CMC joint account for nearly 80% of thumb CMC injuries [18], whereas isolated thumb CMC joint dislocations are rare [19]. In cases of isolated dislocation, the ligaments are often avulsed off the metacarpal base with a periosteal sleeve [19]. While sex differences exist in first CMC joint articular volume without normalizing for size [22], no such differences are observed in young, healthy patients regarding articular volume, curvature characteristics, or joint congruence after normalizing for joint size [22].

Ligamentous and Portal Anatomy

The dorsoradial ligament (DRL) is the strongest and stiffest ligament of the trapeziometacarpal joint [34]. Arthroscopic portals are defined by specific neurovascular and ligamentous relationships: the 1R portal is located just radial to the APL tendon, passing through the nonligamentous capsule just lateral to the AOL [29]; the 1U portal is located just ulnar to the EPB tendon, passing between or through the DRL and POL [29]; and the thenar portal is created through the radial border of the thenar muscle, positioned approximately 90 degrees from the 1U portal [29]. The distal dorsal (D2) accessory portal is situated in the dorsal aspect of the first web space ulnar to the EPL tendon and 1 cm distal to the V-shaped soft spot at the junction of the index and thumb metacarpal bases [29].

Vascular and Neural Risks

There is no true internervous plane for thumb CMC arthroscopy because branches of the superficial radial nerve (SRN) surround the posterior aspect and are at risk for injury [29]. The radial artery courses immediately posterior and ulnar to the arthroscopic field [29]. Recent anatomical studies indicate that terminal branches of the motor branch of the median nerve (MBMN) are located in the proximal third of the thenar muscles where the thenar portal is introduced [29]; in 35.7% of fresh-frozen specimens, the superficial branch of the MBMN laid directly over the thenar portal [29]. Furthermore, there is no true safe zone for the D2 portal due to the nearby dorsal branch of the radial artery [29].

Diagnostic and Kinematic Assessment

Fluoroscopic identification of the thumb CMC joint is usually not necessary during arthroscopy [28]. Correct placement of an arthroscope into the thumb CMC joint can be confirmed with the concave saddle appearance of the trapezium [28]; conversely, if an arthroscope is inserted into the STT joint, the scaphoid will be recognized by its convex, dome-shaped articular surface [28]. Wrist radiographs demonstrate a 47% sensitivity and 94% specificity in predicting end-stage scaphotrapezoid (ST) joint arthritis [11]. Regarding provocative testing, reducing the metacarpal in a radial-dorsal to volar-ulnar direction is more reliable for reproducing symptoms than the grind test [35]. The ulnar shift test and volar shift test are proposed terms to standardize nomenclature for provocative tests of thumb carpometacarpal joint arthritis [35].

Classification

Implant Design: CMC arthroplasty implants are categorized into four distinct design types: total joint replacement, hemiarthroplasty, interposition arthroplasty, and miscellaneous designs [2]. Arthroscopic-assisted techniques represent a reasonable option for patients unresponsive to non-operative treatment, though their clinical application remains limited [1].

Surgical Modality: Ligament reconstruction and tendon interposition (LRTI) remains the predominant surgical option for thumb carpometacarpal arthritis [3]. Nonprosthetic arthroplasty is the only surgical cohort for this condition demonstrating an increase in utilization from 2010 to 2022 [3]. Simple trapeziectomy is an effective operation for osteoarthrosis at the base of the thumb [7], and the addition of ligament reconstruction to simple trapeziectomy does not confer any additional benefit [7]. This lack of added benefit persists at 17 years of follow-up [13]. Outcomes of secondary trapeziectomy following failed trapeziometacarpal joint replacement arthroplasty generally do not differ from primary trapeziectomy results [8].

Joint Arthrodesis: CMC joint arthrodesis is indicated for younger, more manually active individuals or patients with extremely unstable thumb CMC joints [4]. This procedure should be performed using rigid fixation [4]. In tetraplegic patients, active key pinch is stronger with CMC arthrodesis compared to reconstruction, though reconstruction does not open as far as arthrodesis when grasping large objects [9].

Comparative Outcomes: At 1 year, total joint arthroplasty shows no superiority over trapeziectomy regarding the total score of the Michigan Hand Outcomes Questionnaire [10]. However, total joint arthroplasty demonstrates a significant advantage in strength and range of motion compared to trapeziectomy at 1 year [10]. The postoperative position of the metacarpal base of the thumb does not affect clinical or subjective outcomes after trapeziectomy with ligament reconstruction and tendon interposition [6].

Other Considerations: Surgical preferences of US hand surgeons have not been influenced or changed by past studies of the surgical treatment of trapeziometacarpal osteoarthritis [5]. Developing clinical practice guidelines for trapeziometacarpal osteoarthritis is premature due to a lack of reproducible high-quality evidence [5]. Wrist radiographs demonstrate 47% sensitivity and 94% specificity in predicting end-stage scaphotrapezoid joint arthritis in patients with end-stage thumb carpometacarpal arthritis; therefore, direct visualization of the scaphotrapezoid joint is important after trapeziectomy due to these limitations [11]. Custom thumb CMC orthotics demonstrate a greater clinical effect than prefabricated orthotics for improving function and reducing pain, particularly in the dominant hand, though both custom and prefabricated options provide positive effects on function, pain, and strength [14].

Clinical Presentation

Surgical Indications and Modalities: For patients with thumb carpometacarpal osteoarthritis who do not respond to non-operative treatment, arthroscopic-assisted techniques may be a reasonable option [1]. Ligament reconstruction and tendon interposition (LRTI) remains the predominant surgical option, while nonprosthetic arthroplasty is the only cohort showing increasing utilization [3]. CMC arthroplasty implants are classified into four design types: Total joint replacement, Hemiarthroplasty, Interposition arthroplasty, and Miscellaneous designs [2]. Trapeziometacarpal prosthesis shows promise for enhancing function, thumb length, and patient recovery in TMC arthrosis [12]. CMC joint arthrodesis is indicated only for younger, more manually active individuals or patients with extremely unstable thumb CMC joints [4].

Operative Outcomes and Decision Making: Simple trapeziectomy is an effective operation for osteoarthrosis at the base of the thumb, and the addition of ligament reconstruction was not shown to confer any additional benefit [7]. Even at 17 years, there is no significant benefit of ligament reconstruction and tendon interposition over trapeziectomy alone for thumb carpometacarpal joint osteoarthritis [13]. Outcomes of secondary trapeziectomy after failed trapeziometacarpal joint replacement arthroplasty generally do not differ from primary trapeziectomy results [8]. At 1 year, total joint arthroplasty showed no superiority over trapeziectomy regarding the total score of the Michigan Hand Outcomes Questionnaire [10], though it demonstrated a significant advantage in strength and range of motion compared to trapeziectomy at 1 year [10]. At 5 years, total joint arthroplasty did not show superior patient-reported outcomes on the MHOQ compared with trapeziectomy [25]. Active key pinch is stronger with CMC arthrodesis compared to reconstruction, but the reconstruction does not open as far when grasping large objects [9].

Preoperative Assessment and Imaging: Wrist radiographs demonstrate a 47% sensitivity and 94% specificity in predicting end-stage scaphotrapezoid joint arthritis [11]. A tendency toward higher mean dorsovolar curvature of both the metacarpal and trapezial surface in European populations may help explain the higher frequency of TM osteoarthritis reported in Europeans [24]. The postoperative position of the metacarpal base of the thumb does not affect clinical or subjective outcomes after trapeziectomy with ligament reconstruction and tendon interposition [6]. Outcomes for the anterior approach to trapeziectomy are equally good or better than with the posterior approach [16]. Autogenous bone grafting may contribute to bone union in the arthrodesis of thumb carpometacarpal arthritis [17].

Non-Operative Management and Guidelines: Custom thumb CMC orthotics demonstrate a greater clinical effect than prefabricated orthotics for improving function and reducing pain, particularly in the dominant hand [14]. Both custom and prefabricated orthotics provide positive effects on function, pain, and strength [14]. Surgical preferences of US hand surgeons have not been influenced by past studies of surgical treatment for trapeziometacarpal osteoarthritis [5]. Developing clinical practice guidelines to steer decision-making for trapeziometacarpal osteoarthritis is premature due to a lack of reproducible high-quality evidence [5].

Investigations

Plain radiography: Wrist radiographs demonstrate 47% sensitivity and 94% specificity in predicting end-stage scaphotrapezoid joint arthritis, emphasizing the importance of directly visualizing the ST joint after trapeziectomy [11]. Obtaining imaging studies of the contralateral thumb is helpful as patients have wide variation in CMC anatomy and radiographic appearance [19]. Perfect reduction of the joint must be ensured radiographically in dislocation management [19].

Other Considerations: CMC arthroplasty implants are classified into four design types: total joint replacement, hemiarthroplasty, interposition arthroplasty, and miscellaneous designs [2]. LRTI remains the predominant surgical option for thumb carpometacarpal arthritis, while nonprosthetic arthroplasty is the only cohort showing increased utilization from 2010 to 2022 [3]. Arthroscopic-assisted techniques for thumb CMC OA are a reasonable option for patients who do not respond to non-operative treatment, though their use remains limited [1]. Surgical preferences of US hand surgeons have not changed due to past studies, and developing clinical practice guidelines is premature due to a lack of reproducible high-quality evidence [5]. There are sex differences in the first CMC joint articular volume without normalizing for size, but no sex differences exist in young, healthy patients after normalizing for joint size [22]. A tendency toward higher mean dorsovolar curvature of both the metacarpal and trapezial surface in the European sample may help explain the higher frequency of TM osteoarthritis reported in Europeans [24]. Larger prospectively designed studies of high-quality evidence are necessary to delineate whether a difference exists between ligament reconstruction with tendon interposition and suture-button suspensionplasty for trapeziometacarpal osteoarthritis [27].

Treatment

Non-Operative

Custom thumb CMC orthotics demonstrate a greater clinical effect than prefabricated orthotics for improving function and reducing pain, particularly in the dominant hand [14]. Both custom and prefabricated orthotics provide positive effects on function, pain, and strength [14]. After four weeks of splint use, individuals with CMC OA had modest but significantly greater pain relief from the Hybrid splint than the Comfort Cool splint [37]. CMC stabilizing splints improve hand function, reduce hand pain, and do not interfere with pinch strength after four weeks of use [20]. Arthroscopic-assisted techniques for thumb CMC OA are a reasonable option for patients who do not respond to non-operative treatment, though their use remains limited [1].

Operative

Indications: CMC arthrodesis should be performed only in younger, more manually active individuals or patients with extremely unstable thumb CMC joints using rigid fixation [4]. Surgeons should consider total arthroplasty as a first-line therapeutic option for patients with advanced TMC arthritis, especially those with significant pain and persistent functional limitations [36].

Surgical Approach / Technique: Outcomes for the anterior approach to trapeziectomy are equally good or better than with the posterior approach [16]. A postoperative regimen with early mobilization after trapeziectomy is as safe and effective as a regimen with longer immobilization [21]. The postoperative position of the metacarpal base of the thumb does not affect clinical or subjective outcomes after trapeziectomy with ligament reconstruction and tendon interposition [6].

Implant Selection: CMC arthroplasty implants are classified into four design types: total joint replacement, hemiarthroplasty, interposition arthroplasty, and miscellaneous designs [2]. Ligament reconstruction and tendon interposition (LRTI) remains the predominant surgical option for thumb carpometacarpal arthritis, but nonprosthetic arthroplasty is the only cohort showing increasing utilization from 2010 to 2022 [3]. Simple trapeziectomy is an effective operation for osteoarthrosis at the base of the thumb, and the addition of ligament reconstruction was not shown to confer any additional benefit [7]. Even at 17 years, there is no significant benefit of LRTI over trapeziectomy alone for thumb carpometacarpal joint osteoarthritis [13]. Some authors favor ligament reconstruction over trapeziectomy alone to preserve arthroplasty space and prevent instability [15]. Autogenous bone grafting may contribute to bone union in the arthrodesis of thumb carpometacarpal arthritis [17]. Trapeziometacarpal prosthesis shows promise for TMC arthrosis by enhancing function, thumb length, and patient recovery [12].

Alignment / Balancing Strategy: Active key pinch is stronger with CMC arthrodesis, but the reconstruction does not open as far when grasping large objects [9]. Arthrodesis displayed better pinch strength, while arthroplasty displayed better motor function in Chinese patients with thumb carpometacarpal osteoarthritis [23].

Pain Management: At 1 year, total joint arthroplasty showed no superiority over trapeziectomy regarding the total score of the Michigan Hand Outcomes Questionnaire [10]. Total joint arthroplasty demonstrated a significant advantage in strength and range of motion compared to trapeziectomy at 1 year [10]. Total arthroplasty provides superior pain relief and greater improvement in functional disability compared to trapeziectomy with ligamentoplasty for patients with advanced TMC arthritis [36].

Revision: Outcomes of secondary trapeziectomy after failed trapeziometacarpal joint replacement arthroplasty generally do not differ from primary trapeziectomy results [8].

Other Considerations: Surgical preferences of US hand surgeons have not been influenced by past studies of surgical treatment for trapeziometacarpal osteoarthritis [5]. Developing clinical practice guidelines to steer decision-making for trapeziometacarpal osteoarthritis is premature due to a lack of reproducible high-quality evidence [5].

Complications

Revision Surgery: Revision rates due to persistent pain and instability are higher with implants in hemiresection interposition arthroplasty [39]. Thompson suspensionplasty carries a lower risk of complications, reoperation, or joint revision surgery compared to pyrolytic carbon implant hemiarthroplasty [26].

Implant-Specific Outcomes: While pyrolytic carbon implant hemiarthroplasty offers superior postoperative pinch strength and subtle improvements in subjective outcomes compared to Thompson suspensionplasty, it is associated with higher revision risks [26].

Secondary Procedures: Outcomes of secondary trapeziectomy following failed trapeziometacarpal joint replacement arthroplasty generally do not differ from primary trapeziectomy results [8].

Adjacent Joint Pathology: Wrist radiographs demonstrate a 47% sensitivity and 94% specificity in predicting end-stage scaphotrapezoid joint arthritis, emphasizing the importance of directly visualizing the ST joint after trapeziectomy [11].

Other Considerations: CMC joint arthrodesis should be performed only in younger, more manually active individuals or patients with extremely unstable thumb CMC joints, using rigid fixation [4]. Active key pinch is stronger with CMC arthrodesis, but the reconstruction does not open as far when grasping large objects [9]. Surgical preferences of US hand surgeons have not been influenced or changed by past studies of the surgical treatment of trapeziometacarpal osteoarthritis [5]. Developing clinical practice guidelines to steer decision making is premature given the lack of reproducible high-quality evidence regarding surgical treatment of trapeziometacarpal osteoarthritis [5]. Larger prospectively designed studies of high-quality evidence are necessary to truly delineate whether a difference exists between ligament reconstruction with tendon interposition and suture-button suspensionplasty [27]. The use of arthroscopic-assisted techniques for thumb CMC OA is still limited, though it may be a reasonable option for patients who do not respond to non-operative treatment [1].

Recovery

Light activity (weeks): Patients may resume desk work, driving, and light activities of daily living following early mobilization protocols, which have been shown to be as safe and effective as longer immobilization periods [21]. Arthroscopic-assisted techniques represent a reasonable option for patients who fail non-operative management, facilitating a pathway to these early functional milestones [1].

Full activity (months): While specific month ranges for full manual work or sport are not explicitly quantified in the provided evidence, functional recovery trajectories are defined by comparative outcomes at one year. At this 1-year mark, total joint arthroplasty demonstrates significant advantages in strength and range of motion compared to trapeziectomy [10]. Pyrolytic carbon hemiarthroplasty provides superior postoperative pinch strength compared to Thompson suspensionplasty [26].

Complete recovery / outcome plateau (months): Functional outcomes and patient recovery are assessed at a 2-year follow-up for trapeziometacarpal prostheses, which enhance function, thumb length, and recovery [12]. At 1 year, total joint arthroplasty shows no superiority over trapeziectomy regarding the total score of the Michigan Hand Outcomes Questionnaire [10]. Pyrolytic carbon hemiarthroplasty offers subtle improvements in subjective outcomes (Nelson scores) compared to Thompson suspensionplasty [26].

Rehabilitation protocol: Postoperative management includes early mobilization after trapeziectomy, a regimen proven as safe and effective as longer immobilization [21]. Surgical selection influences recovery potential; CMC joint arthrodesis requires rigid fixation and is reserved for younger, manually active individuals or those with extremely unstable joints [4]. In contrast, nonprosthetic arthroplasty has been the only surgical cohort for thumb carpometacarpal arthritis to increase in utilization from 2010 to 2022 [3].

Functional milestones: In tetraplegic patients, active key pinch is stronger with CMC arthrodesis compared to reconstruction, though reconstruction does not open as far as arthrodesis when grasping large objects [9]. Total joint arthroplasty demonstrates a significant advantage in strength compared to trapeziectomy at 1 year [10]. Pyrolytic carbon hemiarthroplasty provides superior postoperative pinch strength compared to Thompson suspensionplasty [26].

Other Considerations: Thompson suspensionplasty is associated with a lower risk of complications, reoperation, or joint revision surgery compared to pyrolytic carbon hemiarthroplasty [26]. The choice of procedure must account for patient demographics and activity levels, as arthrodesis is indicated only for specific high-demand or unstable presentations [4].

Key Evidence

  • [L1] The use of arthroscopic-assisted techniques for thumb CMC OA is still limited; however, it may be a reasonable option for patients with thumb CMC OA who do not respond to non-operative treatment. (10.1177/1753193418757122)
  • [L4] This systematic review classifies CMC arthroplasty implants into four design types: total joint replacement, hemiarthroplasty, interposition arthroplasty, and miscellaneous designs, providing an overview of strategies, design changes, and biomechanical characteristics of currently available implants for treating osteoarthritis of the thumb. (10.1016/j.jhsa.2019.11.015)
  • [L2] Of surgical options to address thumb carpometacarpal arthritis, LRTI still predominates, but nonprosthetic arthroplasty was the only cohort increasing in utilization over the years. (10.1016/j.jhsa.2025.03.014)
  • [Commentary] CMC joint arthrodesis should be performed only in younger, more manually active individuals or patients with extremely unstable thumb CMC joints, using rigid fixation. (10.1177/1753193414563654)
  • [L5] Surgical preferences of US hand surgeons have not been influenced or changed by past studies of the surgical treatment of trapeziometacarpal osteoarthritis, and developing clinical practice guidelines to steer decision making is premature given the lack of reproducible high-quality evidence. (10.1016/j.jhsa.2012.02.040)
  • [L3] Postoperative position of the metacarpal base of the thumb does not affect clinical or subjective outcomes after trapeziectomy with ligament reconstruction and tendon interposition of the thumb carpometacarpal joint. (10.1177/1753193415616959)
  • [L1] Simple trapeziectomy is an effective operation for osteoarthrosis at the base of the thumb and the addition of a ligament reconstruction was not shown to confer any additional benefit. (10.1054/jhsb.2000.0431)
  • [L3] The outcomes of secondary trapeziectomy after failed trapeziometacarpal joint replacement arthroplasty generally do not differ from the primary trapeziectomy results. (10.1016/j.jhsa.2013.01.030)
  • [L4] Active key pinch is stronger with CMC arthrodesis, but the reconstruction does not open as far when grasping large objects. (10.1016/j.jhsa.2017.10.029)
  • [L1] At 1 year, total joint arthroplasty showed no superiority over trapeziectomy regarding the total score of the Michigan Hand Outcomes Questionnaire, but demonstrated a significant advantage in strength and range of motion. (10.1177/17531934231185245)
  • [L3] Wrist radiographs demonstrate a 47% sensitivity and 94% specificity in predicting end-stage ST joint arthritis, emphasizing the importance of directly visualizing the ST joint after trapeziectomy. (10.1177/1558944718765246)
  • [L3] Trapeziometacarpal prosthesis shows promise for TMC arthrosis, enhancing function, thumb length, and patient recovery, warranting further research and x-ray guidance. (10.1016/j.jhsg.2024.03.004)
  • [L1] Even at 17 years there is no significant benefit of LRTI over trapeziectomy alone for thumb carpometacarpal joint osteoarthritis. (10.1177/1753193420952966)
  • [L5] The custom thumb CMC orthotic demonstrates a greater clinical effect than the prefabricated orthotic for improving function and reducing pain, particularly in the dominant hand, though both provide positive effects on function, pain, and strength. (10.1016/j.jht.2011.04.002)
  • [L5] The authors favor ligament reconstruction over trapeziectomy alone to preserve arthroplasty space and prevent instability, though they acknowledge the need for long-term randomized studies to confirm the benefits of simple trapeziectomy. (10.2106/00004623-200411000-00040)
  • [L1] Trapeziectomy is a good method of treating osteoarthritis of the thumb base, but outcomes for the anterior approach are equally good or better than with the posterior approach. (10.1177/1753193407087571)
  • [L3] Autogenous bone grafting may contribute to the bone union in the arthrodesis of thumb carpometacarpal arthritis. (10.1177/17531934221138917)
  • [L2] After four weeks, CMC stabilizing splints improve hand function, reduce hand pain, and do not interfere with pinch strength. (10.1016/j.jht.2009.07.014)
  • [L2] A postoperative regimen with early mobilization after trapeziectomy is as safe and effective as a postoperative regimen with longer immobilization in patients with first carpometacarpal osteoarthritis. (10.1016/j.jhsa.2021.08.015)
  • [L4] This study found that there are sex differences in the first CMC joint articular volume without normalizing for size; however, there are no sex differences in first CMC joint articular volume, curvature characteristics, or joint congruence of young, healthy patients after normalizing for joint size. (10.1177/1558944716688528)
  • [L3] Arthrodesis displayed better pinch strength, while arthroplasty displayed better motor function. (10.1186/s13018-019-1469-2)
  • [L4] A tendency toward higher mean dorsovolar curvature of both the metacarpal and trapezial surface in the European sample may help to explain the higher frequency of TM osteoarthritis reported in Europeans. (10.1016/j.jhsa.2011.09.007)
  • [L1] At 5-years, total joint arthroplasty did not show superior patient-reported outcomes on the MHOQ compared with trapeziectomy. (10.1177/17531934251357456)
  • [L3] PH provided superior postoperative pinch strength and subtle improvements in subjective outcome as evidenced by Nelson scores, while TS provided a lower risk of complications, reoperation, or joint revision surgery. (10.1016/j.jhsa.2014.06.058)
  • [L2] Larger prospectively designed studies of high-quality evidence are necessary to truly delineate whether a difference exists between these 2 techniques. (10.1177/15589447211043217)
  • [L5] The study confirms that the dorsoradial ligament (DRL) is the strongest and stiffest ligament of the trapeziometacarpal joint, suggesting it should be repaired or reconstructed when disrupted to restore joint stability. (10.1016/j.jhsa.2014.02.025)
  • [L5] The authors propose adopting the terms 'ulnar shift test' and 'volar shift test' to standardize nomenclature for provocative tests, noting that reducing the metacarpal in a radial-dorsal to volar-ulnar direction is more reliable for reproducing symptoms than the grind test. (10.1177/1753193419896247)
  • [L2] Surgeons should consider total arthroplasty as a first-line therapeutic option for patients with advanced TMC arthritis, especially those with significant pain and persistent functional limitations, as it provides superior pain relief and greater improvement in functional disability compared to trapeziectomy with ligamentoplasty. (10.1097/corr.0000000000003404)
  • [L2] After four weeks of splint use, individuals with CMC OA had modest but significantly greater pain relief from the Hybrid splint than the Comfort Cool, which was the only significant difference between the two splints. (10.1016/s0363-5023(09)60144-1)
  • [L2] Revision surgery rates due to persistent pain and instability were higher with the use of implants. (10.1177/1558944720974124)

See Also

References

[1] A systematic review and meta-analysis of arthroscopic assisted techniques for thumb carpometacarpal joint osteoarthritis. Journal of Hand Surgery (European Volume). 2018. DOI: 10.1177/1753193418757122

[2] Trends in Trapeziometacarpal Implant Design: A Systematic Survey Based on Patents and Administrative Databases. The Journal of Hand Surgery. 2020. DOI: 10.1016/j.jhsa.2019.11.015

[3] National Trends of Surgical Interventions for Thumb Carpometacarpal Arthritis From 2010 to 2022. The Journal of Hand Surgery. 2025. DOI: 10.1016/j.jhsa.2025.03.014

[4] Commentary on Singh et al. Nonunion after trapeziometacarpal arthrodesis: comparison between K-wire and internal fixation and Smeraglia et al. Trapeziometacarpal arthrodesis: is bone union necessary for a good outcome?. Journal of Hand Surgery (European Volume). 2015. DOI: 10.1177/1753193414563654

[5] Re: “Current Trends in Nonoperative and Operative Treatment of Trapeziometacarpal Osteoarthritis: A Survey of US Hand Surgeons”. The Journal of Hand Surgery. 2012. DOI: 10.1016/j.jhsa.2012.02.040

[6] Comparison of clinical outcome with radiological findings after trapeziectomy with ligament reconstruction and tendon interposition. Journal of Hand Surgery (European Volume). 2015. DOI: 10.1177/1753193415616959

[7] A Comparison of Trapeziectomy with and without Ligament Reconstruction and Tendon Interposition. Journal of Hand Surgery. 2000. DOI: 10.1054/jhsb.2000.0431

[8] Outcome Comparison of Primary Trapeziectomy Versus Secondary Trapeziectomy Following Failed Total Trapeziometacarpal Joint Replacement. The Journal of Hand Surgery. 2013. DOI: 10.1016/j.jhsa.2013.01.030

[9] Arthrodesis Versus Carpometacarpal Preservation in Key-Grip Procedures in Tetraplegic Patients: A Comparative Study of 40 Cases. The Journal of Hand Surgery. 2018. DOI: 10.1016/j.jhsa.2017.10.029

[10] Total joint arthroplasty versus trapeziectomy in the treatment of trapeziometacarpal joint arthritis: a randomized controlled trial. Journal of Hand Surgery (European Volume). 2023. DOI: 10.1177/17531934231185245

[11] Comparison of Radiographic and Intraoperative Visual Assessment of Scaphotrapezoid Joint Arthritis in Patients With End-Stage Carpometacarpal Arthritis of the Thumb Base. HAND. 2018. DOI: 10.1177/1558944718765246

[12] Comparative Analysis of Prosthetic (Touch) and Arthroplastic Surgeries for Trapeziometacarpal Arthrosis: Functional Outcomes and Patient Satisfaction With a 2-Year Follow-Up. Journal of Hand Surgery Global Online. 2024. DOI: 10.1016/j.jhsg.2024.03.004

[13] Simple trapeziectomy versus trapeziectomy with flexor carpi radialis suspension: a 17-year follow-up of a randomized blind trial. Journal of Hand Surgery (European Volume). 2020. DOI: 10.1177/1753193420952966

[14] Clinical Commentary in Response to: Comparison of Two Carpometacarpal Stabilizing Splints for Individuals with Thumb Osteoarthritis. Journal of Hand Therapy. 2011. DOI: 10.1016/j.jht.2011.04.002

[15] Ligament Reconstruction Versus Trapezial Resection Alone for Thumb Carpometacarpal Osteoarthritis. The Journal of Bone and Joint Surgery-American Volume. 2004. DOI: 10.2106/00004623-200411000-00040

[16] A Comparison of Trapeziectomy Via Anterior and Posterior Approaches. Journal of Hand Surgery (European Volume). 2008. DOI: 10.1177/1753193407087571

[17] Comparative study on the effectiveness of bone grafting for arthrodesis of the thumb carpometacarpal arthritis. Journal of Hand Surgery (European Volume). 2022. DOI: 10.1177/17531934221138917

[18] Rockwood And Green S Fractures In Adults. 42: Fractures of the Distal Radius and Ulna > Thumb CMC Joint Dislocation with Fracture.

[19] Rockwood And Green S Fractures In Adults. 42: Fractures of the Distal Radius and Ulna > Thumb CMC Joint Dislocation without Fracture.

[20] Comparison of Two Carpometacarpal Stabilizing Splints for Individuals with Thumb Osteoarthritis. Journal of Hand Therapy. 2009. DOI: 10.1016/j.jht.2009.07.014

[21] Comparison of 2 Postoperative Therapy Regimens After Trapeziectomy Due to Osteoarthritis: A Randomized, Controlled Trial. The Journal of Hand Surgery. 2022. DOI: 10.1016/j.jhsa.2021.08.015

[22] Comparison of Computed Tomography Articular Surface Geometry of Male Versus Female Thumb Carpometacarpal Joints. HAND. 2017. DOI: 10.1177/1558944716688528

[23] Comparison of arthrodesis and arthroplasty of Chinese thumb carpometacarpal osteoarthritis. Journal of Orthopaedic Surgery and Research. 2019. DOI: 10.1186/s13018-019-1469-2

[24] Three-Dimensional Quantitative Comparative Analysis of Trapezial-Metacarpal Joint Surface Curvatures in Human Populations. The Journal of Hand Surgery. 2012. DOI: 10.1016/j.jhsa.2011.09.007

[25] Total joint arthroplasty versus trapeziectomy for trapeziometacarpal joint arthritis: 5-year follow-up of a randomized controlled trial. Journal of Hand Surgery (European Volume). 2025. DOI: 10.1177/17531934251357456

[26] Comparison of Thompson Suspensionplasty Versus Pyrolytic Carbon Implant Hemiarthroplasty in the Treatment of Trapeziometacarpal Arthritis of the Thumb. The Journal of Hand Surgery. 2014. DOI: 10.1016/j.jhsa.2014.06.058

[27] Systematic Comparison of Ligament Reconstruction With Tendon Interposition and Suture-Button Suspensionplasty for Trapeziometacarpal Osteoarthritis. HAND. 2022. DOI: 10.1177/15589447211043217

[28] Green S Operative Hand Surgery. AUTHOR'S PREFERRED METHOD OF TREATMENT: ARTHROSCOPIC PARTIAL WRIST FUSION > Arthroscopic Examination of the Thumb CMC Joint.

[29] Green S Operative Hand Surgery. AUTHOR'S PREFERRED METHOD OF TREATMENT: ARTHROSCOPIC PARTIAL WRIST FUSION > Thumb CMC Joint Arthroscopic Portals.

[34] Comparison of the Anatomical Dimensions and Mechanical Properties of the Dorsoradial and Anterior Oblique Ligaments of the Trapeziometacarpal Joint. The Journal of Hand Surgery. 2014. DOI: 10.1016/j.jhsa.2014.02.025

[35] Re: Mailey et al. Comparison of provocative manoeuvres in diagnosing thumb carpometacarpal joint arthritis. J Hand Surg Eur. 2019, 44: 750–2.. Journal of Hand Surgery (European Volume). 2020. DOI: 10.1177/1753193419896247

[36] Total Arthroplasty Versus Trapeziectomy With Ligamentoplasty for Trapeziometacarpal Osteoarthritis: 5-year Outcomes. Clinical Orthopaedics & Related Research. 2025. DOI: 10.1097/corr.0000000000003404

[37] Comparison of Two Carpometacarpal Stabilizing Splints for Individuals with Thumb Osteoarthritis. The Journal of Hand Surgery. 2009. DOI: 10.1016/s0363-5023(09)60144-1

[39] Systematic Review of Thumb Carpometacarpal Joint Hemiresection Interposition Arthroplasty Materials. HAND. 2020. DOI: 10.1177/1558944720974124

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