CMC Arthritis
Conditions
Brief summary
Background: The thumb (or first) carpometacarpal (CMC) joint is commonly affected by osteoarthritis. Literature has reported a prevalence of 15% in women and 7% in men. First CMC joint osteoarthritis can present with decreased grip strength, pain, instability and inability to engage in routine daily activities. Definitive management is with surgery, however these are associated with known risks and increased weight times for the patient. First CMC joint denervation surgery is supported in the literature as a safe and effective approach to treat pain, strength, and thumb opposition which still allows for definitive surgery to be performed later if the arthritis progressed or if the pain returned later after the surgery. Objectives: (1) evaluate the effectiveness of the neurectomy in patients with with CMC arthritis with respect to pain relief, functional parameters, and Quick disabilities of the arm, shoulder and hand (QuickDASH) scores; (2) to determine whether pain relief with selective nerve blocks are predictive of the outcome of the combined neurectomy; and (3) to determine whether improvement in grip strength following selective blocks is predictive of final grip strength and outcome following neurectomy. Methods: Patients referred to the plastic surgery clinic for assessment of symptomatic first CMC joint osteoarthritis will be provided options for standard treatment or denervation procedure. Patients who agree to denervation will undergo local anesthetic block at their initial consult. At their initial consultation as well as at the 2-week, 3-month, 6-month, 12-month and 24-month post-surgical follow-up, patients will complete a QuickDASH, Kapandji score, pain scores, 2-point discrimination and grip/key/3-point strength measurements. The total patient population included in this study will be 60 patients.
Interventions
OTHERWrist denervation procedure
To summarize, a Wagner incision is made starting over the junction of the glabrous and non-glabrous skin overlying the thumb CMC joint extending toward the distal wrist crease. The branches of the superficial radial nerve are identified as lying perpendicular to the plane overlying the fascia of the thenar muscles. The branches of the lateral antebrachial cutaneous nerve are identified and resected within the anatomic snuffbox deep to the first compartment. Finally, the thenar muscle fibers are divided at their proximal origin to identify the articular branches of the posterior cutaneous branch of the median nerve.
Sponsors
University of Calgary
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Radiographic Eaton stage 2 or 3 1st carpometacarpal joint arthritis * Failed medical management, requesting surgical intervention
Exclusion criteria
* Pediatric population * Eaton stage 1 or 4 * Medically unfit for procedure
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Pain outcomes from neurectomy | 2 years | Participants will have their pre-operative pain scores compared to their post-operative denervation procedure evaluated with a QuickDASH questionnaire. This form will be completed at pre-operative visits and each follow-up appointment. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Selective nerve block pain predictions | 2 years | Number of participants with changes in pain with pre-operative selective nerve blocks evaluated on the Quick DASH questionnaire will be compared to the scores on the same questionnaire following the denervation procedure at each follow-up visit. |
| Selective nerve block grip strength predictions | 2 years | Participants will have grip strength measurements with pre-operative selective nerve blocks evaluated by the key-pinch and 3-point strength tests will be compared to the grip strength measurements at each follow-up visit following the denervation procedure on the same scale. |
Contacts
Primary ContactAlexander Platt, MD
Outcome results
None listed