Abstract
Objective
To describe outcomes of nonsurgical treatment for symptomatic thumb carpometacarpal
joint (CMC-1) instability. Secondary, to evaluate the conversion rate to surgical
treatment.
Design
Prospective cohort study.
Setting
A total of 20 outpatient clinics for hand surgery and hand therapy in the Netherlands.
Participants
A consecutive sample of patients with symptomatic CMC-1 instability (N=431).
Intervention
Nonsurgical treatment including exercise therapy and an orthosis.
Main Outcome Measures
Pain (visual analog scale [VAS], 0-100) and hand function (Michigan Hand Outcomes
Questionnaire [MHQ], 0-100) at baseline, 6 weeks, and 3 months. Conversion to surgery
was recorded for all patients with a median follow-up of 2.8 years (range, 0.8-6.7y).
Results
VAS scores for pain during the last week, at rest, and during physical load improved
with a mean difference at 3 months of 17 (97.5% CI, 9-25), 13 (97.5% CI, 9-18), and
19 (97.5% CI, 12-27), respectively (P<.001). No difference was present at 3 months for MHQ total score, but the subscales
activities of daily living, work, pain, and satisfaction improved by 7 (97.5% CI,
1-14), 10 (97.5% CI, 4-16), 5 (97.5% CI, 2-9), and 12 (97.5% CI, 2-22) points, respectively
(P<.001-.007). After median follow-up of 2.8 years, only 59 participants (14%) were
surgically treated. Both in the subgroups that did and did not convert to surgery,
VAS pain scores decreased at 3 months compared with baseline (P<.001-.010), whereas MHQ total score did not improve in both subgroups. However, VAS
and MHQ scores remained worse for patients who eventually converted to surgery (P<.001).
Conclusions
In this large sample of patients with symptomatic CMC-1 instability, nonsurgical treatment
demonstrated clinically relevant improvements in pain and aspects of hand function.
Furthermore, after 2.8 years, only 14% of all patients were surgically treated, indicating
that nonsurgical treatment is a successful treatment of choice.
Keywords
List of abbreviations:
ADL (activities of daily living), CMC-1 (thumb carpometacarpal joint), MHQ (Michigan Hand Outcomes Questionnaire), OA (osteoarthritis), VAS (visual analog scale)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: October 11, 2019
Footnotes
Supported by Handtherapie Nederland, Xpert Clinic, and Erasmus MC.
Disclosures: none.
Identification
Copyright
© 2019 by the American Congress of Rehabilitation Medicine
