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Journal of the Korean Society for Surgery of the Hand 2004;9(2):89-94.
Published online June 1, 2004.
Treatment of the Painful Unstable, Osteoarthritic Carpometacarpal Joint of the Thumb
Seung-Koo Rhee, Seok-Whan Song, Joo-Yup Lee, Young-Whan Suh,Yong-Hoon Kim
무지의 수근 중수 관절에 발생한 불안정 및 골성 관절염의 치료
이승구, 송석환, 이주엽, 서영완, 김용훈
Abstract
igament reconstruction (tendinoplasty) for the treatment of the painful unstable, osteoarthritic carpometacarpal joint of the thumb. Materials and Methods: From May of 1980 to 2003, 16 patients (17 thumbs) with thumb carpometacarpal arthritis, who underwent three different procedures were investigated. 8 cases classified as stage I & II according to Eaton & Littler’s staging system underwent ligament reconstruction using FCR half-slip. 9 cases classified as stage III & IV underwent carpometacarpal arthrodesis in 7 cases, and tendinoplasty in 2 cases. Postoperative results were assessed using visual analog pain score, grip & pinch strength, range of motion, radiographic progression of carpometacarpal arthritis. Results: The arthrodesis group had stronger grip & pinch strength than the other two groups. The ligament reconstruction and tendinoplasty group had wider range of motion than the arthrodesis group. Subjective evaluation of pain demonstrated that the arthrodesis group had better relief of pain from moderate to severe degree arthritis of the carpometacarpal joint. The tendinoplasty group had the worst results in terms of strength and pain relief. Scaphotrapezial arthritis developed in 2 patients in the arthrodesis group, and proximal migration of the thumb developed in 1 patient in the tendinoplasty group. Conclusion: In the early stages of CMC arthritis, ligament reconstruction can restore strength & stability of the thumb CMC joint and prevent progression of arthritis. In the late stages, arthrodesis is recommended to gain strength & pain relief, but should consider scaphotrapezial arthritis and hypermobility of the MP joint later. Tendinoplasty without ligament reconstruction gives inferior results in terms of strength and pain relief.
 


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