Carpometacarpal and metacarpophalangeal joint collapse is associated with increased pain but not functional impairment in persons with thumb carpometacarpal osteoarthritis

Vicky Duong; Sarah R Robbins; Leticia A Deveza; Anne Wajon; Ray Jongs; Elisabet Hagert; David J Hunter

doi:10.1016/j.jht.2020.07.003

Carpometacarpal and metacarpophalangeal joint collapse is associated with increased pain but not functional impairment in persons with thumb carpometacarpal osteoarthritis

J Hand Ther. 2021 Oct-Dec;34(4):561-566. doi: 10.1016/j.jht.2020.07.003. Epub 2020 Jul 30.

Authors

Vicky Duong¹, Sarah R Robbins², Leticia A Deveza², Anne Wajon³, Ray Jongs⁴, Elisabet Hagert⁵, David J Hunter²

Affiliations

¹ Rheumatology Department, Royal North Shore Hospital; Institute of Bone and Joint Research, Kolling Institute of Medical Research, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia. Electronic address: vicky.duong@sydney.edu.au.
² Rheumatology Department, Royal North Shore Hospital; Institute of Bone and Joint Research, Kolling Institute of Medical Research, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia.
³ Macquarie University Clinic, Macquarie Hand Therapy, Macquarie University, New South Wales, Australia.
⁴ Physiotherapy Department, Royal North Shore Hospital, Sydney, New South Wales, Australia.
⁵ Karolinska Institutet, Department of Clinical Science and Education, Stockholm, Sweden; Arcademy, H.M. Queen Sophia Hospital, Stockholm, Sweden.

PMID: 32893101
DOI: 10.1016/j.jht.2020.07.003

Abstract

Introduction: Due to the complex shape of the carpometacarpal (CMC) joint, a fixed joint collapse deformity of the thumb CMC (CMC1) and metacarpophalangeal (MCP1) joint can present in advanced stages of CMC1 osteoarthritis (OA), resulting in adduction of the first metacarpal (MC1) and hyperextension of the MCP1.

Purpose of the study: To determine whether joint collapse deformity is associated with worse pain and/or functional impairment.

Study design: Cross-sectional.

Methods: This study used the baseline data from 140 patients enrolled in a longitudinal study of treatment for CMC1 OA. (efficacy of combined conservative therapies on clinical outcomes in patients with CMC1 OA). Joint collapse was determined at baseline using a pinch gauge. Pain was assessed on a visual analog scale (0-100) and function was assessed using the Functional Index for Hand Osteoarthritis questionnaire (0-30). Pain and function and the presence of joint collapse were entered in a univariate logistic regression. The final adjusted model for pain and joint collapse included age and sex. The final adjusted model for function and joint collapse included Kellgren Lawrence grade and grip strength.

Results: About 20% of participants demonstrated joint collapse on the tip-pinch test. The presence of joint collapse was associated with increased pain in the unadjusted [P = .047, OR = 2.45, 95% CI (1.01, 5.910)] and adjusted model [P = .049, OR = 2.45, 95% CI (1.00, 5.98)].

Conclusion: CMC1 patients with joint collapse reported increased pain compared with those without joint collapse. Future studies should determine the relationship between thumb hypermobility and joint collapse and how to manage these conditions effectively.

Keywords: Carpometacarpal; Hypermobility; Metacarpophalangeal; Osteoarthritis; Pain; Thumb.

MeSH terms

Carpometacarpal Joints*
Cross-Sectional Studies
Humans
Longitudinal Studies
Metacarpophalangeal Joint
Osteoarthritis* / complications
Osteoarthritis* / diagnosis
Pain
Thumb