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BACKGROUND: Thumb carpometacarpal osteoarthritis is characterized by osteophyte growth and changes in the curvature of the articular surfaces of the trapezium and first metacarpal. The aim of this longitudinal study was to quantify in-vivo bone morphology changes with osteoarthritis progression. METHODS: The study analyzed an observational dataset of 86 subjects with early thumb osteoarthritis and 22 age-matched asymptomatic controls. CT scans of subjects’ affected hands were acquired at enrollment (year 0), and at 1.5, 3, 4.5, and 6-year follow-up visits. Osteoarthritic subjects were classified into stable and progressive groups, as defined by osteophyte volume and the rate of osteophyte growth. Trapezium height, width, and volar facet recession, along with first metacarpal volar beak recession and recession angle, were quantified. FINDINGS: Mean trapezium width increased 12% over six years in the progressive osteoarthritis group. Trapezium volar recession of the progressive osteoarthritis group was significantly greater than stable at enrollment (P < 0.0001) and year 6 (P < 0.0001). The first metacarpal volar beak of the progressive osteoarthritis group recessed significantly faster than stable (P = 0.0004) and control (P = 0.0003). In year 6, volar beak surfaces in subjects with progressive osteoarthritis were flatter with reduced curvature, measuring −8.7 ± 4.0 degrees, compared to the stable osteoarthritis (P < 0.0001) and control groups (P = 0.0003), which maintained nominal curvatures, measuring 0.7 ± 2.5 and 0.2 ± 3.2 degrees, respectively. INTERPRETATION: Our results demonstrate significant recession and reduction in the angle of the first metacarpal volar beak in progressive osteoarthritis. Flattening of the first metacarpal volar beak may have important associations with carpometacarpal joint contact and loading migrations, further propagating osteophyte formation and bony remodeling. This work highlights the volar beak of the first metacarpal as a region of morphology change with disease.

Internal consistency, construct, and criterion validity of the Patient-Reported Outcomes Measurement Information System (PROMIS) upper extremity (UE) v1.2 were evaluated in patients with early-stage carpometacarpal (CMC) osteoarthritis (OA). We hypothesized that in patients with early CMC OA, PROMIS UE scores would: (1) be lower than those in asymptomatic controls; (2) correlate with established patient-reported outcomes; (3) correlate with pinch and grip strengths; and (4) not correlate with radiographic disease progression.Patients with early CMC OA (modified Eaton stage 0 or 1) and matched asymptomatic control patients completed the PROMIS UE, Australian and Canadian Osteoarthritis Hand Index, and Patient-Rated Wrist-Hand Evaluation at 2 time points. The PROMIS UE's internal consistency was evaluated by Cronbach's alpha, construct validity by Spearman correlation coefficients among the patient-reported outcome measures, and criterion validity using measures of strength. A floor or ceiling effect was indicated if more than 15% of patients achieved the lowest or highest possible score.The PROMIS UE had high internal consistency. Patients with early CMC OA had a lower score than healthy controls (average, 42 vs 54, respectively). We observed moderate to high correlations between the PROMIS UEv1.2, Australian and Canadian Osteoarthritis Hand Index, and Patient-Rated Wrist-Hand Evaluation and good criterion validity when compared to key pinch and grip strengths. The PROMIS UE did not correlate to radiographic disease severity.The PROMIS UE had a high correlation with Australian and Canadian Osteoarthritis Hand Index and a moderate correlation with Patient-Rated Wrist-Hand Evaluation. The PROMIS UE had high internal consistency and good criterion validity.The PROMIS UE is a valid assessment for disability in patients with early CMC OA and can serve as a clinical adjunct to an outcome assessment.

Prior research has shown that Open Label Placebos (OLPs; that is, placebos described honestly as inactive pills) are effective for a variety of clinical conditions, including pain. However, little is known about patient attitudes towards OLPs. We conducted qualitative interviews with n = 11 patients (73% female) who recently had hand or wrist surgery and took ≥ 1 opioid pill. Interview topics included: pain management, the placebo effect, and in particular, attitudes towards OLPs. Interviews were analyzed inductively and content-coded. Five themes were identified: 1) Role of the mind in pain and illness, 2) Shortcomings of opioids are the strengths of OLPs, 3) Perceptions of OLP effectiveness, 4) Relational aspects of OLP administration, and 5) Practical considerations for OLP implementation. Most patients agreed that, because of their transparency, OLPs are ethical. Participants indicated some degree of reluctance about using OLPs, but the majority said they would take OLPs if prescribed by a doctor. Patients noted that the primary disadvantage of opioids is their potency, which can lead to addiction or side-effects; by contrast, the primary advantage of placebos is their inertness. Results suggest that OLPs appear to be well received as a postoperative pain treatment among the patients in this study. Perspective This qualitative study examines how hand surgery patients view OLPs, which are placebos described honestly as inactive pills. OLPs were generally well received by patients as a treatment for pain after surgery and could be considered as an adjunctive treatment to potentially reduce reliance on prescription opioids.

Reproduction of healthy wrist biomechanics should minimize the abnormal joint forces that could potentially result in the failure of a total wrist arthroplasty (TWA). To date, the in-vivo kinematics of TWA have not been measured and it is unknown if TWA preserves the healthy wrist kinematics. Therefore, the purpose of this in-vivo study was to determine the center of rotation (COR) for a current TWA design and to compare its location to the healthy wrist. The wrist COR for 6 patients with TWA and 10 healthy subjects were calculated using biplane videoradiography as the subjects performed various range-of-motion and functional tasks that included coupled wrist motions. An open-source registration software, Autoscoper, was used for model-based tracking and kinematics analysis. It was demonstrated that the COR was located near the centers of curvatures of the carpal component for the anatomical motions of flexion-extension and radial-ulnar deviation. When compared to healthy wrists, the COR of TWAs was located more distal in both pure radial deviation (p < 0.0001) and pure ulnar deviation (p = 0.07), while there was no difference in its location in pure flexion or extension (p = 0.99). Across all coupled motions, the TWA’s COR shifted more than two times that of the healthy wrists in the proximal-distal direction (17.1 mm vs. 7.2 mm). We postulate that the mismatch in the COR location and behavior may be associated with increased loading of the TWA components, leading to an increase in the risk of component and/or interface failure.

Objectives/Interrogation: We aim to establish a multidisciplinary consensus in developing a minimum core set of outcomes (COS) with research and clinical relevance for thumb carpometacarpal (CMC) osteoarthritis (OA). Comparative studies of treatment and clinical tools are lacking, since uniform[for full text, please go to the a.m. URL], 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)