A surgeon's opinion on thumb OA 💉

Trapeziometacarpal joint arthritis: A personal approach to its treatment. Davis, T. R. C. (2020) Level of Evidence: 5 Follow recommendation: 👍 Type of study: Therapeutic Topic: Thumb OA - Surgeon's point of view This is a surgeon's opinion on treatment of thumb osteoarthritis (OA). I particularly enjoyed the open minded approach that this surgeon has about thumb OA. They recognise the limitations of their own approach and they are ready to change their practice in light of new evidence, which will inevitably arise in the future. The approach suggested is to delay surgery (e.g. trapeziotomy) as much as possible. This is based on evidence suggesting that a limited proportion of the pain is correlated with radiographic findings and that a flare in pain may resolve within 6 months to a year. Furthermore, conservative treatments may help in the resolution or reduction of pain. More importantly, they recognise the significant impact of psychological factors in the exacerbation of pain (which is the driver for surgery) and the potential effect of other conservative interventions in the management of thumb OA. Cortisone injections are suggested as an additional treatment option. They report being happy to provide more than 3 injections if the benefits last for more than 6 months. A final point was made on the lack of evidence suggesting greater effectiveness of trapeziotomy alone vs trapeziotomy plus suspension arthroplasty. No differences have been identified between these approaches at short and long term in randomised controlled trials. Disclaimer: This publication was reviewed and assessed by one reviewer only and it reflects their interpretation. Readers should come to their own conclusions by reading the original article. Clinical Take Home Message: Based on what we know today, thumb OA should be initially treated conservatively. Conservative treatments should last between 6 to 12 months and consider other factors contributing to pain other than radiographic evidence of thumb OA. Psychological factors (e.g. anxiety, depression, pain catastrophising) have been shown to mediate pain/recovery and should be taken into account more than the degree of "degeneration" of the joint (up to 75% of people with radiographic evidence of thumb OA do not have pain). Have a look at conservative treatments for hand OA (e.g. manual therapy/exercise, illusory resizing, mental health component), we can make a difference! URL: https://journals.sagepub.com/doi/abs/10.1177/1753193420970343?journalCode=jhsc Available through EBSCO Health Databases for PNZ members. Abstract Many hand surgeons have fixed beliefs on how trapeziometcarpal (TMC) osteoarthritis should be treated. However, not all hand surgeons share the same fixed beliefs, so different factions of hand surgeons can hold contradictory beliefs. Many retain their fixed beliefs, rather than reconsidering them, when the best available evidence challenges them. The problem causing this heterogeneity of fixed beliefs is the lack of high-quality evidence that can withstand critical appraisal and cannot be ignored or simply dismissed by those with rigid contradictory beliefs. This article examines some of the dogmas surrounding the treatment of TMC osteoarthritis.


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