Objective: To evaluate the best option among orthoses for carpometacarpal (CMC) osteoarthritis (OA) of the thumb, using a network meta-analysis.
Data Sources: Medline, Embase, Cochrane, and ClinicalTrials.gov registry databases were used. PubMed, Embase, Cochrane Controlled Trials Register, Cochrane, and other databases were used without language restrictions.
Study Selection: We searched randomized controlled trials (RCTs) on adults with OA of the thumb by studying any orthosis from the beginning to March 10, 2020.
Data Extraction: Data were extracted and checked for accuracy and completeness by pairs of reviewers. Outcomes were pain and function. Comparative treatment effects were analyzed by random-effects model for direct pairwise comparisons and Bayesian network meta-analyses to integrate direct and indirect evidence.
Data Synthesis: Eleven RCTs involving 619 patients were included. We evaluated 5 groups, for 4 different orthoses: short thermoplastic CMC splint (rigid CMC) (n=5), long thermoplastic carpometacarpal-metacarpophalangeal splint (rigid CMC-MCP) (n=7), short neoprene CMC splint (soft CMC) (n=1), long neoprene CMC-MCP splint (soft CMC-MCP) (n=5), and one as a control group (n=5). Our results show that all splints were superior to placebo to reduce pain intensity and the top-ranked intervention was the rigid CMC-MCP (surface under the cumulative ranking curve analysis [SUCRA], score: 65.4). In function evaluation, we report a 71.6 SUCRA for rigid CMC.
Conclusions: Although the current evidence is unclear on the use of the splint in OA of the thumb, it is not known which orthosis is more effective and whether the orthosis is more effective than other interventions. The network meta-analysis shows that a long thermoplastic splint it is the best choice for pain relief and the short thermoplastic CMC splint is the best treatment to increase function. These results may suggest initial treatment with a long rigid orthosis and then a short rigid orthosis.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1016/j.apmr.2020.06.012 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
How Accurate and Effective Are Non-image-guided Thumb Basal Joint Injections When Performed by Experienced Fellowship-trained Hand Surgeons?
Clin Orthop Relat Res
November 2024
Department of Orthopedic Surgery, Division of Hand Surgery, NYU Langone Health, New York, NY, USA.
Background: Corticosteroid injections are widely used for treating thumb carpometacarpal (CMC) arthritis, yet the accuracy of non-image-guided injections in expert hands is uncertain, with prior studies reporting intraarticular placement in about 60% of thumbs when performed by physicians with different levels of training. Despite their common use, there is a need to assess both the accuracy and the short-term clinical efficacy of these injections, particularly when performed without image guidance by fellowship-trained hand surgeons.
Questions/purposes: (1) What is the accuracy of thumb CMC injections performed without image guidance by fellowship-trained hand surgeons in an office setting? (2) What is the short-term efficacy of thumb CMC injections performed without image guidance?
Methods: We prospectively enrolled 33 patients with a mean ± SD age of 63 ± 12 years, 76% (25) of whom were female, with symptoms of basal joint arthritis that persisted despite conservative treatment, and we administered 1.
What Are the Most Clinically Effective Nonoperative Interventions for Thumb Carpometacarpal Osteoarthritis? An Up-to-date Systematic Review and Network Meta-analysis.
Clin Orthop Relat Res
November 2024
Academic Team of Musculoskeletal Surgery, Leicester General Hospital, Leicester, UK.
Article Synopsis
- Thumb carpometacarpal osteoarthritis (CMC-1 OA) is a common issue especially in older adults and women, and there's an increasing need for effective non-surgical treatment options as its prevalence rises.
- Previous research included two network meta-analyses on nonoperative interventions for CMC-1 OA but only focused on specific methods (splints and intraarticular injections), highlighting the gap for a comprehensive comparison.
- The study aimed to evaluate the effectiveness of various nonoperative treatments for CMC-1 OA by analyzing pain relief, functional improvement, and grip strength through a systematic review of 29 studies, ultimately including 22 trials for detailed comparison.
Selective Thumb Carpometacarpal Joint Denervation Versus Trapeziectomy and Ligament Reconstruction With Tendon Interposition for Painful Arthritis: A Prospective Study With 2 Years of Follow-Up.
J Hand Surg Am
September 2023
Department of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, MD. Electronic address:
Purpose: Thumb carpometacarpal (CMC) joint denervation is a relatively novel method for the management of osteoarthritis-associated pain by selective transection of articular nerve branches of the CMC joint. This study compared functional/patient-reported outcomes after CMC denervation with those after trapeziectomy and ligament reconstruction with tendon interposition (T + LRTI) over a 2-year follow-up period. We hypothesized that the outcomes of denervation and T + LRTI would be similar over the course of the study and at the final 2-year follow-up.
View Article and Find Full Text PDF[Instabilities of the Thumb Carpometacarpal Joint: Our Surgical Outcomes].
Acta Chir Orthop Traumatol Cech
March 2023
Univerzita Karlova, Lékařská fakulta v Hradci Králové, Ústav anatomie, Hradec Králové.
PURPOSE OF THE STUDY Carpometacarpal (CMC) instabilities of the thumb joint occur after injuries or due to joint overload in patients with congenital joint hypermobility. They are often undiagnosed and, if left untreated, are the basis for the development of rhizarthrosis in young individuals. The authors present the results of the Eaton-Littler technique.
View Article and Find Full Text PDFPyrocarbon Disc Interposition Arthroplasty (PyroDisk) for the Treatment of Carpometacarpal Thumb Joint Osteoarthritis.
JBJS Essent Surg Tech
October 2022
Department of Plastic, Reconstructive and Hand Surgery, Erasmus Medical Center, Rotterdam, the Netherlands.
Unlabelled: In cases of isolated carpometacarpal (CMC) thumb joint osteoarthritis, a hemitrapeziectomy can be performed. To address the risk of subsidence of the first metacarpal, a pyrocarbon disc has been designed as an interposition prosthesis. The disc is made of pyrolytic carbon with the same elastic modulus as cortical bone, making it resistant to wear from surrounding bone.
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!