RESUMEN
BACKGROUND: Thumb orthoses have to reconcile and satisfy competing goals: stability and mobility. The purpose of the study was to characterize the stabilization effectiveness and functionality of different thumb carpometacarpal osteoarthritis orthoses. METHODS: Eighteen female carpometacarpal osteoarthritis subjects were included. Four orthoses were compared: BSN medical (BSN); Push braces (PUSH); Sporlastic (SPOR); and medi (MEDI). Three-dimensional thumb kinematics during active opposition-reposition with and without orthosis was quantified. Ranges-of-motion of the carpometacarpal and metacarpophalangeal joint in x- (flexion-extension), y- (adduction-abduction) and z-direction (pronation-supination) were determined. Hand functionality was examined by Sollerman test. FINDINGS: All orthoses restricted carpometacarpal range-of-motion in all directions. In x-direction carpometacarpal range-of-motion was smallest with MEDI and BSN, in y-direction largest with PUSH compared to all other orthoses, in z-direction smaller with BSN and MEDI compared to PUSH, but similar to SPOR. All orthoses restricted metacarpophalangeal range-of-motion in x-direction, except PUSH. In x-direction metacarpophalangeal range-of-motion was smallest with MEDI compared to all other orthoses. In y-direction and z-direction only BSN and MEDI restricted metacarpophalangeal range-of-motion. Sollerman score was highest with PUSH, lowest with MEDI and both differed from other orthoses. Values for BSN and SPOR were similar and lay between PUSH and MEDI. INTERPRETATION: Stabilization is borne by functionality. The high stabilization effectiveness provided by MEDI resulted in lowest hand functionality. PUSH, which partially stabilized the CMC joint and allowed large motions in the MCP joint, afforded largest hand functionality. Best compromise of stability and functionality could be reached with BSN. Long-term studies are needed to monitor clinical efficacy.
Asunto(s)
Articulaciones Carpometacarpianas/fisiopatología , Aparatos Ortopédicos/normas , Osteoartritis/rehabilitación , Pulgar/fisiopatología , Anciano , Fenómenos Biomecánicos , Tirantes , Terapia por Ejercicio , Femenino , Mano/fisiopatología , Humanos , Persona de Mediana Edad , Osteoartritis/fisiopatología , Rango del Movimiento Articular/fisiologíaRESUMEN
PURPOSE: To investigate the influence of trapeziometacarpal (TMC) osteoarthritis (OA) on the 3-dimensional motion capability of the TMC and thumb metacarpophalangeal (MCP) joints. In order to examine other factors affecting the thumb's motion kinematics, we further aimed to address the influence of sex and handedness on the motion capability of normal TMC and MCP joints. METHODS: We included 18 healthy subjects (9 women, 9 men; 8 dominant hands, 10 nondominant hands) and 18 women with stage II/III TMC OA. A motion analysis system using surface markers was used to quantify the thumb's 3-dimensional opposition-reposition kinematics. The range of motion of the thumb's TMC and MCP joints in flexion-extension, abduction-adduction, and pronation-supination were determined. RESULTS: TMC OA led to a loss in abduction-adduction in the TMC joint (38° in controls, 26° in TMC OA subjects), although neither flexion-extension nor pronation-supination were affected. At the MCP joint, the TMC OA subjects showed a 48% reduction in abduction-adduction (32° controls, 16° TMC OA subjects) and 42% reduction in pronation-supination (34° in controls, 20° in TMC OA subjects) than the healthy controls. Ranges of motion of the healthy TMC and MCP joints were similar in dominant and nondominant hands as well as in women and men. DISCUSSION: The study demonstrated that stage II/III TMC OA restricts the motion of the TMC joint in abduction-adduction and of the MCP joint in abduction-adduction and pronation-supination. Thumb motion capability was unaffected by sex and handedness. CLINICAL RELEVANCE: Osteoarthritis-induced loss of TMC motion did not reflect a generalizable clinical parameter, rather, it seemed to distinctly affect the TMC and the MCP joints and their motion planes and directions. As neither sex nor handedness influenced the motion capabilities of the healthy thumb, kinematic factors contributing to TMC OA may develop at a later age.