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Midcarpal and STT arthritis in patients with CMC arthritis
Evan Katzel, MD1; Deidre Bielicka, MD1; John R. Fowler, MD1; Glenn A. Buterbaugh, MD2; Joseph E. Imbriglia, MD2
1UPMC, Pittsburgh, PA; 2Hand & Upper Ex Center, Pittsburgh, PA

Background: CMC (carpometacarpal) arthroplasty provides well-documented pain relief with preservation of thenar function for the treatment of basal joint arthritis. Nevertheless, a segment of the population undergoing this procedure will continue to have pain following surgery. In addition to documented basal joint arthritis, the authors of this study hypothesize that some of these patients also suffer from unrecognized midcarpal arthritis. The prevalence of midcarpal arthritis in patients with basal joint arthritis is unknown. The goal of this study is to establish the prevalence of midcarpal arthritis in patients with CMC arthritis and/or STT arthritis. This data will allow hand surgeons to better prepare patients for the possibility of incomplete pain relief following CMC arthroplasty.
Methods: Patients with basal joint arthritis were identified using CPT code 716.94. Hand and wrist x-rays were retrospectively reviewed and graded using the Eaton, and Sodha classification for CMC arthritis. STT (scaphotrapezotrapezoidal) arthritis and midcarpal arthritis were graded using the Sodha classification for arthritis as follows, grade 1: no or nearly no arthrosis, grade 2: definite arthrosis but not severe, grade 3: severe arthrosis.
Results: 896 x-rays were reviewed. At the CMC joint, the average Eaton score was 3.14 ± 0.03 (mean± SEM) and the average Sohda score was 2.51 ± 0.02. The mean Sohda score at the STT joint was 1.90 ± 0.03 for a 64% prevalence of STT arthritis in this population. The mean Sohda score at the midcarpal joint was 1.30 ± 0.02 for a 23.5% prevalence of midcarpal arthritis in this population. For patients with an Eaton CMC grade of 1, the mean midcarpal Sodha score was 1.06 ± 0.03; for patients with an Eaton CMC grade of 2, the mean midcarpal Sodha score was 1.08 ± 0.02; for patients with an Eaton CMC grade of 3, the mean midcarpal Sodha score was 1.11 ± 0.03; and for patients with an Eaton CMC grade of 4, the mean midcarpal Sodha score was 1.47 ± 0.03 (Pearson Chi square value: 95.3, p < 0.001).
Conclusions: The prevalence of midcarpal arthritis in patients with basal joint arthritis is 23.5%. The presence of two types of pathology may explain persistent hand and wrist pain in this population despite CMC arthroplasty. Clinically, this data will allow hand surgeons to better educate patients with basal joint and midcarpal arthritis regarding the possibility of incomplete pain relief following CMC arthroplasty.


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