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Stress View Radiograph in Normal and Arthritic Thumbs: The Effect of Intermetacarpal Angle and Load
Erin Kelly Campaigniac, MD; Chason Ziino, BA; Laura Ferraro, BA; Federico Martinez, MD; Travis Peterson, DO; Wenyun Yang, MS; Thomas Breen, MD; Marci Dara Jones, MD; University of Massachusetts
University of Massachusetts, Worcester, MA, USA

Introduction: Stress view radiographs can evaluate subluxation of the trapeziometacarpal (TM) joint and demonstrate laxity. This study aims to characterize the behavior of the normal and arthritic thumb TM joint with different applied load and intermetacarpal angle using the stress view radiograph

Methods:We recruited 41 volunteer subjects with no history of thumb pain, and 38 subjects with symptomatic thumb trapeziometacarpal arthritis. Each subject underwent stress view radiographs of bilateral thumb TM joints at 3 different intermetacarpal angles (IMA) and 3 different loads for a total of 9 views of bilateral hands. Articular width (AW) of the thumb metacarpal base, radial subluxation (RS) of the thumb metacarpal base on the trapezium, and the angle between the index and thumb metacarpals (IMA) were measured, and overhang ratio (RS/AW) was analyzed for each view. QuickDASH and Beighton Score, a measure of ligamentous laxity, were collected on all subjects.

Results:There were 30 female and 11 male normal subjects, with an average age of 45 years, and 38 female and 10 male symptomatic arthritis hands with an average age of 60 years. In the normal group, IMA was inversely related to overhang ratio, while increasing load and Beighton Score were directly and independently related. IMA maintained its inverse relationship with radial subluxation in the arthritis group. The effect of load was opposite that of the normal group, with higher load showing a trend towards a decreased ratio, and in the contralateral, asymptomatic, hand, this was significant. When comparing the normal and arthritis groups, the overhang ratios were significantly lower for the symptomatic hands across all IMAs and loads.

Conclusion: Trapeziometacarpal joint subluxation was more pronounced in normal hands than those with arthritis. Because of the theory that patients with joint laxity are more prone to arthritis, we hypothesized that the overhang ratios would be greater in the arthritic TM joints. We found, however, that TM subluxation was greater in the normal hands compared to those with arthritis despite IMA or applied load. This is likely due to decreased joint mobility within the arthritic TM joint. IMA and load have significant effects on TM joint subluxation in normal subjects. IMA is also inversely related to TM joint subluxation in the arthritis group, however the effect of load is less pronounced. This suggests that a standardized IMA should be sought in the stress view radiograph, but that a standardized load need not be applied.

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