Outcomes of FCR Tenotomy and STT Debridement for STT arthritis
Marijke J DeVos, MD1, Saral J Patel, M.B.B.S, M.S.1, Sebastian D Arango, B.S.1, Adam B Strohl, M.D.1, David S Zelouf, MD2 and Andrew J. Miller, M.D.3, (1)Philadelphia Hand to Shoulder Center - Thomas Jefferson University, Philadelphia, PA, (2)Department of Orthopaedic Surgery, Philadelphia Hand to Shoulder Center - Thomas Jefferson University, Philadelphia, PA, (3)Orthopaedics, Philadelphia Hand to Shoulder Center – Thomas Jefferson University, Philadelphia, PA
Background:
Scaphotrapeziotrapezoid (STT) arthritis is present in 59% of all wrists that present to clinic for hand surgery evaluation and often is not associated with tenderness at the STT joint or with wrist pain (Wollstein 2012). However, flexor carpi radialis (FCR) tendinopathy presents with volar pain at the palmar wrist crease over the scaphoid tubercle and is thought to be secondary to STT osteoarthritis in some cases (Khan). In cases where patients have pain at the STT joint and along the FCR, FCR tenotomy with STT joint debridement is an effective treatment option. Here, we present a retrospective series of patients with STT osteoarthritis and FCR tendinopathy who failed conservative management and were treated with FCR tenotomy and STT joint debridement.
Methods:
Patients with FCR tenotomy and diagnoses of FCR tendinopathy, tendinosis, or tendonitis as well as STT osteoarthritis, were included for the study. Charts of 18 patients who met the study criteria, were reviewed for demographics, clinical and radiographic data.
Results:
Study included 6 male and 12 female patients with 65 (48-81) years as the median age at the time of surgery. The most common preoperative symptom was volar radial wrist pain (84.2%). White stage was Stage 1 in two wrists, Stage 2 in six wrists, Stage 3 in eight wrists. Jamar Grip strength percentage of contralateral, improved to 85.7% (46.2-115.4) from 75% (16.7-92.3%), n=12 wrists (p=0.0186). 12 patients with 13 operated wrists participated in a telephonic survey conducted at a median 16.6 (2.4-136.6) months post-surgery. Patients reported a median 90 (50-100) % improvement in pain. With regards to overall satisfaction with the surgery, patients felt slightly satisfied in 7 operated wrists, fully satisfied in 4, and neutral in 2. 10 out of 12 patients were willing to undergo the same surgery if needed. The median Q-DASH score improved from 40.91 (13.64-72.5) to 11.4 (0-20.5), n=6, p=0.0312. Time to return to work was 51 days (8-153). Only three complications were reported, one post op hematoma, one scar neuroma, and one dorsal radial sensory nerve neuritis.
Conclusion:
FCR tendinopathy associated with STT osteoarthritis may be effectively treated with FCR tenotomy and STT joint debridement. Patients may be immobilized for a shorter time and return to activities sooner with a procedure such as FCR tenotomy in comparison to other procedures such as STT arthroplasty or arthrodesis, distal pole of scaphoid excision, or trapeziectomy and partial trapezoidectomy with a lower complication rate.
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