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Non-Surgical Treatment for Thumb Carpometacarpal Instability: Evaluating its Long-Term Durability
Niek J. Nieuwdorp, MSc
1, Isabel C. Jongen, MD
1, Ruud W. Selles, PhD
1, Robbert M. Wouters, PT, PhD
1, Thybout M. Moojen, MD, PhD
2, Caroline A. Hundepool, MD, PhD
1, The Hand Wrist Study Group, .
1,2; J. Michiel Zuidam, MD, PhD
1(1)Erasmus MC, Rotterdam, Netherlands, (2)Xpert Clinics, Amsterdam, Netherlands
Introduction: Thumb carpometacarpal (CMC) joint instability, typically resulting from ligament laxity, is most common in young females and can cause pain and reduced hand function. Although it can resemble early-stage osteoarthritis (Eaton-Glickel stage 1) in clinical presentation, CMC instability occurs in the absence of degenerative changes and should be regarded as a separate clinical condition requiring a distinct therapeutic approach, ranging from targeted hand therapy to stabilizing surgery. Initial management of CMC instability typically involves non-surgical treatment, such as splinting and targeted exercise therapy. While this approach has shown short-term effectiveness, its long-term outcomes remain unclear. Given the chronic nature of non-traumatic CMC instability, understanding long-term outcomes is crucial to provide patients and clinicians with better insight into the durability of nonoperative management. Therefore, this study aims to evaluate pain, functional limitations, and patient satisfaction during long-term follow-up after non-surgical treatment for non-traumatic CMC instability.
Material & Methods: This multicenter prospective cohort study included patients diagnosed with CMC instability who underwent hand therapy with or without an orthosis. The primary outcomes were pain and hand function, assessed at baseline, 3 months, 12 months, and long-term follow-up using the Visual Analogue Scale (VAS, 0-100). A linear mixed model was used to compare VAS scores at different time points.
Results: Out of 262 patients treated non-surgically, 42 (16%) proceeded to stabilizing surgery during the follow-up, with a median time to surgery of 4.2 months. The remaining 220 patients were included in the long-term analysis, with a median follow-up of six years (range 3.3-12.9 years). Mean VAS pain scores significantly improved from 50 (95% CI, 46-53) at baseline to 24 (95% CI, 20-28) at 12 months (p = .020) and remained stable over long term follow-up (p = 1.000). The mean VAS function score increased from 57 (95% CI, 54-60) at intake to 81 (95% CI, 76-85) at 12 months (p=.003), with no further changes at long-term follow-up (p=1.000). At long-term follow-up, 84% of patients reported they would choose to undergo the same treatment again.
Conclusions: Non-surgical treatment of CMC instability results in long-term improvements in pain and hand function, with high patient satisfaction and 84% of patients not requiring surgery. These results highlight the effectiveness and long-term durability of non-surgical treatment, strongly supporting its role as the first-line approach for managing non-traumatic CMC instability.
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