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Discordance of preoperative imaging with intraoperative findings during thumb CMC arthroscopy
Margaret Szymanski, BS
1, Khusboo Desai, MD
2; Erin L Weber, MD, PhD
1(1)Indiana University, Indianapolis, IN, (2)Indiana University School of Medicine, Indianapolis, IN
Introduction: Arthritic pain at the thumb carpometacarpal (CMC) joint is common in women above 50 and typically treated with arthroplasty. However, management of young patients with thumb CMC pain and no evidence of arthritis is challenging. Arthroscopy and denervation of the thumb CMC joint may provide pain relief. The purpose of this study was to determine whether preoperative findings on Xray and MRI correlate with intraoperative findings during arthroscopy in young female patients with thumb CMC pain.
Materials and Methods: Six female patients (seven thumbs), age 22-44, with thumb CMC pain underwent arthroscopy with concomitant synovectomy and/or denervation, where indicated. Preoperative X-rays and MRIs were evaluated for arthritis, synovitis, trapezial slope (posteroanterior view) and first metacarpal bony offset (oblique view). Findings on imaging were compared to findings of arthritis and synovitis during arthroscopy. Pre- and post-operative visual analog (VAS) pain scores and demographics were collected.
Results:
Five of seven thumbs had no signs of arthritis on X-ray while one patient exhibited arthritic changes bilaterally. Four of the five patients without evidence of arthritis on X-ray underwent MRI for further evaluation; all were negative for arthritic changes and only one noted synovitis. MRI for one patient demonstrated a ganglion cyst at the CMC joint. Average trapezial slope and bony offset measured on X-ray were 146° and 3.51 mm, respectively, compared to published normal values of <135° and 0.79 mm.
All patients failed conservative management (splinting, steroid injection, NSAIDs) and chose to undergo thumb CMC arthroscopy. All underwent CMC denervation except the patient with the ganglion cyst.
Of the five patients without evidence of arthritis on imaging, one patient was noted intraoperatively to have mild arthritic changes. Moderate synovitis was observed in three of the five patients. Early postoperative outcomes have demonstrated mixed results, with an average improvement in VAS pain scores of 0.5 at 1-19 months postop. Fibromyalgia, autoimmune disease, and tobacco use were overrepresented comorbidities.
Conclusions:
- MRI did not provide further diagnostic value beyond X-ray for this cohort of young female patients with non-arthritic thumb CMC pain.
- Variable postoperative pain relief was observed following CMC arthroscopy with synovectomy and/or denervation.
- Elevated trapezial slope and bony offset may suggest an anatomical predisposition for thumb CMC pain.
- Fibromyalgia, autoimmune disease, and tobacco use may lessen effects of synovectomy and/or denervation.
- Limitations include the small cohort size. Future efforts will focus on the evaluation of additional patients over longer periods of follow-up.
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