Note originaleCotation clinique de l'opposition et de la contre-opposition du pouceClinical opposition and reposition test of the thumb
Résumé
La méthode de cotation de l'opposition et de la contre-opposition du pouce ici exposée ne fait intervenir aucune mesure d'angle, et son seul système de référence est la main elle-même. L'opposition peut se coter de 1 à 10 grâce au parcours par la pulpe du pouce de la « grande course d'oppositionsur la face externe de l'index, puis sur la pulpe des quatre autres doigts, pour finir par suivre la face palmaire de l'auriculaire jusqu'au pli palmaire inférieur. Le degré 1 correspond à l'opposition termino-latérale pouce-index, au niveau de la deuxième phalange ; l'opposition termino-terminale commence à 3 avec l'index, jusqu'à 6 avec l'auriculaire ; le degré 10 correspond au pli palmaire inférieur. La validité de cette mesure est le parcours de la « grande courseet non de la petite. La contre-opposition se mesure de 1 à 4, la main posée à plat sur une table. L'autre main posée sur son bord cubital servant de référence : le pouce, en écartement maximum, est soulevé activement au-dessus du plan de la table en regard de la base des quatre derniers doigts de l'autre main ; la cotation à 1 correspond à l'impossibilité de décoller le pouce du plan de la table ; pour la cotation 4, il s'élève jusqu'à la base de l'index. Cette manœuvre apprécie l'efficacité du long extenseur propre du pouce.
Summary
In order to test the opposition and the counter-opposition (reposition) of the thumb, the method proposed here does not require the measuring of angles ; rather, the hand itself is used as the system of reference. The opposition test consists of touching the four long fingers with the tip of the thumb : the score is 1 for the lateral side of the second phalanx of the index finger, 2 for the lateral side of the third phalanx, 3 for the tip of the index finger, 4 for the tip of the middle finger, 5 for the ring finger and 6 for the little finger. Then, moving the thumb proximally along the volar aspect of the little finger, the score is 7 when it touches the DIP crease, 8 on the PIP crease, 9 on the proximal crease of the little finger and 10 when it reaches the distal volar crease of the hand. This test is valid only if the first stages are possible : a crawling thumb in the palm is not an opposition motion. The counter-opposition test (or reposition test) needs the other hand as a reference system. The hand to be tested is set upon the table palm-down while ; the other hand is laid on the table on its medial side, close to the tip of the first hand thumb ; now this thumb is actively drawn up as high as possible. The upper point is noted by reference of the MP joints of the second hand : 1 for the MP joint of the little finger, 2 for the MP joint of the ring finger, 3 for that of the middle finger and 4 for that the index finger.
Références (8)
- DuchenneG.B. (de Boulogne)
Physiologie des mouvements
- DuparcJ. et al.
A propos des mouvements du premier métacarpien
Presse Méd
(1970) - DuparcJ. et al.
Approche biomécanique et cotation des mouvements du premier métacarpien
Rev Chir Orthop
(1971) - KapandjiA.
La rotation du pouce sur son axe longitudinal lors de l'opposition
Etude géométrique et mécanique de la trapézo-métacarpienne. Modèle mécanique de la main
Rev Chir Orthop
(1972)
Cited by (433)
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Long-term outcomes of trapeziectomy with Gore-Tex® ligament reconstruction for trapezio-metacarpal osteoarthritis
2024, Orthopaedics and Traumatology: Surgery and ResearchTrapezio-metacarpal osteoarthritis is a common condition for which the reference standard treatment after failure of non-operative measures is trapeziectomy. Several techniques have been devised to avoid proximal migration of the first metacarpal bone (M1) with impingement on the scaphoid bone. We have developed a Gore-Tex® ligament reconstruction technique that avoids potential complications of tendon harvesting. The objective of this study was to assess the long-term outcomes of this technique.
Trapeziectomy with Gore-Tex® ligament reconstruction is a reliable option for providing lasting pain relief in patients with trapezio-metacarpal osteoarthritis.
We conducted an observational, single-centre, single-surgeon, retrospective cohort study in consecutive patients managed by primary trapeziectomy. We excluded patients with revision trapeziectomy or less than 10 years’ follow-up. The primary outcome was event-free survival, defined as absence of revision surgery and of a numerical rating scale score for pain above 3/10. The secondary criteria were clinical tolerance of the Gore-Tex® implant and radiological changes. The patients were assessed at last follow-up either in person or during a teleconsultation.
Of 78 included joints, 54 were assessed during patient visits and 24 by teleconsultation. At 10 years, the event-free survival rate was 91.3%, and 60.3% of patients were free of pain. Evidence of osteolysis was visible in 24% of patients. No patient experienced clinical intolerance of the Gore-Tex® implant. The mean Disabilities of Arm, Shoulder and Hand score was 25.5. Metacarpo-phalangeal hyperextension was significantly increased, to 30.6°, and the mean trapezial space ratio was significantly decreased, to 39.1% of the baseline value.
Long-term event-free survival was high. Functional outcomes and pain were similar to previous reports. Trapeziectomy with Gore-Tex® ligament reconstruction obviates the need for tendon harvesting. Osteolysis developed in some patients but did not correlate with clinical intolerance. Long-term clinical and radiological monitoring is in order after Gore-Tex® implantation.
IV, Observational, single-centre, single-surgeon, retrospective cohort study.
Long-term outcomes of trapeziectomy with Gore-Tex® ligament reconstruction for trapezio-metacarpal osteoarthritis
2024, Revue de Chirurgie Orthopedique et TraumatologiqueLa rhizarthrose est une pathologie fréquente. La trapézectomie est le gold standard chirurgical après échec d’un traitement médical. Plusieurs techniques ont été décrites pour éviter l’ascension du premier métacarpien (M1) et l’apparition d’un conflit scapho-M1. Nous avons décrit une technique de ligamentoplastie au Gore-Tex® pour s’épargner un prélèvement tendineux potentiellement délétère. Nous analyserons les résultats de cette technique à l’aide d’une courbe de survie à long terme.
Étude rétrospective observationnelle monocentrique mono-opérateur. Les critères d’inclusion étaient la réalisation d’une trapézectomie de première intention. Les critères d’exclusion étaient la trapézectomie de reprise et le suivi inférieur à 10 ans. Le critère de jugement principal était la survie sans événement (reprise chirurgicale et/ou Echelle Numérique de douleur > 3). Les critères de jugement secondaires étaient la tolérance clinique du Gore-Tex® et l’évolution radiologique. Les patients ont été revus en consultation ou par télé consultation.
Cinquante-quatre patients ont été revus en consultation et 24 par télé consultation. La survie sans événement à 10 ans est de 91,3 %. La survie sans reprise à 10 ans est de 95 %. 60,3 % des patients sont indolores. Des signes d’ostéolyses sont retrouvés chez 24 %. Nous n’avons pas rapporté de mauvaise tolérance clinique du Gore-Tex®. Le Disabilities of Arm, Shoulder and Hand Score (DASH) moyen est de 25,5. L’hyperextension MP moyenne est de 30,6° et se majore de manière significative. L’index trapézien moyen est à 39,1 % de celui d’origine et diminue de manière significative.
La survie sans événement à long terme est importante. Les données recueillies sont semblables aux données de la littérature concernant la qualité fonctionnelle ou les douleurs. La trapézectomie avec ligamentoplastie au Gore-Tex® permet de s’affranchir d’un prélèvement tendineux. Il est à noter l’apparition d’ostéolyse dans une partie de la population. Elle n’est pas corrélée avec une mauvaise tolérance clinique. Il est nécessaire de surveiller l’évolution radiologique et clinique à distance après mise en place de Gore-Tex®.
IV, Etude observationnelle rétrospective monocentrique mono-opérateur.
Trapezio-metacarpal osteoarthritis is a common condition for which the reference standard treatment after failure of non-operative measures is trapeziectomy. Several techniques have been devised to avoid proximal migration of the first metacarpal bone (M1) with impingement on the scaphoid bone. We have developed a Gore-Tex® ligament reconstruction technique that avoids potential complications of tendon harvesting. The objective of this study was to assess the long-term outcomes of this technique.
We conducted an observational, single-centre, single-surgeon, retrospective cohort study in consecutive patients managed by primary trapeziectomy. We excluded patients with revision trapeziectomy or less than 10 years’ follow-up. The primary outcome was event-free survival, defined as absence of revision surgery and of a numerical rating scale score for pain above 3/10. The secondary criteria were clinical tolerance of the Gore-Tex® implant and radiological changes. The patients were assessed at last follow-up either in person or during a teleconsultation.
Fifty-four patients were assessed during patient visits and 24 by teleconsultation. At 10 years, the event-free survival rate was 91.3%, and 60.3% of patients were free of pain. Evidence of osteolysis was visible in 24% of patients. No patient experienced clinical intolerance of the Gore-Tex® implant. The mean Disabilities of Arm, Shoulder and Hand score was 25.5. Metacarpo-phalangeal hyperextension was significantly increased, to 30.6̊, and the mean trapezial space ratio was significantly decreased, to 39.1% of the baseline value.
Long-term event-free survival was high. Functional outcomes and pain were similar to previous reports. Trapeziectomy with Gore-Tex® ligament reconstruction obviates the need for tendon harvesting. Osteolysis developed in some patients but did not correlate with clinical intolerance. Long-term clinical and radiological monitoring is in order after Gore-Tex® implantation.
IV, Observational, single-centre, single-surgeon, retrospective cohort study.
Long-Term Results of Suture-Button Suspensionplasty in the Treatment of Thumb Carpometacarpal Arthritis: A Minimum 10-Year Follow-Up
2024, Journal of Hand Surgery Global OnlineCombined trapeziectomy and suture-button suspensionplasty (SBS) is a common and well-established surgical treatment for thumb carpometacarpal (CMC) osteoarthritis. Although short and mid-term follow-up studies have shown promising outcomes with patients retaining excellent range of motion and strength, long-term data are lacking. The aim of our study was to assess the long-term outcomes of patients who underwent SBS surgery for thumb CMC arthritis, with a minimum follow-up period of 10 years.
We evaluated 17 patients, at least 10 years after undergoing SBS surgery for thumb CMC arthritis. We measured grip and pinch strength, range of motion, and trapezial space height and compared it with the respective values measured on the routine postoperative 3-month follow-up visit. All patients have additionally completed the Quick Disabilities of the Arm, Shoulder, and Hand questionnaire.
The study included 11 women and 6 men with an average age of 60.3 ± 6.4 years and a mean follow-up of 137.4 ± 11.4 months after surgery. The mean Quick Disabilities of the Arm, Shoulder, and Hand score was 9 (range: 0–40.9) at the long-term follow-up, compared with 26.2 (range: 4.5–75) recorded 3 months after the surgery. Grip and pinch strengths were 116% and 111% of the 3-month postoperative value, respectively. Radial abduction and palmar abduction were 98% and 94% of the 3-month postoperative value, respectively. Kapandji scores were either equal or higher than the previously documented scores. Average height of the trapezial space was 69% of the previous postoperative measurement.
Our findings demonstrate that patients who underwent SBS surgery for thumb CMC osteoarthritis achieve excellent long-term outcomes by maintaining favorable subjective and objective results, despite some radiographic subsidence over time. These results indicate SBS to be an effective and durable technique for the long-term management of thumb CMC osteoarthritis.
Therapeutic IV.
Thumb basal joint arthritis in 2023
2024, Orthopaedics and Traumatology: Surgery and ResearchThumb carpometacarpal or basal joint arthritis is the second most common location for osteoarthritis in the hand. It mainly affects women over 50 years of age. Basal joint arthritis causes pain, loss of strength during pinch grips, and eventually stiffness and progressive deformity of the thumb column. Conservative treatment must be implemented first. It aims to spare the joint by using standardized methods. It must be initiated as soon as pain starts, not once the deformity has settled in. There is broad agreement that surgery is indicated when pain relief is not achieved after at least 6 months of conservative treatment. The available surgical techniques can be classified as joint-sparing (extra-articular) and joint-sacrificing (intra-articular). The former consists of trapeziometacarpal stabilizing ligament reconstruction, subtraction osteotomy of the first metacarpal and thumb carpometacarpal denervation. The latter consists of trapeziometacarpal fusion, trapeziectomy (and its variants) and implant arthroplasty. Except in very specific cases, trapeziectomy and trapeziometacarpal implant arthroplasty with a total joint prosthesis or an interposition implant are the two main surgical techniques for treating basal joint arthritis. After reviewing the pathophysiology and the diagnosis of thumb basal joint arthritis, we will provide an overview of the available treatment options, with emphasis on the accepted surgical strategies in 2023.
III.
Psychometric properties of body structures and functions measures in non-surgical thumb carpometacarpal osteoarthritis: A systematic review
2024, Journal of Hand TherapyMeasurement of treatment outcomes and change in health status over time is a critical component of clinical practice and research for people with osteoarthritis. Numerous clinical tools are used to assess the structures and function of the thumb in persons with thumb carpometacarpal osteoarthritis however their psychometrics have not yet been systematically explored.
The purpose of this study was to explore the psychometric properties of clinical tools used in persons with non-surgical thumb carpometacarpal osteoarthritis to objectively measure thumb structures and function, evaluate the quality of such studies, and subsequently make clinical and future research recommendations.
Systematic review.
A systematic search and screening was conducted across nine databases. Original research published between 2002 and 2022 that involved the assessment of psychometric properties (validity, reliability, precision, responsiveness, sensitivity, specificity, and minimal clinically important difference) of clinical tools were included. Sample characteristics, methods, and psychometric findings from each study were compiled. The methodological quality of included studies was evaluated using the COnsensus‐based Standards for the selection of health Measurement Instruments' checklist. Two independent researchers screened articles and assessed methodological quality and when not in agreement, a third party was consulted.
Eleven studies were included in the review. The mean age of all participants in the studies was 69 years of age. The study designs included prospective case–control, prospective cohort, and cross-sectional to determine the psychometric properties of the measurements and tools. The included studies examined techniques to assess range of motion, strength, and pain-pressure thresholds, and screen for arthritis (ie, provocative tests). The intermetacarpal distance method, Kapandji index, pain-pressure threshold test, and pain-free grip and pinch dynamometry demonstrate excellent reliability and acceptable precision. Metacarpal extension, adduction, and pressure-shear provocative tests have superior sensitivity and specificity and the extension and adduction tests have excellent reliability. Other assessments included in the review yielded less robust psychometric properties. Studies were of variable methodological quality spanning from inadequate to very good.
Based on the available literature on the psychometric properties of assessments of body structures and functions in persons with non-operative thumb carpometacarpal osteoarthritis, we offer a limited set of recommendations for use when screening for arthritis symptomology and measuring hand strength, thumb mobility, and pain thresholds. Additional psychometric research is needed in these domains as well as in dexterity, sensation, and objective measures of hand function. Future research should employ best practices in psychometric research.