Please confirm topic selection

Are you sure you want to trigger topic in your Anconeus AI algorithm?

Please confirm action

You are done for today with this topic.

Would you like to start learning session with this topic items scheduled for future?

Basilar Thumb Arthritis
Posted: Jan 11 2023 #(C102124)
A

Basilar Thumb Arthritis in 67F

HPI

A 67-year-old right-hand dominant female homemaker presents with a two-year history of right thumb CMC pain. The pain is worse with gripping and pinching. She has had multiple corticosteroid injections into the right thumb CMC joint in the past year with minimal improvement. She has tried anti-inflammatory medications and thumb spica bracing for the past three months, which have been only mildly helpful. She is currently limited in her daily activities as a result of this issue.

PMH

She has no significant past medical history and does not smoke or drink.

PE

Physical exam of the right arm shows a positive thumb CMC grind test, a negative Finkelstein maneuver, and full thumb ROM. Fingers are warm and well-perfused. Her sensation is intact to light touch in the median, ulnar, and radial nerve distributions. She has 5/5 strength in the abductor pollicis brevis, extensor pollicis longus, and intrinsic hand muscles.

Poll
1 of 12
1. In addition to AP and LAT radiographs of the thumb, would you obtain any additional imaging to guide your treatment?
No - AP and LAT radiographs are sufficient
67%
458/683
Yes - additional radiographs (aXR)
13%
92/683
Yes - CT scan of the hand (CT)
8%
59/683
Yes - MRI of the hand (MRI)
5%
39/683
Yes - aXR + CT
0%
5/683
Yes - aXR + MRI
0%
4/683
Yes - CT + MRI
0%
3/683
Yes - aXR + CT + MRI
0%
1/683
Outside my area of expertise - best if I don't vote
3%
22/683
2. Would you use a Classification system to guide your management?
No - a classification system would not help me
46%
298/643
Yes - Eaton and Littler classification
39%
256/643
Yes - Burton classification
2%
18/643
Yes - other
1%
8/643
Outside my area of expertise - best if don't vote
9%
63/643
3. If you choose to use the Eaton and Littler classification (Grade I-IV), how much does it help you determine treatment decisions?
I would not choose to use the Eaton and Littler classification
26%
161/615
Not helpful - It does not help me determine treatment
16%
100/615
Somewhat helpful - Somewhat helps guide treatment
41%
253/615
Very Helpful - I use it entirely to dictate my treatment
7%
44/615
Outside my area of expertise - best if I don't vote
9%
57/615
4. How would you treat this patient.
Nonoperative
16%
102/623
Operative
79%
495/623
Outside my area of expertise - best if I don't vote
4%
26/623
5. If choosing Nonoperative Treatment, would you perform injections?
I would not choose Nonoperative Treatment
42%
259/609
No, I would not perform injections
7%
48/609
Yes - Steroid Injections (ST)
30%
184/609
Yes - Hyaluronic acid injections (HA)
4%
28/609
Yes - Platelet Rich Plasma injections (PRP)
5%
32/609
Yes - Stem Cell Injections (SC)
0%
3/609
Yes - ST + HA
1%
12/609
Yes - ST + PRP
2%
14/609
Yes - ST + SC
0%
2/609
Yes - Other combination of above
0%
5/609
Outside my area of expertise - best if I don't vote
3%
22/609
6. If choosing Operative treatment, what Treatment would you perform?
I would not choose Operative treatment
1%
10/617
CMC Arthroscopic Debridement Alone
2%
13/617
Trapeziectomy (CMC arthroplasty) +/- Ligament reconstruction ALone
68%
424/617
Osteotomy of 1st Metacarpal Alone
0%
5/617
CMC Arthrodesis Alone
7%
46/617
CMC prosthetic arthroplasty Alone
11%
74/617
CMC Denervation Alone
0%
2/617
Outside my area of expertise - best if I don't vote
6%
43/617
7. If performing a Trapeziectomy (CMC arthroplasty) +/- ligament reconstruction, what technique would you do?
I would NOT choose Trapeziectomy (CMC arthroplasty) and/or ligament reconstruction
5%
30/579
Hematoma arthroplasty (trapezial resection without LRTI)
8%
49/579
Trapeziectomy + LRTI (ligament reconstruction and tendon interposition)
49%
284/579
Volar Ligament reconstruction with FCR
2%
17/579
Trapeziectomy with Suture suspension (suture suspension with APL to FCR)
24%
139/579
Outside my area of expertise - best if I don't vote
10%
60/579
8. If performing ligament reconstruction tendon insertion (LRTI), what technique would you do?
I would not perform Ligament Reconstruction
18%
96/526
Entire FCR tendon, drill through bone
16%
87/526
Half of FCR, drill through bone
37%
198/526
Entire APL, anchored to bone
3%
21/526
1 slip of APL, anchored to bone
7%
40/526
FCR to APL suture suspension
11%
62/526
All of the above
4%
22/526
9. If you choose Implant arthroplasty, what type would you perform?
I would not choose Implant arthroplasty
56%
293/515
Hemiarthroplasty
10%
53/515
Total joint arthroplasty
24%
128/515
Outside my area of expertise - best if I don't vote
7%
41/515
10. If you choose Hemiarthroplasty, what implant material would you utilize?
I would not choose Hemiarthroplasty
63%
320/502
Silicone
7%
39/502
Ceramic
3%
20/502
Polyethylene
3%
16/502
Pyrolytic Carbon
5%
30/502
Metal
5%
28/502
Outside my area expertise - best if I don't vote
9%
49/502
11. If you performed the operation listed and obtained the final construct shown, how would you immobilize the patient once the initial postoperative dressing was removed?
I would not choose Hemiarthoplasty
17%
82/480
No immobilization - soft dressing
10%
50/480
Thumb spica splint
35%
171/480
Removable thumb spica brace
18%
91/480
Thumb spica cast
12%
58/480
Outside my area of expertise - best if I don't vote
5%
28/480
12. If you performed the operation listed and obtained the final construct shown, at what time point would you allow patient-directed active thumb range of motion?
I would not choose Hemiarthroplasty
12%
57/464
<2 weeks
9%
42/464
2-4 weeks
32%
152/464
5-6 weeks
32%
150/464
7-8 weeks
6%
31/464
9-10 weeks
0%
2/464
11-12 weeks
0%
3/464
>12 weeks
0%
0/464
Outside my area of expertise - best if I don't vote
5%
27/464
PROCEDURE #1

Trapeziectomy with mini-tight rope /cortical button placement

Intra-procedure P1
icon
OUTCOMES
Post-procedure P1
Attach Treatment Poll
Treatment poll is required to gain more useful feedback from members.
Please enter Question Text
Please enter at least 2 unique options
Please enter at least 2 unique options
Please enter at least 2 unique options