cmc1 clumsy
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Finsen V, Wold CB, Russwurm H,
CLUMSINESS. A COMPLICATION OF TRAPEZIECTOMY FOR ARTROSIS OF THE BASAL JOINT OF THE THUMB?
J Hand Surg (Eur) 2015; 40: 326 DOI:10.1177/1753193414567828
Dear Sir,
In a
recent follow-up review of 45 patients (49 hands) treated by simple
trapeziectomy for osteoarthritis of the trapeziometacarpal joint carried out 26
(range 15 to 26) months after surgery, 20 of the patients (21 hands)
reported that the hand was clumsier than before the operation, when
specifically asked about this symptom. They had trouble doing activities such
as threading a needle, sewing, buttoning a blouse or shirt, turning over the
pages of a newspaper, or picking up small objects. On a scale from 0 to 10
these patients reported a mean value of 6.5 (SD 2.0) for their current
clumsiness, compared to 0.8 (SD 2.4) for remembered pre-operative clumsiness. The figures for those who did not complain of
clumsiness were 0.6 (SD 1.1; p<0.0001) at review compared to 1.4 (SD 2.7;
n.s.) before operation. At review the mean Quick-DASH scores was 33 (SD 20) for
those who complained of clumsiness and 18 (SD 20; p=0.02) for those who did
not. The corresponding PRWHE scores were 34 (SD 24) and 13 (SD 17; p=0.001).
Mean loss of key pinch strength compared to the opposite hand was 31% (SD 28%)
among those with clumsiness and 11% (SD 25%; p=0.01) among those without. The
corresponding figures for loss of grip strength were 13% (SD 18%) and a mean
gain of 3% (SD 23%; p=0.01). Eight patients stated that they would not have
consented to surgery if they had known the outcome in advance. Seven of them were
among those who complained of clumsiness after the operation. We have not seen
other reports of this complication after surgery for basal joint arthritis. It
is possible that it is a spurious finding among our patients, but this seems
unlikely. We draw attention to this symptom to encourage others who are doing
longer term follow-ups of operations for osteoarthritis of the basal joint of
the thumb to ask patients about it, to see whether it is a common complaint and
whether or not it is specific to simple trapeziectomy.”
Yours faithfully
Vilhjalmur
Finsen1,2,
Cecilie
Bendiksen Wold1,
Harald
Russwurm1
1Department of Orthopaedic Surgery, St.
Olav’s University Hospital
2Faculty of Medicine, Norwegian University of
Science and Technology
Trondheim,
Norway