Midcarpal and STT Arthritis in Patients with CMC Arthritis
Evan B. Katzel, MD, Dierde Bielicka, MD, John Fowler, MD, Glenn A. Buterbaugh, MD, Joseph E. Imbriglia, MD.
UPMC, Pittsburgh, PA, USA.
A segment of the population undergoing Carpometacarpal (CMC) arthroplasty will continue to have pain following surgery. The authors hypothesize that unrecognized midcarpal (capitolunate) arthritis may contribute to persistent pain after CMC arthroplasty. The prevalence of midcarpal arthritis in patients with basal joint arthritis is unknown. The purpose of this study is to establish the radiographic prevalence of midcarpal arthritis in patients with CMC arthritis and/or STT (scaphotrapezotrapezoid) arthritis.
Patients with CMC arthritis were identified from a billing search using ICD-9 code 716.94. Hand radiographs were graded using the Eaton classification and Sodha classification for CMC arthritis. STT arthritis and midcarpal arthritis were graded using the Sodha classification for arthritis as follows: grade 1: no or nearly no arthrosis, grade 2: definite arthrosis but not severe, grade 3: severe arthrosis.
896 AP x-rays were reviewed. At the CMC joint, the average Eaton score was 3.14±0.03 (mean±SEM) and the average Sohda score was 2.51±0.02. The prevalence of STT arthritis was 64% and the mean Sohda score at the STT joint was 1.90±0.03. The prevalence of midcarpal arthritis was 24% and the mean Sohda score at the midcarpal joint was 1.30±0.02.
The prevalence of midcarpal arthritis in patients with CMC arthritis is 24%. The presence of two locations of arthritis may explain persistent hand and wrist pain in this population despite CMC arthroplasty. Clinically, this data will allow hand surgeons to better educate patients with CMC and midcarpal arthritis regarding the possibility of incomplete pain relief following CMC arthroplasty.
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