Beneficial Effects of Non-surgical Treatment for Symptomatic Thumb Carpometacarpal Instability in Clinical Practice: A Cohort Study

Publication date: Available online 11 October 2019

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Robbert M. Wouters, Harm P. Slijper, Lisa Esteban Lopez, Steven E.R. Hovius, Ruud W. Selles, Hand-Wrist Study Group

Abstract

Objective

To describe outcomes of non-surgical treatment for symptomatic thumb carpometacarpal (CMC-1) instability. Secondary, to evaluate the conversion rate to surgical treatment.

Design

Prospective cohort study

Setting

20 outpatient clinics for hand surgery and hand therapy in the Netherlands;

Participants

A consecutive sample of 431 patients with symptomatic CMC-1 instability;

Intervention

non-surgical treatment including exercise therapy and an orthosis

Main Outcome Measure(s)

Pain (Visual Analog Scale, VAS, 0-100) and hand function (Michigan Hand Questionnaire, MHQ 0-100) at baseline, 6 weeks and 3 months. Conversion to surgery was recorded for all patients with a median follow-up of 2.8 years (range 0.8-6.7y).

Results

VAS scores for pain during the last week, at rest and during physical load improved with a mean difference at 3 months of 17 [97.5% Confidence interval: 9:25], 13 [9:18] and 19 [12:27] respectively (p<0.001). No difference was present at 3 months for MHQ total score, but the subscales ADL, work, pain and satisfaction improved by 7 [1:14], 10 [4:16], 5 [2:9] and 12 [2:22] points respectively (p<0.001-0.007). After median follow-up of 2.8y, only 59 (14%) participants were surgically treated. Both in the subgroups that did and did not convert to surgery, VAS pain scores decreased at 3 months compared to baseline (p<0.001-0.010), whereas MHQ total score did not improve in both subgroups. However, VAS and MHQ scores remained worse for patients that eventually converted to surgery (p<0.001).

Conclusions

In this large sample of patients with symptomatic CMC-1 instability, non-surgical treatment demonstrated clinically relevant improvements in pain and aspects of hand function. Furthermore, after 2.8 years, only 14% of all patients were surgically treated, indicating that non-surgical treatment is a successful treatment of choice.

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