O'Brien Virginia, Johnson Jennifer, Pisano Katie, Enke Ashley
Department of Rehabilitation and Orthopedics, University of Wisconsin Hospitals and Clinics, Madison, WI, USA.
M Health Fairview Hand Therapy, Minneapolis, MN, USA.
J Hand Ther. 2022 Jul-Sep;35(3):388-399. doi: 10.1016/j.jht.2022.06.007. Epub 2022 Aug 16.
Expert opinion INTRODUCTION: Thumb carpometacarpal joint (CMC) osteoarthritis is a common condition seen in the hand therapy clinic. Prevalence is generally higher in females, and the percentage rises for post-menopausal females. Patients typically present with pain and functional difficulties. Conservative management is recommended before a surgical consult. Evidence is mounting that a dynamic stability modeled approach has a significant effect on pain and improving function.
The purpose of this paper is two-fold: first, to present the history and development of a dynamic stabilization model for treatment of the patient with thumb CMC osteoarthritis (OA), and second, to provide expert clinical commentary and recommendations for the treatment of thumb CMC OA in light of the best available evidence.
Expert clinical commentary is based on an extensive review of relevant literature.
The current literature and expert opinion supports an evidence-informed multimodal intervention: modalities, pain relief techniques, manual release, joint mobilizations as deemed necessary, neuromuscular re-education through proprioceptive exercises, and education in joint protection principles.
A rationale for a dynamic stabilization approach is presented. The unique anatomy of the thumb deserves finely tuned care based on high quality research. To advance our knowledge and clinical skills we must not become stagnant, but continue to generate high level evidence. The standard for future thumb CMC OA studies should be well-defined intervention parameters, consistent documentation, and the use of appropriate patient-rated outcome measures.
专家意见
拇指腕掌关节（CMC）骨关节炎是手部治疗诊所中常见的病症。女性的患病率通常更高，绝经后女性的患病率上升幅度更大。患者通常表现为疼痛和功能障碍。建议在进行手术咨询前先进行保守治疗。越来越多的证据表明，动态稳定性模型方法对疼痛和功能改善有显著影响。
本文的目的有两个：第一，介绍用于治疗拇指CMC骨关节炎（OA）患者的动态稳定模型的历史和发展；第二，根据现有最佳证据，为拇指CMC OA的治疗提供专家临床评论和建议。
专家临床评论基于对相关文献的广泛回顾。
当前文献和专家意见支持基于证据的多模式干预：根据需要采用各种治疗方法、疼痛缓解技术、手法松解、关节松动术、通过本体感觉训练进行神经肌肉再教育以及关节保护原则教育。
提出了动态稳定方法的基本原理。拇指独特的解剖结构需要基于高质量研究进行精细护理。为了提升我们的知识和临床技能，我们不能停滞不前，而必须继续产生高水平的证据。未来拇指CMC OA研究的标准应该是明确的干预参数、一致的记录以及使用适当的患者自评结局指标。
