Sun Michael, Yoshida Ryu, Tsai Eugene, Kulber David
Department of Orthopaedic Surgery, Cedars Sinai Medical Center, Los Angeles, Calif.
Division of Plastic and Reconstructive Surgery, University of Southern California, Los Angeles, Calif.
Plast Reconstr Surg Glob Open. 2023 Mar 13;11(3):e4877. doi: 10.1097/GOX.0000000000004877. eCollection 2023 Mar.
The radiographic staging of arthritic changes in the thumb carpometacarpal (CMC) joint is known to have poor correlation with pain level. This may be due to the limited ability of radiographs to evaluate degenerative changes. The purpose of this study was to examine the relationship between radiographic versus arthroscopic findings of thumb CMC and scaphotrapeziotrapezoidal (STT) joint arthritis.
Twenty patients with symptomatic thumb CMC arthritis underwent arthroscopy of thumb CMC and STT joints with concomitant synovectomy or arthroplasty depending on the degree of articular degeneration found. All patients had preoperative radiographs of the thumb CMC and STT joints. Radiographic degeneration was graded based on the Eaton-Glickel classification. Intraoperative arthroscopic images were reviewed and graded based on the Brown grading system.
At the thumb CMC joint, five patients had discordant radiographic and arthroscopic findings of arthritis. At the STT joint, one patient had discordant radiographic and arthroscopic findings of arthritis.
In comparing the two staging systems, we found a small subset of patients that demonstrated significant discrepancies. Clinical evaluation remains essential, and patients should be informed that radiographs may underestimate the actual severity of arthritis.
已知拇指腕掌（CMC）关节关节炎改变的影像学分期与疼痛程度相关性较差。这可能是由于X线片评估退行性改变的能力有限。本研究的目的是检查拇指CMC和舟大多角小多角（STT）关节关节炎的影像学与关节镜检查结果之间的关系。
20例有症状的拇指CMC关节炎患者接受了拇指CMC和STT关节镜检查，并根据发现的关节退变程度进行了滑膜切除术或关节成形术。所有患者术前均有拇指CMC和STT关节的X线片。根据伊顿-格利克尔分类对影像学退变进行分级。回顾术中关节镜图像并根据布朗分级系统进行分级。
在拇指CMC关节，5例患者的关节炎影像学和关节镜检查结果不一致。在STT关节，1例患者的关节炎影像学和关节镜检查结果不一致。
在比较这两种分期系统时，我们发现一小部分患者存在显著差异。临床评估仍然至关重要，并且应该告知患者X线片可能低估了关节炎的实际严重程度。
