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Conservative treatment of thumb base osteoarthritis: a systematic review
Anne J Spaans1, L Paul van Minnen1, Moshe Kon1
1Department of Plastic, Reconstructive and Hand Surgery, University Medical Centre Utrecht, Utrecht; Department of Rehabilitation Medicine, Erasmus Medical Centre Rotterdam, Rotterdam; Xpert Clinic, Hilversum, The Netherlands.
Purpose:
To provide a systematic review of randomized controlled trials regarding the conservative treatment of thumb base osteoarthritis (OA).
Methods:
A systematic literature search was conducted in the electronic bibliographic databases Medline (Pubmed) and Embase (both starting year to May 2014) using predetermined criteria for studies on nonoperative treatment of thumb base OA.
Results:
Twenty-three articles fulfilled our inclusion criteria. Systematic evaluation demonstrated the following: (1) Hand therapy can possibly reduce pain. However, owing to the lack of good-quality (randomized controlled) trials with sufficient follow-up time, no proper conclusions can be drawn. (2) Although both steroid and hyaluronate intra-articular injections can provide pain relief, most authors conclude that injection of hyaluronate is more effective. Follow-up is rather short with a maximum of 12 months in 1 study. Furthermore, study comparison is hampered by heterogeneity of study design and outcome parameters. (3) The use of orthoses reduces pain without effect on function, strength, or dexterity. Included studies used various types of orthoses. Follow-up times varied (2 wk-7 y). (4) There is no justification for the use of transdermal steroid delivery. (5) There is insufficient evidence justifying the use of leech therapy. (6) There are no high-level evidence studies specifically evaluating the effect of analgesics and patient education in joint protection in patients with thumb base OA.
Conclusions:
There are only a few high-quality studies addressing the conservative treatment of trapeziometacarpal OA. Available evidence suggests only some effect of orthoses and intra-articular hyaluronate or steroid injections.
