Trapeziometacarpal Osteoarthritis : Patient-centered care: An understanding of the pathophysiology and treatment options

Abstract

The thumb is the most important “digit” of the hand. It provides approximately 40% of the hand function; mostly due to the unique and complex biomechanical function of the trapeziometacarpal (TMC) joint. Symptoms associated with TMC osteoarthritis likely fluctuate and generally regress to a mean baseline over time. It is important that patients understand this pattern and not solely decide when symptoms peak. We could recognize that radiographic severity is not a good predictor of symptoms and that these slowly progressive diseases are often misperceived as relatively new. Treatment of degenerative TMC osteoarthritis remains challenging. There are no disease modifying treatments, but patients can benefit from supportive (palliative) non-operative treatment options or can request operative treatment. The substantial variation in treatment recommendation seems mostly dominated by surgeon characteristics and preferences. The involvement of patients in the decision for treatment however – ‘shared decision making’ – is increasingly appreciated. It goes without saying that an accurate understanding of one’s illness is requisite to making decisions consistent with one’s values. Review of a web-based decision aid prior to the appointment with a hand surgeon – developed to present dispassionate information on current best evidence, including uncertainties – makes patients more comfortable with their decision. The goal of a decision aid is not to encourage any particular treatment. Rather, the goal is to reduce surgeon-to-surgeon variation; to be sure that treatment choice matches patient values instead of misconceptions or clinician bias. When surgery is requested, many surgical techniques have been described, without one surgical intervention being superior and about 4% of patients will undergo secondary surgery. The use of arthroscopic assisted techniques is still limited; however, it may be a reasonable option for patients with TMC osteoarthritis who do not respond to non-operative treatment. In addition, optimal mood and coping strategies have the potential to make recovery from surgery more comfortable, speed return to one’s routine, and limit dissatisfaction and subsequent treatments.