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2014 ; 472
(12
): 3605-22
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The 2014 ABJS Nicolas Andry Award: The puzzle of the thumb: mobility, stability,
and demands in opposition
#MMPMID25171934
Ladd AL
; Crisco JJ
; Hagert E
; Rose J
; Weiss AP
Clin Orthop Relat Res
2014[Dec]; 472
(12
): 3605-22
PMID25171934
show ga
BACKGROUND: The paradoxical demands of stability and mobility reflect the purpose
and function of the human thumb. Its functional importance is underscored when a
thumb is congenitally absent, injured, or afflicted with degenerative arthritis.
Prevailing literature and teaching implicate the unique shape of the thumb
carpometacarpal (CMC) joint, as well as its ligament support, applied forces, and
repetitive motion, as culprits causing osteoarthritis (OA). Sex, ethnicity, and
occupation may predispose individuals to OA. QUESTIONS/PURPOSES: What evidence
links ligament structure, forces, and motion to progressive CMC disease?
Specifically: (1) Do unique attributes of the bony and ligamentous anatomy
contribute to OA? (2) Can discrete joint load patterns be established that
contribute to OA? And (3) can thumb motion that characterizes OA be measured at
the fine and gross level? METHODS: We addressed the morphology, load, and
movement of the human thumb, emphasizing the CMC joint in normal and arthritic
states. We present comparative anatomy, gross dissections, microscopic analysis,
multimodal imaging, and live-subject kinematic studies to support or challenge
the current understanding of the thumb CMC joint and its predisposition to
disease. RESULTS: The current evidence suggests structural differences and
loading characteristics predispose the thumb CMC to joint degeneration,
especially related to volar or central wear. The patterns of degeneration,
however, are not consistently identified, suggesting influences beyond inherent
anatomy, repetitive load, and abnormal motion. CONCLUSIONS: Additional studies to
define patterns of normal use and wear will provide data to better characterize
CMC OA and opportunities for tailored treatment, including prevention, delay of
progression, and joint arthroplasty.