Background: Conventional wisdom holds that hyperextension of the metacarpophalangeal joint of the thumb is secondary to degenerative subluxation of the trapeziometacarpal joint as occurs in osteoarthritis. We propose that a hypermobile metacarpophalangeal joint may have a causative role in the development of primary osteoarthritis at the base of the thumb by concentrating forces on the palmar aspect of the trapeziometacarpal joint.
Methods: Twenty fresh-frozen cadaveric forearm specimens were obtained post mortem from donors with no history of connective-tissue disease. Each specimen was categorized by its passive range of metacarpophalangeal joint motion. Testing was conducted with Fuji ultra-low-pressure‐sensitive film while the hand was in the lateral-pinch mode with the metacarpophalangeal joint in each of the following positions: unrestrained, pinned in neutral, pinned in 30° of flexion, and pinned in maximal hyperextension. Quantitative analysis of the trapezial contact surface at each of the metacarpophalangeal joint positions was performed, and the center of pressure was determined. Each specimen was then classified according to the extent of arthritic disease (nonarthritic, moderately arthritic, or affected by end-stage arthritis).
Results: In specimens affected by end-stage osteoarthritis, the center of pressure on the trapeziometacarpal joint moved dorsally by 56.8% of the length of the trapezial surface with metacarpophalangeal joint flexions of 30° (p < 0.01), whereas the corresponding values were 28.2% and 40.9% in the hyperextended and neutral metacarpophalangeal joint positions, respectively. In specimens with moderate osteoarthritis, 30° of metacarpophalangeal joint flexion also produced the most dorsal trapeziometacarpal center of pressure (44.8%); however, this center of pressure was not significantly different from the centers of pressure at the other metacarpophalangeal joint positions. In nonarthritic specimens, the center of pressure was again significantly more dorsal with metacarpophalangeal joint flexion of 30° than it was at the other positions (p < 0.01).
Conclusion: Metacarpophalangeal joint flexion effectively unloaded the most palmar surfaces of the trapeziometacarpal joint regardless of the presence or severity of arthritic disease in this joint.
Clinical Relevance: The presence of hyperextension laxity of the metacarpophalangeal joint may identify individuals who are predisposed to the development of arthritis of the trapeziometacarpal joint; such individuals might benefit from early intervention to stabilize the metacarpophalangeal joint and thus to retard the natural progression of osteoarthritic disease at the base of the thumb. Likewise, in symptomatic patients with a hypermobile metacarpophalangeal joint, fixation of the metacarpophalangeal joint in flexion by either splinting or surgical stabilization may alleviate basal joint symptoms by redirecting trapeziometacarpal joint forces away from the palmar compartment and onto the healthier dorsal aspect of the joint.
Mark J.R. Moulton, MD; Michael A. Parentis, MD; Matthew J. Kelly, MD; Christopher Jacobs, PhD; Sanjiv H. Naidu, MD, PhD; Vincent D. Pellegrini Jr., MD; Department of Orthopaedics and Rehabilitation, The Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA 17033. E-mail address for V.D. Pellegrini: email@example.com