The 2014 ABJS Nicolas Andry Award: The Puzzle of the Thumb: Mobility, Stability, and Demands in Opposition

• Published in: Clinical orthopaedics and related research Vol. 472; no. 12; pp. 3605 - 3622
• Main Authors: Ladd, Amy L., Crisco, Joseph J., Hagert, Elisabet, Rose, Jessica, Weiss, Arnold-Peter C.
• Format: Journal Article
• Language: English
• Published: Boston Springer US 01.12.2014; Lippincott Williams & Wilkins Ovid Technologies
• Subjects: Age Factors; Awards and Prizes; Biomechanical Phenomena; Carpometacarpal Joints - pathology; Carpometacarpal Joints - physiopathology; Conservative Orthopedics; Ethnic Groups; Female; Hand; Humans; Joint Instability - diagnosis; Joint Instability - ethnology; Joint Instability - etiology; Joint Instability - physiopathology; Male; Medicin och hälsovetenskap; Medicine; Medicine & Public Health; Motor Activity; Occupations; Orthopedics; Osteoarthritis - diagnosis; Osteoarthritis - ethnology; Osteoarthritis - etiology; Osteoarthritis - physiopathology; Range of Motion, Articular; Risk Factors; Sex Factors; Society Awards; Sports Medicine; Stress, Mechanical; Surgery; Surgical Orthopedics; Thumb - pathology; Thumb - physiopathology; Dense Subchondral Bone; Ulnar Collateral Ligament; Golf Swing; Thumb Motion; Thenar Muscle
• ISSN: 0009-921X; 1528-1132; 1528-1132
• DOI: 10.1007/s11999-014-3901-6

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.