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Rhizarthrose

Kennzeichen des Früh- und Spätstadiums

CMC I osteoarthritis

Characteristics in early and advanced stages

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Obere Extremität Aims and scope Submit manuscript

Zusammenfassung

Hintergrund

Die Rhizarthrose ist eine fortschreitende Erkrankung, die nach röntgenologischen Kriterien in 4 Stadien eingeteilt wird. Klinisch korrelieren die Röntgenbefunde häufig nicht mit der bestehenden Symptomatik der betroffenen Patienten. In der vorliegenden Studie wurden Patienten mit einem Früh- und Spätstadium der Rhizarthrose verglichen und die klinische Symptomatik sowie konventionelle Röntgenaufnahmen einer erweiterten MRT-Untersuchung gegenübergestellt.

Material und Methoden

Untersucht wurden 12 Patienten mit symptomatischer Rhizarthrose, 6 Patienten mit Stadium I nach Eaton/Littler vs. 6 Patienten mit Stadium III nach Eaton/Littler. Die standardisierte klinische Untersuchung wurde ergänzt durch eine 3-Tesla-MRT-Akquisition des Daumensattelgelenks in 4 Untersuchungspositionen des Daumens: Extension, Flexion, Abduktion, Adduktion. Beurteilt wurden 4 Ligamente, die dorsale und radiale Translation des 1. Mittelhandknochens (MHK I) sowie die Größe und Lokalisation von Osteophyten.

Ergebnisse

Belastungsschmerzen und Kraftverlust sind Kennzeichen beider Stadien der Rhizarthrose. Bandläsionen betreffen v. a. das vordere Schrägband (AOL), nicht nur bei Patienten im Stadium III nach Eaton/Littler, sondern auch bereits in früheren Stadien der Rhizarthrose. Bei weiter fortgeschrittener Arthrose ist eine vergrößerte Translationsbewegung des MHK I nach dorsal erkennbar. Osteophyten > 2 mm treten v. a. radial sowie ulnar am Os trapezium auf.

Schlussfolgerung

Die Röntgendiagnostik des Daumensattelgelenks erfasst nicht die bereits im Frühstadium der Rhizarthrose vorhandenen Bandläsionen. Dies ist insbesondere bei gelenkerhaltenen Operationsverfahren zu berücksichtigen. Zunehmende Häufigkeit und Kombinationen von Bandläsionen, aber auch eine dorsale Translation des MHK I, nicht eine radiale, sind Kennzeichen der fortgeschrittenen Rhizarthrose.

Abstract

Backround

Osteoarthritis of the first carpometacarpal joint (CMC I) is a progressive disease that is classified into four stages based on radiological criteria. Frequently, the X-ray does not correlate with the symptoms the patients present. In this study, we compared patients with early and advanced stages of CMC I osteoarthritis (OA) and evaluated clinical symptoms, X-ray results, and an advanced MRI examination.

Methods

A total of 12 patients with CMC I OA were evaluated (6 Eaton/Littler stage I vs. 6 Eaton/Littler stage III). The clinical examination and X-ray was supplemented by a 3 T MRI in four thumb positions: extension, flexion, abduction, adduction. We assessed the four ligaments of CMC I, the dorsal and radial translation of the first metacarpal (MC I), and the location of osteophytes.

Results

Pain during strain and loss of power are characteristics of both stages of osteoarthritis of CMC I. Lesions of the ligaments include the anterior oblique ligament (AOL) and are present in both stage III according to Eaton/Littler and in early stages. In advanced stages of OA of CMC I, increased translation of MC I in a dorsal direction is observable. Osteophytes (> 2 mm) are commonly located at the trapezium at the radial and ulnar side.

Conclusion

Clinical X-ray does not record the lesions of ligaments which are already visible in the MRI in an early stage of OA. This is important when joint-preserving surgery as ligament reconstruction or osteotomy is considered. Characteristics of advanced OA of CMC I are increasing frequency of isolated and also combined ligament lesions and dorsal, not a radial, translation of MC I.

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Authors and Affiliations

  1. Unfallchirurgische Klinik, Klinikum Neumarkt i.d.OPf., Neumarkt i.d.OPf., Deutschland

    Sebastian Lerzer

  2. Abteilung für Diagnostische und Interventionelle Radiologie, Universitätsmedizin Göttingen, Göttingen, Deutschland

    Morad Ali Vafa &  Joachim Lotz

  3. Abteilung Kognitive Neurologie MR-Forschung in der Neurologie und Psychiatrie, Universitätsmedizin Göttingen, Göttingen, Deutschland

    Peter Dechent

  4. Abteilung für Unfallchirurgie, Plastische und Wiederherstellungschirurgie, Universitätsmedizin Göttingen, Göttingen, Deutschland

    Mohammad Tezval,  Martin Wachowski &  Klaus Michael Stürmer

  5. Klinik für Unfallchirurgie und Orthopädische Chirurgie, Klinikum Kassel, Mönchebergstr. 41–43, 34125, Kassel, Deutschland

    Clemens Dumont

Authors
  1. Sebastian Lerzer
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  2. Morad Ali Vafa
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  3. Peter Dechent
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  4. Mohammad Tezval
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  5. Joachim Lotz
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  6. Martin Wachowski
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  7. Klaus Michael Stürmer
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  8. Clemens Dumont
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Corresponding author

Correspondence to Clemens Dumont.

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Interessenkonflikt

S. Lerzer, M. Ali Vafa, P. Dechent, M. Tezval, J. Lotz, M. Wachowski, K.M. Stürmer und, C. Dumont geben an, dass kein Interessenkonflikt besteht.

Die Studie wurde von der Ethikkommission der Universitätsmedizin Göttingen bewilligt.

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Lerzer, S., Vafa, M., Dechent, P. et al. Rhizarthrose. Obere Extremität 11, 53–61 (2016). https://doi.org/10.1007/s11678-015-0310-8

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  • DOI: https://doi.org/10.1007/s11678-015-0310-8

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