Monica J Coughlan1, Alexandra Bourdillon2, Joseph J Crisco3, Deborah Kenney2, Arnold-Peter Weiss3, Amy L Ladd2. 1. Department of Orthopaedic Surgery, Robert A. Chase Hand & Upper Limb Center, Stanford University, 450 Broadway Street, Pavilion A, 2nd Floor, Dept A26 MC 6342, Redwood City, CA, 94063, USA. mcoughlan@stanford.edu. 2. Department of Orthopaedic Surgery, Robert A. Chase Hand & Upper Limb Center, Stanford University, 450 Broadway Street, Pavilion A, 2nd Floor, Dept A26 MC 6342, Redwood City, CA, 94063, USA. 3. Department of Orthopaedics, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI, USA.
Abstract
BACKGROUND: Advanced thumb carpometacarpal (CMC) osteoarthritis (OA) can cause substantial impairment in hand function, from grasping heavy objects to fine manipulation of implements and tools. In the clinical setting, we commonly measure the grip strength of gross grasp with a hand dynamometer in patients with CMC OA. Cylindrical grasp, which requires more thumb contribution than gross grasp, is an alternative method of measuring grip strength and one that may provide insight into thumb-related conditions. Because gross grasp and cylindrical grasp use the thumb in different planes, measurement of gross grasp alone might underestimate impairment. Therefore, it is important to evaluate cylindrical grasp as well. To our knowledge this tool has yet to be examined in a population with early thumb CMC OA. QUESTIONS/PURPOSES: (1) Is cylindrical grasp and gross grasp strength reduced in subjects with early thumb CMC OA compared with asymptomatic control subjects? (2) What is the association of cylindrical and gross grasp to thumb CMC OA after adjusting for age, sex, and hand dominance? METHODS: We recruited 90 subjects with early symptomatic and radiographic thumb CMC OA and 38 asymptomatic healthy control subjects for this multisite controlled study. Demographic information, hand examination, comprehensive histories, plain film radiographs, and cylindrical and gross grasp strength data were collected on all 128 subjects. Mean grasp strength was calculated for cylindrical and gross grasp in the population with early CMC OA and the control population. A t-test was performed on cylindrical and gross grasp to evaluate the difference between the mean in the control and early CMC OA populations. We used separate linear regression models for the two types of grasp to further quantify the association of grasp with a diagnosis of early thumb CMC OA controlling for age, sex, and whether the subject used their dominant or nondominant hand in the study. RESULTS: Cylindrical grasp was weaker in the population with thumb CMC OA compared with healthy control subjects (6.3 ± 2.7 kg versus 8.4 ± 2.5 kg; mean difference, 2.1; 95% CI, 1.1-3.1; p < 0.001), but there was no difference in gross grasp force (29.6 ± 11.6 kg versus 31.4 ± 10.1 kg; mean difference, 1.7; 95% CI, -2.5 to 6.0; p = 0.425). When adjusting for age, sex, and handedness, cylindrical grasp reduction was related to CMC OA (β = -2.3; standard error [SE], 0.46; p < 0.001) (Y-intercept = 8.2; SE, 1.8; R2 = 0.29), whereas gross grasp was not reduced in early thumb CMC OA (β = -2.8; SE, 1.6; p = 0.072) (Y-intercept = 34.3; SE, 6.3; R2 = 0.48). CONCLUSIONS: A reduction in cylindrical grasp is associated with early symptomatic and radiographic CMC OA, whereas gross grasp is not associated with early thumb CMC OA, suggesting that cylindrical grasp may be a better tool to detect changes in thumb and hand function seen during early disease stages. CLINICAL RELEVANCE: Cylindrical grasp may serve as a more-sensitive measure for detecting early changes in early CMC OA. The associated decline in hand function also might provide an opportunity for measuring the effectiveness of treatment and intervention.
BACKGROUND: Advanced thumb carpometacarpal (CMC) osteoarthritis (OA) can cause substantial impairment in hand function, from grasping heavy objects to fine manipulation of implements and tools. In the clinical setting, we commonly measure the grip strength of gross grasp with a hand dynamometer in patients with CMC OA. Cylindrical grasp, which requires more thumb contribution than gross grasp, is an alternative method of measuring grip strength and one that may provide insight into thumb-related conditions. Because gross grasp and cylindrical grasp use the thumb in different planes, measurement of gross grasp alone might underestimate impairment. Therefore, it is important to evaluate cylindrical grasp as well. To our knowledge this tool has yet to be examined in a population with early thumb CMC OA. QUESTIONS/PURPOSES: (1) Is cylindrical grasp and gross grasp strength reduced in subjects with early thumb CMC OA compared with asymptomatic control subjects? (2) What is the association of cylindrical and gross grasp to thumb CMC OA after adjusting for age, sex, and hand dominance? METHODS: We recruited 90 subjects with early symptomatic and radiographic thumb CMC OA and 38 asymptomatic healthy control subjects for this multisite controlled study. Demographic information, hand examination, comprehensive histories, plain film radiographs, and cylindrical and gross grasp strength data were collected on all 128 subjects. Mean grasp strength was calculated for cylindrical and gross grasp in the population with early CMC OA and the control population. A t-test was performed on cylindrical and gross grasp to evaluate the difference between the mean in the control and early CMC OA populations. We used separate linear regression models for the two types of grasp to further quantify the association of grasp with a diagnosis of early thumb CMC OA controlling for age, sex, and whether the subject used their dominant or nondominant hand in the study. RESULTS: Cylindrical grasp was weaker in the population with thumb CMC OA compared with healthy control subjects (6.3 ± 2.7 kg versus 8.4 ± 2.5 kg; mean difference, 2.1; 95% CI, 1.1-3.1; p < 0.001), but there was no difference in gross grasp force (29.6 ± 11.6 kg versus 31.4 ± 10.1 kg; mean difference, 1.7; 95% CI, -2.5 to 6.0; p = 0.425). When adjusting for age, sex, and handedness, cylindrical grasp reduction was related to CMC OA (β = -2.3; standard error [SE], 0.46; p < 0.001) (Y-intercept = 8.2; SE, 1.8; R2 = 0.29), whereas gross grasp was not reduced in early thumb CMC OA (β = -2.8; SE, 1.6; p = 0.072) (Y-intercept = 34.3; SE, 6.3; R2 = 0.48). CONCLUSIONS: A reduction in cylindrical grasp is associated with early symptomatic and radiographic CMC OA, whereas gross grasp is not associated with early thumb CMC OA, suggesting that cylindrical grasp may be a better tool to detect changes in thumb and hand function seen during early disease stages. CLINICAL RELEVANCE: Cylindrical grasp may serve as a more-sensitive measure for detecting early changes in early CMC OA. The associated decline in hand function also might provide an opportunity for measuring the effectiveness of treatment and intervention.
Authors: Eni Halilaj; Douglas C Moore; Tarpit K Patel; Amy L Ladd; Arnold-Peter C Weiss; Joseph J Crisco Journal: J Orthop Res Date: 2015-06-12 Impact factor: 3.494
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Authors: Joseph A Gil; Justin Kleiner; Thomas J McQuillan; Deborah Kenney; Amy L Ladd; Arnold-Peter C Weiss; Joseph J Crisco Journal: Hand (N Y) Date: 2020-09-16