Pain and Disability Related to Osteoarthrosis of the Trapeziometacarpal Joint

Abstract

We investigated the relationship between trapeziometacarpal arthrosis, pain, and upper extremity specific disability by surveying patients from a prior prevalence study. The 456 adult (age 18 or greater) patients from a prior prevalence study were mailed a questionnaire consisting of the full DASH outcome measure as well as additional questions to identify sources of pain other than the thumb, pain in the thumb and whether the patient has received treatment for thumb arthritis. A response rate of 27% was achieved (122 responses). Thumb pain correlated with pain elsewhere in the arm (r=0.354, p<0.001), but not with higher grades of arthrosis. The average DASH score was 9.9 [range 0–60.0]. Higher grades of arthrosis (p = 0.013), pain in the thumb (r=0.602, p<0.001) and pain elsewhere in the arm (r=0.665, p<0.001) were found to be predictors of a higher DASH score. Arthrosis grade explained only 3% of the variation of DASH scores in linear regression modeling, but was included in the best multivariable model—along with thumb pain and pain elsewhere in the arm—which explained 52% of the variation in DASH scores. Higher grades of trapeziometacarpal arthrosis do not correlate with complaints of thumb pain and have a significant, but very limited affect on arm-specific disability, compared to pain elsewhere in the arm.

Keywords

Thumb - Arthritis - Carpalmetacarpal - Trapeziometacarpal - Pain - Disability

Level of Evidence: Level IV

• References

• 1 Sodha S, Ring D, Zurakowski D, Jupiter JB. Prevalence of osteoarthrosis of the trapeziometacarpal joint. J Bone Joint Surg Am 2005; 87 ((12)) 2614-2618
• 2 Haara MM, Heliövaara M, Kröger H, Arokoski JP, Manninen P, Kärkkäinen A et al Osteoarthritis in the carpometacarpal joint of the thumb. Prevalence and associations with disability and mortality. J Bone Joint Surg Am 2004; 86-A ((7)) 1452-1457
• 3 Glickel SZ. Clinical assessment of the thumb trapeziometacarpal joint. Hand Clin 2001; 17 ((2)) 185-195
• 4 Armstrong AL, Hunter JB, Davis TR. The prevalence of degenerative arthritis of the base of the thumb in post-menopausal women. J Hand Surg Br 1994; 19 ((3)) 340-341
• 5 Whyte A, Carroll LJ. The relationship between catastroph-izing and disability in amputees experiencing phantom pain. Disabil Rehabil 2004; 26 ((11)) 649-654
• 6 Vlaeyen JW, Timmermans C, Rodriguez LM, Crombez G, van Horne W, Ayers GM et al Catastrophic thinking about pain increases discomfort during internal atrial cardioversion. J Psychosom Res 2004; 56 ((1)) 139-144
• 7 Ring D, Guss D, Malhotra L, Jupiter JB. Idiopathic arm pain. J Bone Joint Surg Am 2004; 86-A ((7)) 1387-1391
• 8 Leavitt F, Garron DC, D’Angelo CM, McNeill TW. Low back pain in patients with and without demonstrable organic disease. Pain 1979; 6 ((2)) 191-200
• 9 Kirmayer LJ, Looper KJ. Abnormal illness behaviour: physiological, psychological and social dimensions of coping with distress. Curr Opin Psychiatr 2006; 19 ((1)) 54-60
• 10 Keefe FJ, Rumble ME, Scipio CD, Giordano LA, Perri LM. Psychological aspects of persistent pain: current state of the science. J Pain 2004; 5 ((4)) 195-211
• 11 Granot M, Lavee Y. Psychological factors associated with perception of experimental pain in vulvar vestibulitis syndrome. J Sex Marital Ther 2005; 31 ((4)) 285-302
• 12 Edwards RR, Bingham 3rd CO, Bathon J, Haythornthwaite JA. Catastrophizing and pain in arthritis, fibromyalgia and other rheumatic diseases. Arthritis Rheum 2006; 55 ((2)) 325-332
• 13 Turner JA, Aaron LA. Pain-related catastrophizing: what is it?. Clin J Pain 2001; 17 ((1)) 65-71
• 14 Sullivan MJ, Lynch ME, Clark AJ. Dimensions of catastrophic thinking associated with pain experience and disability in patients with neuropathic pain conditions. Pain 2005; 113 ((3)) 310-315
• 15 Roth RS, Geisser ME, Theisen-Goodvich M, Dixon PJ. Cognitive complaints are associated with depression, fatigue, female sex, and pain catastrophizing in patients with chronic pain. Arch Phys Med Rehabil 2005; 86 ((6)) 1147-1154
• 16 Ring D, Kadzielski J, Malhotra L, Lee SG, Jupiter JB. Psychological factors associated with idiopathic arm pain. J Bone Joint Surg Am 2005; 87 ((2)) 374-380
• 17 Jensen MP, Nielson WR, Turner JA, Romano JM, Hill ML. Readiness to self-manage pain is associated with coping and with psychological and physical functioning among patients with chronic pain. Pain 2003; 104 ((3)) 529-537
• 18 Fietta P, Fietta P, Manganelli P. Fibromyalgia and psychiatric disorders. Acta Biomed 2007; 78 ((2)) 88-95
• 19 Edwards RR, Fillingim RB, Maixner W, Sigurdsson A, Haythornthwaite J. Catastrophizing predicts changes in thermal pain responses after resolution of acute dental pain. J Pain 2004; 5 ((3)) 164-170
• 20 Barsky AJ, Ahern DK. Cognitive behavior therapy for hypochondriasis: a randomized controlled trial. JAMA 2004; 291 ((12)) 1464-1470
• 21 Jensen MP, Turner JA, Romano JM. Changes in beliefs, catastrophizing, and coping are associated with improvement in multidisciplinary pain treatment. J Consult Clin Psychol 2001; 69 ((4)) 655-662
• 22 Jensen MP, Turner JA, Romano JM. Changes after multidisciplinary pain treatment in patient pain beliefs and coping are associated with concurrent changes in patient functioning. Pain 2007; 131 ((1–2)) 38-47
• 23 Pfingsten M, Hildebrandt J, Leibing E, Franz C, Saur P. Effectiveness of a multimodal treatment program for chronic low-back pain. Pain 1997; 73 ((1)) 77-85
• 24 Sullivan MJ, Adams H, Thibault P, Corbière M, Stanish WD. Initial depression severity and the trajectory of recovery following cognitive-behavioral intervention for work disability. J Occup Rehabil 2006; 16 ((1)) 63-74