Death, taxes, and trapeziometacarpal arthrosis

Abstract

Background: Hand surgeons treat trapeziometacarpal arthrosis as if everyone with the disease presents for treatment despite evidence that suggests that trapeziometacarpal arthrosis is a normal part of human aging for which--it seems safe to assume--most people never seek medical attention.

Questions/purposes: The aims of our study were (1) to confirm the prevalence of radiographic trapeziometacarpal arthrosis in a very large sample and to determine if age and sex are associated with (2) any radiographic evidence of trapeziometacarpal arthrosis; and (3) radiographic evidence of severe trapeziometacarpal arthrosis.

Methods: A total of 2321 patients 31 years or older with radiographs obtained during treatment of a distal radius fracture at a tertiary care medical center emergency department between 2002 and 2012 were analyzed. Trapeziometacarpal arthrosis was graded using the 3-point scale of Sodha et al. (none, definite, destroyed trapeziometacarpal joint); we used regression analyses to determine the association of age (in 10-year age groups) and sex with the presence of trapeziometacarpal arthrosis.

Results: The prevalence of trapeziometacarpal arthrosis steadily increased to 85% between the ages of 71 and 80 years and reached 100% in women (with 50% of them being classified as severe) aged 91 years or older and 93% in men of 81 years or older. Severe arthrosis was more prevalent at earlier ages among women and reached 35% in women and 34% in men who were 81 years or older. Logistic regression identified higher age as the strongest factor associated with trapeziometacarpal arthrosis, but sex was also a factor.

Conclusions: Radiographic trapeziometacarpal arthrosis is an expected part of human aging. Given that only three patients in this large cohort had evidence of prior surgery, it seems that most people adapt to trapeziometacarpal arthrosis. Treatments that optimize adaptation in patients who present with trapeziometacarpal arthrosis-related symptoms and disability merit additional study.

Fig. 1

Flow diagram is shown detailing subject selection for study.

Fig. 2A–D

Examples of trapeziometacarpal arthrosis according to each Sodha Grade. (A) Sodha Grade 1, no or nearly no trapeziometacarpal arthrosis. (B) Sodha Grade 2, definite trapeziometacarpal arthrosis but not severe. (C) Sodha Grade 2 or 3, definite trapeziometacarpal arthrosis which might be graded as severe. (D) Sodha Grade 3, severe trapeziometacarpal arthrosis.

Fig. 3

The prevalence of trapeziometacarpal arthrosis increases with age in both men and women. *Note that there were only six men older than 90 years in our cohort; therefore, the prevalence among men in this age group is not reliable.

Fig. 4

The prevalence of severe trapeziometacarpal arthrosis increases with age in both men and women. *Note that there were only six men older than 90 years in our cohort; therefore, the prevalence among men in this age group is not reliable.