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Rhizarthrosis: diagnostic assessment of rhizarthrosis and clinical-radiological correlation


International Physical Medicine & Rehabilitation Journal
Samuel Ribak,1,2 Eduardo Daniel Ferreira,1,2 Helton Hiroshi Hirata,1 Eduardo Lavor Segura,1Rafael Barcellos de Campos,1 Alexandre Tietzmann1

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Abstract

Objective:To evaluate diagnostic tests described for rhizarthrosis, to determine its sensitivity, specificity and accuracy, and to try to establish correlations between clinical and radiological conditions.

Method:This is a prospective study carried out at a university hospital, in the city of Campinas, Brazil. Patients were divided into 2 groups, Group A was evaluated according to the following data: age, sex, laterality of the pathology, dominant hand, length of symptoms, diagnostic tests (Grind Test, Digit-Pressure Test, Shear Test, 1st Metacarpal Flexion test, and 1st Metacarpal Extension Test), pain, radiological evaluation, and upper extremity functional index through the Quick DASH method. Group B (control group - with the same number of patients) was evaluated using the same methodology as Group A according to age, sex, diagnostic tests, and radiological evaluation.

Results:Group A- 34 patients were evaluated, 30 of whom were female (88.2%), with a mean age of 60.6 years. Regarding the radiological classification, 3% were Eaton type 1, 38% type 2, 56% type 3, and 3%, type 4. The mildest group (Eaton type 1 and 2) represented 41.2% of the patients, and the more severe group (type 3 or 4) represented 58.8%.There was statistical significance for the diagnosis of rhizarthrosis with the Digit-Pressure test (p<0.001), Digit-Pressure test/Shear test (p<0.001), Metacarpal Extension test (p<0.001), Digit-Pressure/Metacarpal Extension tests (p<0.001), Grind Test/Digit-Pressure test (p<0.001), and Shear Test (p=0.001). The Shear test/Metacarpal Extension test had the highest specificity, with 85.7%. The Grind Test/Digit-pressure test had the highest accuracy, with 70.6% and the Digit-pressure test had the highest sensitivity, with 100%. When all the tests were analyzed, individually and in pairs, there was greater specificity in digit-pressure test (85.1%); sensitivity in digit-pressure test (95.2%) and greater accuracy in digit-pressure test (88.2%). There was statistical significance of the radiological classification with the Digit-Pressure test (p=0.030), and the Grind test/Digit-Pressure test combination (p=0.026) with Eaton and Littler stages 3 and 4.

Conclusion:The Digit Pressure Test, Digit Pressure test/Shear test, Shear Test, Metacarpal Extension test, Digit Pressure test/Metacarpal Extension test, and Grind Test/Digit Pressure test are significant for the diagnosis of rhizarthrosis. The clinical-radiological correlation of the Digit-Pressure Test with Eaton and Littler stages 3 and 4 is significant.

Keywords

rhizarthrosis, carpometacarpal joint, osteoarthritis, trapeziometacarpal joint, trapeziometacarpal joint pathologies, diagnosis of rhizarthrosis, quantitative variables, metacarpal extension test, carpal instability, synovial cyst, complementary tests

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