title: Surgical stabilization for symptomatic carpometacarpal hypermobility; a randomized comparison of a dorsal and a volar technique and a cohort of the volar technique.
abstract: BACKGROUND
  Hypermobility of the first carpometacarpal joint is mostly surgically treated with a volar approached stabilization by Eaton, but recent studies indicate the importance of the dorsoradial and intermetacarpal ligaments (DRL and IML) for carpometacarpal joint stability. The aim of this study was to compare a dorsal and volar technique for primary carpometacarpal hypermobility regarding pain and functional outcome.
  
  
  METHODS
  Patients with non-degenerative, painful carpometacarpal hypermobility were included and were randomly assigned to either the volar technique using the FCR, or a dorsal technique using the ECRL. After premature termination of the trial, we followed all patients treated with the volar approach. Pain, strength, and ADL function using DASH and Michigan Hand Questionnaires (MHQ) were measured at baseline and 3 and 12 months after surgery.
  
  
  RESULTS
  After including 16 patients, the randomized trial comparing the volar and dorsal technique was terminated because of significant increased pain in the dorsal group. Although none of the other outcome measures were significant in the underpowered comparison, in line with the pain scores, all variables showed a trend towards a worse outcome in the dorsal group. Between 2009 and 2012, 57 thumbs were surgically stabilized. We found significant better pain and MHQ scores, and after 1 year improved grip and key pinch strength. Patients returned to work within 8 (±7) weeks, of which 85 % in their original job.
  
  
  CONCLUSIONS
  Surgical stabilization of the thumb is an effective method for patients suffering from hypermobility regarding pain, daily function, and strength. We recommend a volar approach. Level of Evidence: Level I, therapeutic study.
authors.affiliation: Division of Plastic, Reconstructive and Hand surgery, Erasmus Medical Center, Rotterdam, the Netherlands ; Division of Hand surgery, Xpert Clinic, Hilversum, the Netherlands.
authors.forename: Kim Robin
authors.initials: KR
authors.lastname: Spekreijse
authors.affiliation: Division of Plastic, Reconstructive and Hand surgery, Erasmus Medical Center, Rotterdam, the Netherlands ; Division of Hand surgery, Xpert Clinic, Hilversum, the Netherlands.
authors.forename: Guus Maarten
authors.initials: GM
authors.lastname: Vermeulen
authors.affiliation: Division of Plastic, Reconstructive and Hand surgery, Erasmus Medical Center, Rotterdam, the Netherlands ; Division of Hand surgery, Xpert Clinic, Hilversum, the Netherlands.
authors.forename: Thybout M
authors.initials: TM
authors.lastname: Moojen
authors.affiliation: Division of Plastic, Reconstructive and Hand surgery, Erasmus Medical Center, Rotterdam, the Netherlands ; Division of Hand surgery, Xpert Clinic, Hilversum, the Netherlands.
authors.forename: Harm P
authors.initials: HP
authors.lastname: Slijper
authors.affiliation: Division of Plastic, Reconstructive and Hand surgery, Erasmus Medical Center, Rotterdam, the Netherlands.
authors.forename: Steven E R
authors.initials: SE
authors.lastname: Hovius
authors.affiliation: Division of Plastic, Reconstructive and Hand surgery, Erasmus Medical Center, Rotterdam, the Netherlands.
authors.forename: Ruud W
authors.initials: RW
authors.lastname: Selles
authors.affiliation: Division of Plastic, Reconstructive and Hand surgery, Erasmus Medical Center, Rotterdam, the Netherlands ; Division of Hand surgery, Xpert Clinic, Hilversum, the Netherlands.
authors.forename: Reinier
authors.initials: R
authors.lastname: Feitz
keywords: Carpometacarpal; Hypermobility; Stabilization; Thumb