Image-Based Analysis of Thumb Carpometacarpal Joint Biomechanics in Health and Early Osteoarthritis


Humans have a unique opposable thumb that maintains a fine balance between mobility and stability to allow motions that span from precision handling to power grasping. Much of the versatility of the thumb is due to the saddle geometry of first carpometacarpal (CMC) joint. Located at the base of the thumb, the CMC joint is the most common site of reconstructive surgery in the upper extremity. Nearly 40% of postmenopausal women are affected by CMC osteoarthritis (OA)—a progressive degenerative disease of articular cartilage, bone, and synovium that results in decreased dexterity and partial impairment of the upper extremity. Although current treatment options can alleviate pain, they cannot restore the lost strength and mobility, or halt disease progression, because the pathophysiology of the disease is poorly understood. While both biological and mechanical factors are implicated in the etiology of CMC OA, the synergistic mechanism of disease evolution remains unclear, partially due to a paucity of published data on CMC joint biomechanics in healthy and diseased populations. Accordingly, the objective of this work was to study CMC joint biomechanics using in vivo image-based techniques, and to determine if there are any differences with sex, age, or OA onset that could point to the etiology of the disease. 155 subjects—healthy men and women of two age groups and patients with early stage CMC OA—were recruited for the study. Sequential computed tomography scans of the hands and wrists of all the participants were acquired while they performed functional tasks and range-of-motion activities. The imaging data were used to study joint motion, stability, contact mechanics, articular shape and congruence, as well as to model soft tissue: cartilage and ligaments. The findings presented here suggest that there may not be a mechanical predisposition to CMC OA, but that women may be more susceptible to cartilage loss due to systemic changes with aging. In addition to channeling future research in the right direction, the furthered understanding of CMC joint biomechanics should serve to refine the current surgical procedures and to inspire new conservative options for disease treatment and prevention.
Thesis (Ph.D. -- Brown University (2015)

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Halilaj, Eni, "Image-Based Analysis of Thumb Carpometacarpal Joint Biomechanics in Health and Early Osteoarthritis" (2015). Biomedical Engineering Theses and Dissertations. Brown Digital Repository. Brown University Library.