- Trapeziometacarpal arthrosis: Presentation, psychosocial aspects, and management
C.M.A.M. van der Horst
- Award date
- 11 December 2015
- Number of pages
- Document type
- PhD thesis
- Faculty of Medicine (AMC-UvA)
Idiopathic TMC arthrosis is a part of normal human aging. There is substantial variability in pain intensity and limitations related to trapeziometacarpal arthrosis. Common sense suggests and our study results confirm that a substantial portion of people never seek care for their trapeziometacarpal arthrosis, experience manageable symptoms, and adapt well. Given that many if not most people adapt, and the finding that coping strategies are the strongest correlates of trapeziometacarpal arthrosis-related symptoms and disability, it seems that an optimal mindset can facilitate adaptation to trapeziometacarpal arthrosis. Future studies should measure the influence of care based on cognitive behavioral therapy principles including the option of coaching, training, and practice of more effective coping strategies and determine if this can decrease symptoms and disability in patients with trapeziometacarpal arthrosis.
Patients can decide if they want a pre-fabricated neoprene, a custom-made thermoplast splint, or no splint at all given that the improvements were slight and there was no difference between splints. The effectiveness of a corticosteroid injection for treatment of trapeziometacarpal arthrosis seems limited, transient, and uncertain.
There is substantial and unexplained variation in the use of nonoperative and operative treatments among hand surgeons treating hand arthrosis. We and others hypothesize that greater involvement of the patient in the decision making process (e.g., via the use of decision aids) might decrease variation by ensuring that the patients preference and values have as much or more influence on treatment decisions than the beliefs, preferences, and values of the surgeon.
- Version of the thesis without "Acknowledgements" (pp. 231-235).
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