XXXX of the thumb and digits: current concepts.

@entity1 @entity571 @entity625 @entity425 @entity1410 @entity158
@entity571 of the hand continues to be a problem in an aging population and affects the proximal and distal interphalangeal, metacarpophalangeal, and carpometacarpal joints in the hands. Heberden nodes develop in the distal interphalangeal joints and typically present as a deformed and enlarged joint and can cause @entity158 . Surgery rarely is necessary because functional difficulties are uncommon; however, there may be problems if the metacarpophalangeal and proximal interphalangeal joints are involved because cartilage destruction generates @entity158 and causes @entity425 . Implant arthroplasty typically can improve @entity158 but does not reliably improve range of motion, and complication and revision rates are substantial. Arthrodesis continues as a treatment for @entity571 , but the surgeon must balance the risks of complications with the benefits of improved @entity1 outcomes. The opposable thumb, which is critical for hand dexterity and strength, can be severely disabled by basal joint @entity625 . The complex architecture of the basal joint continues to be defined by its relationship to the surrounding bony and ligamentous anatomy and its effect on the trapeziometacarpal joint. Nonsurgical treatment may be beneficial, but surgical options, including arthroscopy, osteotomy, and arthroplasty, should be considered if nonsurgical management fails. Prosthetic arthroplasty has a historically poor record; therefore, trapeziectomy remains the hallmark of current reconstructive techniques. Ligament reconstruction and tendon interposition arthroplasty are the most commonly performed surgical procedures, but @entity1410 distraction arthroplasty and various methods of suspensionplasty also are currently used.
