Doctor of Philosophy / The aim of the studies reported in this project was to examine factors associated with the prevention and management of trapeziometacarpal osteoarthritis, both in musculoskeletal physiotherapists and the general patient population. Two studies were undertaken to investigate factors associated with the aggravation of thumb pain in musculoskeletal physiotherapists. Study 1 was a survey of the prevalence of thumb pain, and allowed determination of the most aggravating spinal manipulative therapy technique. It identified that 83% of respondents complained of an aggravation of thumb pain due to the performance of spinal manipulative therapy techniques, with 85-87% of the painful respondents complaining of thumb pain aggravated by unilateral and central PA glides. Study 2 was conducted to determine whether the alignment of the joints of the thumb during performance of these glides was associated with thumb pain. This observational study of 129 musculoskeletal physiotherapists performing a PA glide identified that aligning the metacarpophalangeal and interphalangeal joints in extension was associated with a lower prevalence of work-related thumb pain. Therefore, it is suggested that musculoskeletal physiotherapists be taught to perform these techniques with the joints of their thumb in extension in an effort to reduce the development of work-related thumb pain. Furthermore, it is suggested that those who are unable to maintain this alignment voluntarily be provided with a thermoplastic thumb splint to maintain the extended alignment. Two studies were undertaken to investigate the conservative and surgical management of patients with trapeziometacarpal osteoarthritis. Study 3 was a randomised controlled trial conducted to compare the efficacy of a new thumb strap splint and an abduction exercise regimen against the standard approach to conservative management of trapeziometacarpal osteoarthritis, namely a short opponens splint and pinch exercise regimen. While there was no additional benefit of one approach over the other, all participants improved in the outcomes of pain, strength and hand function over the six-week period of intervention. Nevertheless, some people find that symptom relief from conservative intervention is inadequate and short-lived, requesting surgery for the treatment of disabling and persistent pain from trapeziometacarpal osteoarthritis. Study 4 was a systematic review, conducted to determine evidence of efficacy of one surgical procedure over another. This review identified six randomised controlled trials of surgery for trapeziometacarpal osteoarthritis. While there was evidence of no difference in the reduction in weakness between the procedures, there was insufficient evidence to confirm that there was no difference in the outcomes of pain, contracture, hand function, or patient global assessment. Furthermore, there was sufficient evidence to conclude that trapeziectomy had significantly fewer adverse effects, and trapeziectomy with ligament reconstruction and tendon interposition (LRTI) had significantly more, when compared with the other procedures analysed in this review. It is suggested that the decision as to which intervention is most appropriate for a given patient be based upon the individual patient’s requirements, the extent of disease, and the demands placed upon the joint by domestic duties, work, leisure and recreational activities. The studies presented in this project assist in formulating preventative and management strategies for people with trapeziometacarpal osteoarthritis.

Doctor of Philosophy / The aim of the studies reported in this project was to examine factors associated with the prevention and management of trapeziometacarpal osteoarthritis, both in musculoskeletal physiotherapists and the general patient population. Two studies were undertaken to investigate factors associated with the aggravation of thumb pain in musculoskeletal physiotherapists. Study 1 was a survey of the prevalence of thumb pain, and allowed determination of the most aggravating spinal manipulative therapy technique. It identified that 83% of respondents complained of an aggravation of thumb pain due to the performance of spinal manipulative therapy techniques, with 85-87% of the painful respondents complaining of thumb pain aggravated by unilateral and central PA glides. Study 2 was conducted to determine whether the alignment of the joints of the thumb during performance of these glides was associated with thumb pain. This observational study of 129 musculoskeletal physiotherapists performing a PA glide identified that aligning the metacarpophalangeal and interphalangeal joints in extension was associated with a lower prevalence of work-related thumb pain. Therefore, it is suggested that musculoskeletal physiotherapists be taught to perform these techniques with the joints of their thumb in extension in an effort to reduce the development of work-related thumb pain. Furthermore, it is suggested that those who are unable to maintain this alignment voluntarily be provided with a thermoplastic thumb splint to maintain the extended alignment. Two studies were undertaken to investigate the conservative and surgical management of patients with trapeziometacarpal osteoarthritis. Study 3 was a randomised controlled trial conducted to compare the efficacy of a new thumb strap splint and an abduction exercise regimen against the standard approach to conservative management of trapeziometacarpal osteoarthritis, namely a short opponens splint and pinch exercise regimen. While there was no additional benefit of one approach over the other, all participants improved in the outcomes of pain, strength and hand function over the six-week period of intervention. Nevertheless, some people find that symptom relief from conservative intervention is inadequate and short-lived, requesting surgery for the treatment of disabling and persistent pain from trapeziometacarpal osteoarthritis. Study 4 was a systematic review, conducted to determine evidence of efficacy of one surgical procedure over another. This review identified six randomised controlled trials of surgery for trapeziometacarpal osteoarthritis. While there was evidence of no difference in the reduction in weakness between the procedures, there was insufficient evidence to confirm that there was no difference in the outcomes of pain, contracture, hand function, or patient global assessment. Furthermore, there was sufficient evidence to conclude that trapeziectomy had significantly fewer adverse effects, and trapeziectomy with ligament reconstruction and tendon interposition (LRTI) had significantly more, when compared with the other procedures analysed in this review. It is suggested that the decision as to which intervention is most appropriate for a given patient be based upon the individual patient’s requirements, the extent of disease, and the demands placed upon the joint by domestic duties, work, leisure and recreational activities. The studies presented in this project assist in formulating preventative and management strategies for people with trapeziometacarpal osteoarthritis.

No description available.

Presented master thesis focuses on comparison of total replacement with fixed polyethylene and replacement with dual mobility of trapeziometacarpal joint. Computational models consist of bones trapezium, trapezoid, first and second metacarpal and components of total replacements stem, neck, insert and cup. Replacements are compared on basis that how big force is transmitted from replacement to trapezium, contact pressures between neck and insert, equivalent elastic strains of bone tissue and lastly what is the influence of friction coefficient on results. Task was solved with finite element method in software ANSYS Workbench 19.2.

This diploma thesis deals with the comparison of total replacement of a trapeziometacarpal joint with a hemispherical cup and replacement of the same joint with a conical cup. In both cases of implants, these are types of replacements with dual mobility. The focus of the diploma thesis is the comparison of the transfer of forces from the head of the prosthesis to the trapezius bone through the different shape of the cup. The work was processed using computer software ANSYS Workbench 19.3.

Au sein du règne animal, les humains sont considérés comme possédant des capacités manuelles uniques. Cependant, nous ne savons toujours pas quelles sont les réelles capacités manuelles des primates, ni comment elles ont évolué. Les humains sont-ils réellement uniques ? Cette thèse vise à étudier les capacités de manipulation chez des Hominidés en lien avec l’anatomie et la fonction de leur main, en utilisant une approche interdisciplinaire combinant différentes approches : comportementale, morphologique, fonctionnelle et biomécanique. Pour quantifier les stratégies comportementales et les capacités de manipulation chez des Hominidés, j’ai mené une étude éthologique sur différents grands singes captifs et sur les humains au cours d’une même tâche complexe d'utilisation d'outils. J’ai utilisé des approches comparatives de morphométrie géométrique 3D sur le complexe trapézio-métacarpien combiné avec un modèle musculo-squelettique pour mieux interpréter les résultats comportementaux et pour tester le lien entre la morphométrie de la main et les contraintes biomécaniques durant l’utilisation d’outils chez les Hominidés. Les résultats de cette thèse montrent que les grands singes manifestent des capacités dynamiques de manipulation, mais que chaque espèce a ses propres spécificités. Plus de capacités dynamiques complexes, comme les mouvements intra-manuels, sont observés pour les bonobos et les gorilles que pour les orangs-outans. Les différents modes de vie des espèces peuvent expliquer cette variabilité. En outre, au cours de la tâche complexe d’utilisation d’outils, les humains montrent une meilleure performance que les grands singes et montrent des spécificités. Cette nouvelle approche intégrative montre clairement aussi que les différentes capacités de manipulation des Hominidés ne peuvent pas seulement être une conséquence des différentes morphologies de l’articulation trapézio-métacarpienne, mais aussi des différentes contraintes mécaniques liées à la morphométrie globale de la main. Ces résultats mettent en évidence la difficulté de déduire les capacités manuelles d’espèces fossiles à partir de certaines informations provenant de la forme de l'os, sans tenir compte de la morphométrie globale de la main et de son lien possible avec les contraintes biomécaniques. Cette thèse fournit de nouvelles informations sur les capacités manuelles des Hominidés, sur les différentes contraintes entourant ces capacités, et de nouvelles informations afin de mieux comprendre l'évolution des capacités manuelles chez les primates. / Humans are considered to have unique manual abilities in the animal kingdom. However, we still do not know what the real manual abilities of primates are, nor how they evolved. Are humans really unique? This dissertation aims to investigate the manipulative abilities in Hominids related to their hand anatomy and function, using an interdisciplinary framework combining behavioral, morphological, functional, and biomechanical approaches. To quantify the behavioral strategies and manipulative abilities in Hominids, I have conducted an ethological study on different captive great apes and on humans during the same complex tool use task. I used 3D geometric morphometrics and comparative approaches on the trapeziometacarpal complex combined with a musculo-skeletal model to better interpret the behavioral results and to test the link between hand morphometric and biomechanical constraints during tool use in Hominids. The results of this PhD show that great apes demonstrate dynamic manipulative abilities but that each species has its own specificities. More complex dynamic abilities, such as in-hand movements, are observed for bonobos and gorillas than for orangutans. The different lifestyles of the species may explain this variability. Moreover, during the complex tool use task, humans perform better than great apes and show specificities. The new integrative approach also clearly shows that the different manipulative abilities of Hominids cannot only be a consequence of the different morphologies of the trapeziometacarpal joint but also of the different mechanical constraints related to the overall hand morphometric. These results highlight the difficulty to infer manual abilities in fossils from some bone shape information, without taking into account the overall morphometric of the hand and its possible link with biomechanical constraints. This PhD thesis provides new information on the manual abilities of Hominids, on the different constraints surrounding these abilities, and new information to better understand the evolution of manual abilities in primates.

The presented diploma thesis builds on author’s bachelor’s thesis of the similar name which was focused, in particular, on rhizarthrosis. Because of this joint disease, implantations of the total joint replacement are performed. The bachelor’s thesis also served as a familiarization with the finite element method and contact analyses issues, giving a theoretical framework for this diploma thesis. As opposed to that, the diploma thesis aims entirely at deformation and stress analysis of the total replacement. The main objective is to carry out analyses of different variants of geometric models. In addition, there is a tendency to analyze contact pressures of advanced model concerning all the total replacement, bone tissues, ligaments and tendons guaranteeing the static equilibrium of components. The bachelor’s thesis has been developed in ANSYS Workbench, whereas the diploma thesis in ANSYS APDL. Work in APDL allows user to control better over the entire computational process, however, requires more skills and theoretic knowledge. Contact analyses bring a lot of problems associated with convergence of procedures and accuracy of results. Therefore, explanations of important terms and set of recommendations are included for the purpose of easier solving of the contact problems.

Introduction. L’ostéoarthrose trapézo-métacarpienne (OTM) est l’une des ostéoarthroses (OA) de la main la plus prévalente, la plus douloureuse et la plus handicapante. Bien qu’une approche biopsychosociale soit préconisée dans la gestion de douleur chronique, la majorité des études sur l’OTM ne documentent que ses composantes physiques. La gestion de cette pathologie est souvent jugée sous-optimale, probablement due à une méconnaissance de la maladie et à l’absence de guide de pratique clinique. Ce travail doctoral a visé à (1) documenter l’efficacité des interventions non-chirurgicales et chirurgicales et (2) investiguer les impacts de l’OTM dans diverses sphères de la vie, (3) examiner les facteurs biopsychosociaux qui influencent la sévérité de la douleur et des incapacités fonctionnelles, et (4) documenter l’utilisation des ressources en santé que font les personnes atteintes d’OTM. Méthodologie. Le premier objectif a eu recours à deux revues systématiques en suivant la méthodologie de la Cochrane Collaboration. Pour les deuxième, troisième et quatrième objectifs, une étude descriptive a été menée auprès de 228 participants atteints d’OTM. Ils ont répondu à un questionnaire comprenant diverses échelles dûment validées. Des régressions linéaires multiples ont été utilisées afin d’identifier les facteurs de la sévérité de la douleur et des incapacités fonctionnelles. Résultats. Les résultats des revues systématiques ont montré des preuves scientifiques de qualité faible à modérée qui appuient l’efficacité des interventions suivantes en termes de douleur, d’incapacités fonctionnelles, de satisfaction et/ou d’événements indésirables: (1) injections de solution saline (intra-/extra-articulaire); (2) orthèse thermoplastique du pouce; (3) mobilisation nerveuse; (4) combinaison des exercices/mobilisation nerveuse et articulaire; (5) trapézectomie par voie antérieure ou postérieure; (6) trapézectomie et reconstruction ligamentaire avec ½ flexor carpi radialis (FCR) et tunnel métacarpien; (7) trapézectomie et reconstruction ligamentaire et interposition tendineuse en utilisant ½FCR et tunnel métacarpien; et (8) arthroplastie par distraction d’hématome. Pour ce qui est des résultats de l’étude descriptive, les participants étaient âgés de 63 ans en moyenne et plus de 80% d’entre eux rapportaient de la douleur d’intensité modérée à sévère (≥ 4/10). Leur score moyen au QuickDASH (incapacités fonctionnelles) était modéré (46,1/100). Leur score moyen de qualité de vie physique (SF-12v2) était inférieur à la moyenne de la population générale (41,0 vs 50,0). Près de 30% des participants présentaient des signes cliniquement significatifs d’anxiété et/ou de dépression. La fréquence de la douleur et le niveau d’incapacités fonctionnelles expliquaient 59,0 % de la variance dans la sévérité de la douleur tandis que le sexe, l'intensité de la douleur, la dépression et l'éducation expliquaient 60,1 % de la variance dans les scores d’incapacités fonctionnelles. Acétaminophène, anti-inflammatoires non stéroïdiens oraux, injections intra-articulaires de cortisone, orthèses, massage/exercices et application de chaleur/froid étaient fréquemment employées, tandis que les principes ergonomiques, des aides techniques, de la mobilisation nerveuse et des interventions psychosociales l’étaient beaucoup moins. Conclusions. L’OTM peut engendrer une douleur sévère, affectant divers aspects de la vie quotidienne. Les connaissances générées par cette thèse permettront de bonifier les recommandations des guides de pratique pour l’OTM, ainsi que de faciliter la gestion personnalisée de cette pathologie dans une perspective biopsychosociale. / Introduction. Trapeziometacarpal osteoarthritis (TMO) is one of the most prevalent, painful, and handicapping hand osteoarthritis (OA). Although a biopsychosocial approach is advocated in the management of chronic pain, the majority of studies on TMO document only its physical components. The non-surgical management of this pathology is often considered suboptimal, probably due to the poor understanding of the TMO and the absence of a clinical practice guide. This doctoral work thus aimed to (1) document the efficacy of non-surgical and surgical interventions and (2) investigate the impacts of TMO in various spheres of daily life, (3) examine the biopsychosocial factors that influence the severity of pain and functional disability, and (4) document the healthcare resources used by TMO patients. Methods. To answer the first objective, two systematic reviews were conducted using the methodology of the Cochrane Collaboration. For the second, third and forth objectives, a descriptive study was carried out among 228 participants with TMO. They answered a questionnaire comprising various scales duly validated. Multiple linear regression analyses were used to identify factors of pain severity and functional disability. Results. The results of the systematic reviews showed low to moderate quality evidence supporting the efficacy of the following interventions in terms of pain, physical function, satisfaction and/or adverse events: (1) saline injections (intra-/extra-articular); (2) custom-made thermoplastic thumb orthosis; (3) nerve mobilization; (4) combination of exercises/nerve and joint mobilization; (5) trapeziectomy by anterior or posterior approach; (6) trapeziectomy and ligament reconstruction with ½ flexor carpi radialis (FCR) and metacarpal tunnel; (7) trapeziectomy and ligament reconstruction and tendon interposition using ½FCR and metacarpal tunnel; and (8) distraction hematoma arthroplasty. The descriptive study revealed that the participants were on average 63 years old and over 80% of them reported moderate to severe pain (≥ 4/10). Their mean QuickDASH score was moderate (46.1/100) for functional disability. Their mean physical quality of life score (SF-12v2) was lower than the average in the general population (41.0 vs 50.0). Nearly 30% of the participants had clinically significant signs of anxiety and/or depression. Pain frequency and magnitude of disability explained 59.0% of the variance in pain severity while sex, pain intensity, depression and education explained 60.1% of the variance in functional disability scores. Acetaminophen, oral nonsteroidal anti-inflammatory drugs, cortisone injections, orthotics, hand exercise, hand massage and heat/cold application were frequently employed, while ergonomic principles, assistive devices, nerve mobilization and psychosocial intervention were much less used. Conclusions. TMO can cause severe pain and affect various aspects of daily life. The new knowledge generated by this thesis will allow to improve the recommendations for TMO, thus facilitating a tailored management of this pathology from a biopsychosocial perspective.