Research Article|Articles in Press

Pain, function, and radiographic disease in trapeziometacarpal osteoarthritis

Published:December 31, 2021DOI:


      • Trapeziometacarpal osteoarthritis produces significant impairment, but few studies have related radiographic scores to functional and pain-based measures.
      • Use of generalized estimating equations enabled analysis of bilateral data, eliminating confounding personal variables.
      • More advanced radiographic Trapeziometacarpal osteoarthritis is associated with lower grip strength and poorer self-reported functional outcomes
      • Lower radial subluxation scores are associated with higher pain scores and lower grip strength.



      Trapeziometacarpal joint osteoarthritis (OA) produces significant functional impairment due to pain and loss of strength in both power and precision grips, but few studies have related radiographic scores to functional and pain-based measures.


      To investigate the association between markers of radiographic disease and outcomes for symptomatic and functional disease.

      Study Design

      This study in an exploratory analysis of baseline data from the first 100 participants in a clinical trial evaluating the efficacy of combined conservative therapies for base of thumb OA (COMBO).


      Functional Index for Hand Osteoarthritis (FIHOA) scores and Visual Analogue Scale (VAS) scores for pain were recorded for the index hand. Bilateral isometric grip and tip-pinch strength measurements were taken, as well as posteroanterior and Eaton stress-view hand radiographs. Generalized estimating equations (GEEs), univariate, and multivariate analyses were used according to whether the data were bilateral or unilateral.


      A total of 79 females and 21 males were included, with a median Kellgren-Lawrence (KL) grade of 3 in the index hand. Higher KL and Eaton grades were associated with lower grip strength in the GEE analysis (B-coefficients of -1.25 and -1.16, and P-values of .002 and .010, respectively). Higher KL grade was also associated with poorer function and higher pain levels in the multivariable analysis (B-coefficients of 1.029 and 3.681, and P-values of .021 and .047, respectively). Lower radial subluxation ratios were associated with lower grip strength in the GEE analysis, and higher pain scores in the multivariable analysis (B-coefficients of 2.06 and -42.1, and P-values of .006 and .031, respectively). Greater pain scores were also associated with poorer function (B-coefficient 0.082, P-value .001).


      More advanced radiographic trapeziometacarpal OA severity is associated with lower grip strength and poorer self-reported functional outcomes. Lower subluxation ratios were associated with higher pain scores and lower grip strength.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Hand Therapy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Zhang Y
        • Niu J
        • Kelly-Hayes M
        • Chaisson CE
        • Aliabadi P
        • Felson DT.
        Prevalence of symptomatic hand osteoarthritis and its impact on functional status among the elderly: The Framingham Study.
        Am J Epidemiol. 2002; 156: 1021-1027
        • Dieppe PA.
        Relationship between symptoms and structural change in osteoarthritis: what are the important targets for therapy?.
        J Rheumatol. 2005; 32: 1147-1149
        • Neogi T
        • Felson D
        • Niu J
        • et al.
        Association between radiographic features of knee osteoarthritis and pain: results from two cohort studies.
        BMJ. 2009; 339: b2844
        • Lawrence J
        • Bremner J
        • Bier F.
        Osteo-arthrosis. Prevalence in the population and relationship between symptoms and x-ray changes.
        Ann Rheum Dis. 1966; 25: 1
        • Haugen IK
        • Englund M
        • Aliabadi P
        • et al.
        Prevalence, incidence and progression of hand osteoarthritis in the general population: the Framingham Osteoarthritis Study.
        Ann Rheum Dis. 2011; 70: 1581-1586
        • Spacek E
        • Poiraudeau S
        • Fayad F
        • et al.
        Disability induced by hand osteoarthritis: are patients with more symptoms at digits 2–5 interphalangeal joints different from those with more symptoms at the base of the thumb?.
        Osteoarthritis Cartilage. 2004; 12: 366-373
        • Dominick KL
        • Jordan JM
        • Renner JB
        • Kraus VB.
        Relationship of radiographic and clinical variables to pinch and grip strength among individuals with osteoarthritis.
        Arthritis Rheum. 2005; 52: 1424-1430
        • Edmunds JO.
        Current concepts of the anatomy of the thumb trapeziometacarpal joint.
        J Hand Surg [Am]. 2011; 36: 170-182
        • Dahaghin S
        • Bierma-Zeinstra SM
        • Ginai A
        • Pols H
        • Hazes J
        • Koes B.
        Prevalence and pattern of radiographic hand osteoarthritis and association with pain and disability (the Rotterdam study).
        Ann Rheum Dis. 2005; 64: 682-687
        • Jones G
        • Cooley H
        • Bellamy N.
        A cross-sectional study of the association between Heberden's nodes, radiographic osteoarthritis of the hands, grip strength, disability and pain.
        Osteoarthritis Cartilage. 2001; 9: 606-611
        • Deveza LA
        • Hunter DJ
        • Wajon A
        • et al.
        Efficacy of combined conservative therapies on clinical outcomes in patients with thumb base osteoarthritis: protocol for a randomised, controlled trial (COMBO).
        BMJ Open. 2017; 7e014498
        • Dreiser R
        • Maheu E.
        Inter-rater reproducibility of a functional index for hand osteoarthritis (HOA).
        Osteoarthritis Cart. 1997; 5: 57
        • Dreiser R-L
        • Maheu E
        • Guillou GB
        • Caspard H
        • Grouin J-M.
        Validation of an algofunctional index for osteoarthritis of the hand.
        Revue du Rhumatisme et des Maladies Osteoarticulaires-Edition Francaise. 1995; 62: 43S
        • Dreiser R-L
        • Maheu E
        • Guillou G.
        Sensitivity to change of the functional index for hand osteoarthritis.
        Osteoarthritis Cartilage. 2000; 8: S25-S28
        • Wolf JM
        • Oren TW
        • Ferguson B
        • Williams A
        • Petersen B.
        The carpometacarpal stress view radiograph in the evaluation of trapeziometacarpal joint laxity.
        J Hand Surg [Am]. 2009; 34: 1402-1406
        • Eaton R
        • Glickel S.
        Trapeziometacarpal osteoarthritis. Staging as a rationale for treatment.
        Hand Clin. 1987; 3: 455-471
        • Altman RD
        • Gold G.
        Atlas of individual radiographic features in osteoarthritis, revised.
        Osteoarthritis Cartilage. 2007; 15: A1-A56
        • Glickel SZ.
        Clinical assessment of the thumb trapeziometacarpal joint.
        Hand Clin. 2001; 17: 185-195
        • Hunter D
        • Zhang Y
        • Sokolove J
        • Niu J
        • Aliabadi P
        • Felson D.
        Trapeziometacarpal subluxation predisposes to incident trapeziometacarpal osteoarthritis (OA): the Framingham Study.
        Osteoarthritis Cartilage. 2005; 13: 953-957
        • Company LI.
        JAMAR Hydrolic Hand Dynamomometer User Instructions.
        Lafayette. 2004;
        • Ladd AL
        • Crisco JJ
        • Hagert E
        • Rose J
        • Weiss A-PC.
        The 2014 ABJS Nicolas Andry Award: the puzzle of the thumb: mobility, stability, and demands in opposition.
        Clin Orthop Relat Res. 2014; 472: 3605-3622
        • Bagis S
        • Sahin G
        • Yapici Y
        • Cimen OB
        • Erdogan C.
        The effect of hand osteoarthritis on grip and pinch strength and hand function in postmenopausal women.
        Clin Rheumatol. 2003; 22: 420-424
        • Lawrence R
        • Felson D
        • Helmick C
        • et al.
        Estimates of prevalence of arthritis and other rheumatic conditions in the United States, part II.
        Arthritis Rheum. 2008; 58: 26-35
        • Riordan E
        • Robbins S
        • Deveza L
        • et al.
        Radial subluxation in relation to hand strength and radiographic severity in trapeziometacarpal osteoarthritis.
        Osteoarthritis Cartilage. 2018;
        • Bijsterbosch J
        • Visser W
        • Kroon HM
        • et al.
        Thumb base involvement in symptomatic hand osteoarthritis is associated with more pain and functional disability.
        Ann Rheum Dis. 2010; 69: 585-587