Journal of Hand Surgery - June 2022 - S301

Abstract
S301
scores. Arthrotomy has the worst clinical outcome of
the 3 groups.
A-1506 A new conservative approach for early
stage of carpometacarpal joint osteoarthritis
Irene Zotta1,2, Maria Teresa Botta1, Andrea Zoccolan1,
Carlo Rossello1, Maria Concetta Rivellino1 and
Mario Igor Rossello1
1Hand Surgery Department, Ospedale San Paolo, Savona,
Italy
2Orthopaedic Clinic, Department of Surgical Sciences
(DISC), Ospedale Policlinico San Martino, University of
Genoa, Genoa, Italy
Objective: The conservative treatment of thumb carpometacarpal
joint (CMCJ) osteoarthritis is not standardized
and involves changes in lifestyle, use of
dynamic or rigid orthosis, use of NSAIDs, massage
techniques, strengthening exercises and stretching
of the wrist and thumb muscles and manual therapy
techniques. We propose the electrostimulation of the
opponent of the thumb and first dorsal interosseous
muscles because of their close insertion to the
CMCJ, to obtain a strengthening of the joint stability
and prevent the radial dislocation of the first metacarpal
bone. Method: We examined 109 patients
(F:M¼85:24), mean age 59.6 years who underwent
electrotherapy of the opponent of the thumb and first
dorsal interosseous muscles using biphasic rectangular
current for cycles of 4-6 seconds, 3-5 seconds
of pause, for fifteen minutes, twice a day for four
weeks. Pre- and post-treatment pain on a visual analogue
score, functional parameters measured with
DASH score, range of motion (Kapandji score),
pinch test and pre-treatment radiographic analysis
were collected.
Results: 46 patients with CMCJ osteoarthritis were
staged Eaton I; 63 patients were staged Eaton II.
After three months of follow-up a significant
improvement of the mean visual analogue, DASH,
Kapandji and pinch scores were observed; this
improvement continued in most patients at a mean
follow-up of 4.8 years (SD 0.8). Only 10 patients
(9.1%) subsequently underwent surgery due to failure
of the procedure. Surgical indications weren't
affected by the time that the conservative treatment
had taken. 99 patients (90.8%) claim they would
repeat the treatment, if proposed.
Conclusion: The electrotherapy treatment, possibly
associated with traditional physiotherapy, aims to
stabilize the balance of the CMCJ of the thumb, and
is fast, cheap and repeatable. We achieved significant
improvements in pain relief, function, and manual
ability in the immediate post-treatment and in the
medium-term follow-up. We believe that treatment
may delay the surgery time and, in some cases, avoid
it. Further studies and longer follow-up are obviously
necessary.
A-1507 The SCOPING study: A Series of Clinical
Observational Parameters Indicating Nerve
reGeneration
Suzanne Beale, Paul Malone, Rowena Williams,
Gilad Rotam, Anuj Mishra and Dominic Power
1The HaPPeN Research Group, Institute of Translational
Medicine, Birmingham, UK
2The Peripheral Nerve Injury Service, University Hospitals
Birmingham NHS Foundation Trust, UK
Objectives: Following repair of a mixed peripheral
nerve, functional recovery requires successful axon
regeneration across the repair site and eventually
re-innervation of distal targets. The inevitable delay
prior to determining an outcome as successful or
otherwise may render late salvage interventions
with revision reconstruction with grafts obsolete.
Reliably determining a failing nerve repair so that
revision may be promptly performed prior to irretrievable
muscle atrophy remains a challenge in
peripheral nerve surgery. The aim of this prospective
observational study was to ascertain whether any
clinical examination tests used in surveillance after
nerve repair are able to detect a failing repair and
prompt earlier salvage intervention.
Methods: A prospective observational cohort study
was performed to evaluate commonly used clinical
determinants of axon regeneration that may provide
surrogate measures of recovery. The protocol was
approved by a Research Ethics Committee. Target
recruitment was 12 patients with an isolated complete
median nerve transection injury in the distal
forearm. Patients were recruited and consented in
the first post-operative week following direct repair
of a complete transection injury to the median nerve
in the distal third of the forearm. Participants were
assessed by a senior research hand therapist at
defined time points to 18 months. Clinical measures
evaluated included the Tinel's progression rate, the
differential Tinel's sign, tender muscle test, static
and moving 2PD, monofilament pressure thresholds
and final sensory and motor outcome measured on
the British Medical Research Council (MRC) Scales.
Threshold for successful innervation was determined
as Sensory-MRC (SMRC) 3 and Motor-MRC
(MMRC) 3 and PROMS (DASH EQ5D and PEM).
Autonomic function return was measured using
return of sweating.
Journal of Hand Surgery - June 2022

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