HAND (2013) 8:422–429 DOI 10.1007/s11552-013-9537-2
Widespread pressure pain hypersensitivity in elderly subjects with unilateral thumb carpometacarpal osteoarthritis Alessandro Chiarotto & Cesar Fernandez-de-las-Peñas & Matteo Castaldo & Stefano Negrini & Jorge Hugo Villafañe
Published online: 6 June 2013 # American Association for Hand Surgery 2013
Abstract Background Widespread pressure hypersensitivity is one of the signs that characterize central pain sensitization in subjects with knee and hip osteoarthritis (OA). The purpose of this study was to evaluate whether widespread pressure pain hyperalgesia is a feature of individuals with unilateral symptomatic thumb carpometacarpal (CMC) OA. Methods A total of 16 patients with unilateral symptomatic thumb CMC OA and 16 healthy sex- and age-matched controls were recruited. Pressure pain thresholds (PPTs) were assessed bilaterally over the first CMC joint; the C5–C6 zygapophyseal joint; the median, ulnar, and radial nerves; and tibialis anterior muscle. Grip and key strength, intensity of pain, and function QuickDASH were also measured. Results The analyses showed that patients with thumb CMC OA present bilaterally decreased PPTs over the first CMC joint, the C5–C6 zygapophyseal joint, and the tibialis anterior, median, ulnar and radial nerve as compared to controls (all, P0.05). Quantitative data without a normal distribution (pain intensity) were analyzed with nonparametric tests, whereas data with a normal distribution (PPT, strength, QuickDASH) were analyzed with parametric tests. A two-way analysis of variance (ANOVA) was used to evaluate differences in PPT over each point and strength measures with side (affected/nonaffected in patients or dominant/non-dominant in controls) as the within-subjects factor and group (patients, or controls) as the between-subjects factor. Separate ANOVAs were conducted with each outcome as the dependent variable. The Spearman rho (rs) was used to determine associations of the intensity of pain with PPT, strength measures, and QuickDASH, and the
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Table 1 Differences in pressure pain thresholds (PPT) over first carpometacarpal (CMC) joint, C5–C6 zygapophyseal joint, and tibialis anterior muscle between patients with thumb carpometacarpal osteoarthritis and healthy controls First CMC joint* Patients with thumb carpometacarpal osteoarthritis (CMC OA) Symptomatic side 272.0±90.0 (95 % CI 223.5–319.4) Non-symptomatic side 316.5±93.0 (95 % CI 267.0–365.9) Healthy controls Dominant side Non-dominant side
432.2±118.7 (95 % CI 368.9–495.5) 413.4±121.6 (95 % CI 349.1–477.7)
C5–C6 zygapophyseal joint*
Tibialis anterior*
270.0±91.0 (95 % CI 221.5–319.4) 274.9±84.1 (95 % CI 230.4–319.4)
290.8±96.9 (95 % CI 239.3–342.2) 304.6±93.9 (95 % CI 255.2–355.1)
359.0±80.1 (95 % CI 316.5–401.5) 326.4±84.1 (95 % CI 280.9–370.9)
506.4±121.6 (95 % CI 442.1–571.6) 480.7±106.8 (95 % CI 424.3–538.0)
Values (kilopascal) are expressed as mean (95 % confidence interval) *P0.186). Pressure Pain Sensitivity over the First CMC Joint The two-way ANOVA revealed significant differences between groups (F=23.262, P
Widespread pressure pain hypersensitivity in elderly subjects with unilateral thumb carpometacarpal osteoarthritis Alessandro Chiarotto & Cesar Fernandez-de-las-Peñas & Matteo Castaldo & Stefano Negrini & Jorge Hugo Villafañe
Published online: 6 June 2013 # American Association for Hand Surgery 2013
Abstract Background Widespread pressure hypersensitivity is one of the signs that characterize central pain sensitization in subjects with knee and hip osteoarthritis (OA). The purpose of this study was to evaluate whether widespread pressure pain hyperalgesia is a feature of individuals with unilateral symptomatic thumb carpometacarpal (CMC) OA. Methods A total of 16 patients with unilateral symptomatic thumb CMC OA and 16 healthy sex- and age-matched controls were recruited. Pressure pain thresholds (PPTs) were assessed bilaterally over the first CMC joint; the C5–C6 zygapophyseal joint; the median, ulnar, and radial nerves; and tibialis anterior muscle. Grip and key strength, intensity of pain, and function QuickDASH were also measured. Results The analyses showed that patients with thumb CMC OA present bilaterally decreased PPTs over the first CMC joint, the C5–C6 zygapophyseal joint, and the tibialis anterior, median, ulnar and radial nerve as compared to controls (all, P0.05). Quantitative data without a normal distribution (pain intensity) were analyzed with nonparametric tests, whereas data with a normal distribution (PPT, strength, QuickDASH) were analyzed with parametric tests. A two-way analysis of variance (ANOVA) was used to evaluate differences in PPT over each point and strength measures with side (affected/nonaffected in patients or dominant/non-dominant in controls) as the within-subjects factor and group (patients, or controls) as the between-subjects factor. Separate ANOVAs were conducted with each outcome as the dependent variable. The Spearman rho (rs) was used to determine associations of the intensity of pain with PPT, strength measures, and QuickDASH, and the
HAND (2013) 8:422–429
425
Table 1 Differences in pressure pain thresholds (PPT) over first carpometacarpal (CMC) joint, C5–C6 zygapophyseal joint, and tibialis anterior muscle between patients with thumb carpometacarpal osteoarthritis and healthy controls First CMC joint* Patients with thumb carpometacarpal osteoarthritis (CMC OA) Symptomatic side 272.0±90.0 (95 % CI 223.5–319.4) Non-symptomatic side 316.5±93.0 (95 % CI 267.0–365.9) Healthy controls Dominant side Non-dominant side
432.2±118.7 (95 % CI 368.9–495.5) 413.4±121.6 (95 % CI 349.1–477.7)
C5–C6 zygapophyseal joint*
Tibialis anterior*
270.0±91.0 (95 % CI 221.5–319.4) 274.9±84.1 (95 % CI 230.4–319.4)
290.8±96.9 (95 % CI 239.3–342.2) 304.6±93.9 (95 % CI 255.2–355.1)
359.0±80.1 (95 % CI 316.5–401.5) 326.4±84.1 (95 % CI 280.9–370.9)
506.4±121.6 (95 % CI 442.1–571.6) 480.7±106.8 (95 % CI 424.3–538.0)
Values (kilopascal) are expressed as mean (95 % confidence interval) *P0.186). Pressure Pain Sensitivity over the First CMC Joint The two-way ANOVA revealed significant differences between groups (F=23.262, P
