Efficacy of Nonsurgical Interventions for Trapeziometacarpal (Thumb Base) Osteoarthritis: A Systematic Review
Bibliographic record
Abstract
OBJECTIVE: To synthesize the literature on the efficacy of existing nonsurgical interventions for trapeziometacarpal (TM) osteoarthritis (TMO). METHODS: A medical librarian conducted an electronic search in 16 databases. Two authors independently carried out study selection, data extraction, and risk-of-bias assessment. The Agency for Healthcare Research and Quality guidance was followed to integrate a valid body of evidence from the existing systematic reviews. Intervention effects were estimated based on the Cochrane Collaboration review methodology. RESULTS: We identified 17 systematic reviews, 34 randomized controlled trials (RCTs), and 6 nonrandomized controlled trials. Most of the studies had unclear or high risk of biases. Evidence of low-to-moderate quality supports the superiority of the following interventions for pain and/or physical function: 1) saline over steroid intraarticular injections confirmed by radiography, 2) saline injections over sham (i.e., pressure) in tender subcutaneous areas, 3) custom-made thermoplastic thumb orthosis over no intervention or a control, 4) custom-made thermoplastic hand-based TM joint orthosis over no intervention, 5) radial nerve mobilization over sham ultrasound, and 6) a combination of hand exercises and TM joint and median/radial nerve mobilization over sham ultrasound. CONCLUSION: This comprehensive systematic review allowed collating evidence-based data on the efficacy of nonsurgical interventions for TMO. Steroid intraarticular injections would not be more effective than saline injections. Rehabilitative interventions (orthosis, exercises, nerve mobilization) would be efficacious. However, these findings must be treated with circumspection due to methodologic limitations in many studies.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.013 | 0.052 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.012 | 0.010 |
| Bibliometrics | 0.010 | 0.007 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.003 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".