Does the Number of Preoperative Corticosteroid Injections Affect Clinical and Radiographic Outcomes of Trapeziectomy and Suspensionplasty?

Published:August 05, 2022DOI:


      This study aimed to determine whether an increasing number of preoperative corticosteroid injections is associated with greater radiographic subsidence of the thumb metacarpal at long-term follow-up after abductor pollicis longus suspensionplasty, secondary to steroid-induced pathologic weakening of capsuloligamentous restraints surrounding the thumb carpometacarpophalangeal joint and greater extension of the lunate, but neither affect patient-reported outcomes nor revision rates.


      A retrospective chart review was performed of patients who underwent primary trapeziectomy and abductor pollicis longus suspensionplasty by a single surgeon over a 10-year period. The number of preoperative corticosteroid injections in the trapeziometacarpal joint was documented, and patients were separated into 4 subgroups: 0, 1, 2, or 3 or more injections. Preoperative and final radiographs were evaluated for a change in the distance between the base of the thumb metacarpal and the distal pole of the scaphoid as a measure of thumb metacarpal subsidence and radiolunate angle as a measure of nondissociative carpal instability, which has been reported as a complication after basal joint arthroplasty. Additionally, the final patient-reported outcomes (Quick Disabilities of the Arm, Shoulder, and Hand and Patient-Rated Wrist Evaluation) and revision rates were also assessed.


      Of a total of 60 patients with an average age of 64 years that were included in the study, 16 (26.7%) received 0, 19 (31.7%) received 1, 12 (20%) received 2, and 13 (21.7%) received 3+ preoperative injections. The median postoperative follow-up was 92 months. The mean distance between the base of the thumb metacarpal and the distal pole of the scaphoid decreased by 2 mm, and the mean radiolunate angle increased by 4° across the entire cohort. When comparing subgroups, no differences were observed in either parameter or the final Patient-Rated Wrist Evaluation and Quick Disabilities of the Arm, Shoulder, and Hand scores.


      This study demonstrates no apparent detrimental effect of an increased number of preoperative corticosteroid injections on radiographic thumb metacarpal subsidence, increase in extension of radiolunate angle (nondissociative carpal instability), patient-reported outcomes, or revision rates at an average of almost 8 years after trapeziectomy and abductor pollicis longus suspensionplasty.

      Type of study/level of evidence

      Therapeutic IV.

      Key words

      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 Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Baker R.H.J.
        • Al-Shukri J.
        • Davis T.R.C.
        Evidence-based medicine: thumb basal joint arthritis.
        Plast Reconstr Surg. 2017; 139: 256e-266e
        • Lin J.D.
        • Karl J.W.
        • Strauch R.J.
        Trapeziometacarpal joint stability: the evolving importance of the dorsal ligaments.
        Clin Orthop Relat Res. 2014; 472: 1138-1145
        • Haara M.M.
        • Heliövaara M.
        • Kröger H.
        • et al.
        Osteoarthritis in the carpometacarpal joint of the thumb. Prevalence and associations with disability and mortality.
        J Bone Joint Surg Am. 2004; 86: 1452-1457
        • Kroon F.P.B.
        • Carmona L.
        • Schoones J.W.
        • Kloppenburg M.
        Efficacy and safety of non-pharmacological, pharmacological and surgical treatment for hand osteoarthritis: a systematic literature review informing the 2018 update of the EULAR recommendations for the management of hand osteoarthritis.
        RMD Open. 2018; 4e000734
        • Gottschalk M.B.
        • Patel N.N.
        • Boden A.L.
        • Kakar S.
        Treatment of basilar thumb arthritis: a critical analysis review.
        JBJS Rev. 2018; 6: e4
        • Spaans A.J.
        • van Minnen L.P.
        • Kon M.
        • Schuurman A.H.
        • Schreuders A.R.T.
        • Vermeulen G.M.
        Conservative treatment of thumb base osteoarthritis: a systematic review.
        J Hand Surg Am. 2015; 40: 16-21.e6
        • Day C.S.
        • Gelberman R.
        • Patel A.A.
        • Vogt M.T.
        • Ditsios K.
        • Boyer M.I.
        Basal joint osteoarthritis of the thumb: a prospective trial of steroid injection and splinting.
        J Hand Surg Am. 2004; 29: 247-251
        • Bahadır C.
        • Onal B.
        • Dayan V.Y.
        • Gürer N.
        Comparison of therapeutic effects of sodium hyaluronate and corticosteroid injections on trapeziometacarpal joint osteoarthritis.
        Clin Rheumatol. 2009; 28: 529-533
        • Paschoal N.D.O.S.
        • Natour J.
        • Machado F.S.
        • de Oliveira H.A.V.
        • Furtado R.N.V.
        Effectiveness of triamcinolone hexacetonide intraarticular Injection in interphalangeal joints: a 12-week randomized controlled trial in patients with hand osteoarthritis.
        J Rheumatol. 2015; 42: 1869-1877
        • Meenagh G.K.
        • Patton J.
        • Kynes C.
        • Wright G.D.
        A randomised controlled trial of intra-articular corticosteroid injection of the carpometacarpal joint of the thumb in osteoarthritis.
        Ann Rheum Dis. 2004; 63: 1260-1263
        • Stahl S.
        • Karsh-Zafrir I.
        • Ratzon N.
        • Rosenberg N.
        Comparison of intraarticular Injection of depot corticosteroid and hyaluronic acid for treatment of degenerative trapeziometacarpal joints.
        J Clin Rheumatol. 2005; 11: 299-302
        • Heyworth B.E.
        • Lee J.H.
        • Kim P.D.
        • Lipton C.B.
        • Strauch R.J.
        • Rosenwasser M.P.
        Hylan versus corticosteroid versus placebo for treatment of basal joint arthritis: a prospective, randomized, double-blinded clinical trial.
        J Hand Surg Am. 2008; 33: 40-48
        • Trellu S.
        • Dadoun S.
        • Berenbaum F.
        • Fautrel B.
        • Gossec L.
        Intra-articular injections in thumb osteoarthritis: a systematic review and meta-analysis of randomized controlled trials.
        Joint Bone Spine. 2015; 82: 315-319
        • Fowler A.
        • Swindells M.G.
        • Burke F.D.
        Intra-articular corticosteroid injections to manage trapeziometacarpal osteoarthritis-a systematic review.
        Hand (N Y). 2015; 10: 583-592
        • Rhee P.C.
        • Paul A.
        • Carlsen B.
        • Shin A.Y.
        Outcomes of surgical management for thumb basilar arthritis in patients 55 years of age and younger.
        Hand (N Y). 2019; 14: 641-645
        • Megerle K.
        • Grouls S.
        • Germann G.
        • Kloeters O.
        • Hellmich S.
        Revision surgery after trapeziometacarpal arthroplasty.
        Arch Orthop Trauma Surg. 2011; 131: 205-210
        • Sadhu A.
        • Calfee R.P.
        • Guthrie A.
        • Wall L.B.
        Revision ligament reconstruction tendon interposition for trapeziometacarpal arthritis: a case-control investigation.
        J Hand Surg Am. 2016; 41: 1114-1121
        • Renfree K.J.
        • Roarke M.C.
        Thumb metacarpal-trapezoid impingement as an etiology of pain after trapeziectomy and basal joint soft tissue arthroplasty: a case series.
        J Hand Surg Am. 2021; 46: 931.e1-931.e6
        • Cole B.J.
        • Schumacher H.R.
        Injectable corticosteroids in modern practice.
        J Am Acad Orthop Surg. 2005; 13: 37-46
        • Centeno L.M.
        • Moore M.E.
        Preferred intraarticular corticosteroids and associated practice: a survey of members of the American College of Rheumatology.
        Arthritis Care Res. 1994; 7: 151-155
        • Matzon J.L.
        • Lebowitz C.
        • Graham J.G.
        • Lucenti L.
        • Lutsky K.F.
        • Beredjiklian P.K.
        Risk of infection in trigger finger release surgery following corticosteroid injection.
        J Hand Surg Am. 2020; 45: 310-316
        • Kirby D.
        • Donnelly M.
        • Buchalter D.
        • Gonzalez M.
        • Catalano L.
        • Hacquebord J.
        Influence of corticosteroid injections on postoperative infections in carpal tunnel release.
        J Hand Surg Am. 2021; 46: 1088-1093
        • Straszewski A.J.
        • Lee C.S.
        • Dickherber J.L.
        • Wolf J.M.
        Temporal relationship of corticosteroid injection and open release for trigger finger and correlation with postoperative deep infections. J Hand Surg Am.
        (Published online October 9, 2021)
        • Lutsky K.F.
        • Lucenti L.
        • Banner L.
        • Matzon J.
        • Beredjiklian P.K.
        The effect of intraoperative corticosteroidinjections on the risk of surgical site infections for hand procedures.
        J Hand Surg Am. 2019; 44: 840-845.e5
        • Qin M.M.
        • Qin C.D.
        • Johnson D.J.
        • Kalainov D.M.
        Risk of infection in thumb carpometacarpal surgery after corticosteroid injection.
        J Hand Surg Am. 2021; 46: 765-771.e2
        • Wiggins M.E.
        • Fadale P.D.
        • Barrach H.
        • Ehrlich M.G.
        • Walsh W.R.
        Healing characteristics of a type I collagenous structure treated with corticosteroids.
        Am J Sports Med. 1994; 22: 279-288
        • Wiggins M.E.
        • Fadale P.D.
        • Ehrlich M.G.
        • Walsh W.R.
        Effects of local injection of corticosteroids on the healing of ligaments. A follow-up report.
        J Bone Joint Surg Am. 1995; 77: 1682-1691
        • Ismail A.M.
        • Balakrishnan R.
        • Rajakumar M.K.
        • Lumpur K.
        Rupture of patellar ligament after steroid infiltration. Report of a case.
        J Bone Joint Surg Br. 1969; 51: 503-505
        • Kleinman M.
        • Gross A.E.
        Achilles tendon rupture following steroid injection. Report of three cases.
        J Bone Joint Surg Am. 1983; 65: 1345-1347
        • Vallone G.
        • Vittorio T.
        Complete Achilles tendon rupture after local infiltration of corticosteroids in the treatment of deep retrocalcaneal bursitis.
        J Ultrasound. 2014; 17: 165-167
        • Mikolyzk D.K.
        • Wei A.S.
        • Tonino P.
        • et al.
        Effect of corticosteroids on the biomechanical strength of rat rotator cuff tendon.
        J Bone Joint Surg Am. 2009; 91: 1172-1180
        • Thompson J.S.
        Suspensionplasty technique.
        Atlas Hand Clin. 1997; 2: 101-126
        • Eaton R.G.
        • Glickel S.Z.
        • Littler J.W.
        Tendon interposition arthroplasty for degenerative arthritis of the trapeziometacarpal joint of the thumb.
        J Hand Surg Am. 1985; 10: 645-654
        • McCann P.A.
        • Wakeley C.J.
        • Amirfeyz R.
        The effect of ultrasound guided steroid injection on progression to surgery in thumb CMC arthritis.
        Hand Surg. 2014; 19: 49-52
        • Renfree K.J.
        • Odgers R.
        • Tillinghast C.
        • Zhang N.
        Effect of partial and complete trapezoid excision on radiographic and functional results after abductor pollicis longus suspensionplasty.
        J Hand Surg Am. 2020; 45: 364.e1-364.e9
        • Herren D.B.
        • Lehmann O.
        • Simmen B.R.
        Does trapeziectomy destabilize the carpus?.
        J Hand Surg Br. 1998; 23: 676-679
        • Yuan B.J.
        • Moran S.L.
        • Tay S.C.
        • Berger R.A.
        Trapeziectomy and carpal collapse.
        J Hand Surg Am. 2009; 34: 219-227
        • McAlindon T.E.
        • LaValley M.P.
        • Harvey W.F.
        • et al.
        Effect of intra-articular triamcinolone vs saline on knee cartilage volume and pain in patients with knee osteoarthritis: a randomized clinical trial.
        JAMA. 2017; 317: 1967-1975
        • Simeone F.J.
        • Vicentini J.R.T.
        • Bredella M.A.
        • Chang C.Y.
        Are patients more likely to have hip osteoarthritis progression and femoral head collapse after hip steroid/anesthetic injections? A retrospective observational study.
        Skeletal Radiol. 2019; 48: 1417-1426
        • Noyes F.R.
        • Grood E.S.
        • Nussbaum N.S.
        • Cooper S.M.
        Effect of intra-articular corticosteroids on ligament properties: a biomechanical and histological study in rhesus knees.
        Clin Orthop Relat Res. 1977; 123: 197-209