Systematic Review on Static and Dynamic Stabilizers of the Trapeziometacarpal Joint: Biomechanical Evidence and Implications for Physical Therapy
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Abstract
Background and objectives: The contribution of ligaments and muscles to containing dorsoradial subluxation related to rhizarthrosis remains debated. Anatomical, cadaveric, in vivo, and clinical evidence on trapeziometacarpal joint (TMC) stabilizers and their implications for physiotherapy were synthesized.
Methods: Systematic review (PRISMA 2020; retrospective registration in PROSPERO) of cadaveric, in vivo, and clinical studies on human TMC, with searches in four databases (May 2025; updated September 2026). Quality with QUACS, PEDro, and JBI. Synthesis without meta-analysis (SWiM) and certainty assessment using GRADE domains, expressed as exploratory confidence in biomechanical experiments.
Results: We included 60 studies: 38 cadaveric, 18 in vivo, three mixed, and one physical model. The dorsoradial ligament (DRL) restricted dorsoradial subluxation according to position and load (moderate exploratory confidence); the role of the anterior oblique was variable (low). The opponens pollicis (OP), alone or with the first dorsal interosseous (FDI), reduced subluxation in experiments. In vivo, FDI-directed activation reduced radial displacement of the base of the first metacarpal in healthy subjects, without excluding coactivation, but did not reduce dorsal displacement in advanced osteoarthritis (very low certainty). No trials isolated FDI/OP (non-gradable) training, and the programs evaluated did not outperform the comparator.
Discussion: The findings give mechanistic plausibility to the contribution of these structures to joint stability, with limited clinical extrapolation; invasive techniques lack direct evaluation.
Conclusions: In experimental models, DRL is a relevant passive restrictor. No direct clinical evidence supports selective FDI/OP training or percutaneous techniques for DRL.
Other information: PROSPERO Registry: CRD420261330988. Funding: This research received no external funding.
Keywords
- Carpometacarpal Joints
- Ligaments, Articular
- Muscle, Skeletal
- Biomechanical Phenomena
- Joint Instability
- Physical Therapy Modalities
- Osteoarthritis
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