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Table 2 Qualitative Review of Study Results

From: Menstrual hormone-induced cyclic thumb CMC instability and degeneration in women: a systematic review

Author, Year N (%F), Factor Interventions; Outcome Variables Hypotheses Study results
Clifton et al. 2014 15 (67%) TMC arthroplasty patients Tissue sampling
Immunostaining for RXFP1 in dorsoradial ligaments and synovium
RXFP1 will be present in tissues stabilizing the TMC joint; therefore, relaxin could impact joint stability Stratifying data by disease severity (Eaton–Littler score, timing to trapeziectomy) demonstrated a rapid pace of TMC degradation in women. Women were significantly younger at time of trapeziectomy, with a strong positive correlation of Eaton score and RXFP-1 concentration
Em et al. 2015 88 (100%) women; 48 with BJHS and 40 controls Assessment for hypermobility, SRC
Average SRC in women with BJHS vs. controls
Elevated relaxin may play a role in certain physiologic manifestations of BJHS Serum relaxin levels of the BJHS group were non-significantly higher than controls (47.1 ± 20.3 pg/mL, 34.4 ± 22.1 pg/mL; p = 0.28). BJHS subjects had higher incidence of musculoskeletal pathologies, significantly (p < 0.05) arthralgia (33.3% vs. 25%), myalgia (55.6% vs. 27.5%), pes planus (57.8% vs. 30%), and hyperkyphosis (62.2% vs. 22.5%). The median relaxin levels were significantly greater in BJHS vs. control subjects with pes planus (33.3 vs. 16.4, p = 0.05) and/or hyperkyphosis (33.3 vs. 12.0, p < 0.05)
Lubahn et al. 2006 8 (100%) premenopausal women; TMC arthroplasty, FCR repair Tissue Sampling
Presence of relaxin receptors in volar oblique ligament
Female TMC OA prevalence may result from hormone-induced laxity of the volar oblique ligament. Relaxin is likely the hormone, it signals collagenases Relaxin specifically bound all VOLs, with binding of cervical tissue > VOL > meniscal tissue. It was presumed that specific VOL binding of relaxin indicated cellular and/or extracellular matrix receptors. The lack of men presenting for treatment/study was noted
Pokorny et al. 2000 55 (100%) women aged 20–25; 3 months with 30 on low-dose OCPs (test), 25 not AP tibial translation, 5th DIP extension, 2nd PIP abduction, adduction
Knee and hand laxity in OCP users vs. non-users
The average joint laxity of women on OCPs will be higher than women not on OCPs, due to the endogenous estrogen and progesterone Joint laxity had no significant difference between groups, including when stratified by cycle day groups. The control group had non-significant greater knee laxity during CD23+, and 2nd PIP laxity during CD12–22
Wolf et al. 2012 49 (61%) patients; TMC arthroplasty, trapeziectomy, ligament repair Preoperative Beighton score and SRC, tissue sampling
SRC, RXFP1 amount on anterior oblique ligament, relationship between MMP-1/MMP-13 and RXFP1 location
Relaxin is potentially involved in TMC joint laxity and eventual OA, via laxity of the anterior oblique ligament Higher serum relaxin correlates with more thumb-area relaxin receptors and MMP-1 expression. Average mixed-sex expression levels were 3.73 pg/mL (0–9.45 pg/mL) for SRC, 5.23*106ag for RXFP1 receptor, 0.022ag for MMP-1, and 0.318ag for MMP-3. Serum relaxin had significant relationships vs. log RXFP1 (p = 0.02); and vs. MMP-1 (p = 0.05). RXFP1, MMP-1, and MMP-3 were identified on the anterior oblique ligament
Wolf, J.M, Cameron, K.L. et al. 2013 289 (53%) healthy volunteers Screening for hypermobility (Beighton), TMC stress X-rays, SRC testing
SRC effect on general laxity, TMC joint laxity
High serum relaxin levels will correlate with laxity on TMC stress X-rays; it will also be associated with generalized joint laxity 42% of subjects had detectable SRC; 63% of women and 37% of men. SRC was 2.5 × greater in women, significant in 40–59yo’s. The all-ages female vs. male average SRC was 2.6 + 7.0 vs. 0.99 + 2.4, p < 0.05; with less significance when limited to detectable values. Women, particularly younger age groups, were more lax. SRC-detectable subjects had greater TM laxity, but only when controlling for age. Greater TM laxity was related to SRC, but so was younger age