Comparative evaluation of novel hyper-supinated with standard radiographic views for thumb carpometacarpal and scaphotrapeziotrapezoid joints: An inter-rater analysis

Published Date: 28th October 2025

Publication Authors: Loh. W, Iyengar. KP

Introduction
Basal thumb osteoarthritis, encompasses degenerative arthropathy of the first carpometacarpal joint (CMCJ) and the scaphotrapezotrapezoidal joint (STTJ), is a prevalent condition that significantly impairs hand function. Complex orientation of these joints renders traditional radiographic assessments with anteroposterior (AP/True Robert's) and lateral views, prone to limitations in visualising peritrapezial joint spaces.
The purpose of this study is to introduce a novel “hypersupinated view” and evaluates its efficacy in visualisation of peritrapezial joint spaces with implications in the clinical decision-making process.
Patient and methods
A total of 26 patients with basal thumb pain underwent radiography of the thumb in three projections: AP, lateral and hypersupinated orientations. Two consultant orthopaedic hand surgeons independently evaluated the visual clarity of the CMCJ and STTJ on a 5-point Likert ordinal scale, with 1 being ‘poor’ and 5 being ‘excellent’ views. Inter-rater agreement was assessed using weighted Cohen's Kappa. Differences in ratings between views were analysed using Friedman and post-hoc Wilcoxon signed-rank tests.
Results
For the first CMCJ, hypersupinated view ratings were highest (R1: 3.38, R2: 4.69), but inter-rater agreement was low (Kappa: 0.070). The AP view showed better agreement (Kappa: 0.160) despite slightly lower ratings (R1: 2.04, R2: 4.35). For the STTJ, the hypersupinated view again received the highest rating (R1: 2.38, R2: 4.62), while the AP view demonstrated the best agreement (Kappa: 0.460). Friedman tests showed significant differences for both raters for the first CMCJ and for rater 2 for the STTJ. Post-hoc tests confirmed that rater 1 preferred the hypersupinated view for first CMCJ, and rater 2 preferred hypersupinated and lateral views for STTJ.
Conclusion
The hypersupinated view provides superior diagnostic detail for both joints though with reduced reproducibility between raters allowing better targeting to guide appropriate patient management.

Hasan, T.; Loh, W.; Iyengar, K.P. et al. (2026). Comparative evaluation of novel hyper-supinated with standard radiographic views for thumb carpometacarpal and scaphotrapeziotrapezoid joints: An inter-rater analysis. Journal of Hand and Microsurgery. 18(1), p.100365. [Online]. Available at: https://doi.org/10.1016/j.jham.2025.100365 [Accessed 17 December 2025].

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