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Carpometacarpal Arthritis

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Other Names

  • Basilar Thumb Arthritis
  • CMCJ Arthritis

Background

History

Epidemiology

  • Very common, affecting up 11% of men and 33% of women[1]
  • Second most common arthritis of hand behind DIPJ

Pathophysiology

  • Main: Osteoarthritis
  • Anatomy
  • Motion: adduction-abduction, flexion-extension and axial rotation
  • Pathophysiology
    • Laxity of the anterior oblique ligament or "beak" ligament leads to increased stress on CMCJ
    • Subsequently, cartilage loss, bony impingement and pain

Risk Factors

  • Men in 50s, Women in 60s
  • Caucasions
  • Ehler-Danlos syndrome
  • Increased BMI

Differential Diagnosis


Clinical Features

  • General: Physical Examination Hand
  • History
    • Patients report pain, laxity and weakness
    • Trouble with pinching or grasping
  • Physical Exam

Evaluation

Wrist XR demonstrating severe carpometacarpal osteoarthritis of the thumb

Radiographs


Classification

Eaton and Littler Classification

  • Stage I: Normal articular cartilage, possible joint widening due laxity of the beak ligament.
  • Stage II: Narrowing of the joint space, debris and osteophytes smaller than 2 mm in size, more than one-third subluxation of the metacarpal.
  • Stage III: Exhibits more severe joint narrowing, osteophytes and debris greater than 2 mm in size.
  • Stage IV: Involvement of the scaphotrapezial joint

Management

Nonoperative

  • Goal is to relieve pain, restore joint stability
  • Activity modification
  • Splints
  • NSAIDS
  • Corticosteroid Injection
    • Eaton Stage I: 80% of individuals with relief at 18 months[2]
    • Eaton Stage IV: Only 25% have relief at 18 months

Operative

  • Indicated when conservative measures fail
  • The greater the Eaton Stage, the more likely they will need surgergy
  • Surgical options
    • Arthroscopy
    • 1st Metacarpal osteotomy
    • Implant and spacers
    • Ligament reconstruction
    • Arthrodesis
    • Arthroplasty

Return to Play

  • Not commonly seen in athletes

Complications

  • MCP Hyperextension deformity

See Also


References


  1. Gillis J, Calder K, Williams J. Review of thumb carpometacarpal arthritis classification, treatment and outcomes. Can J Plast Surg. 2011 Winter;19(4):134-8. PubMed PMID: 23204884; PubMed Central PMCID: PMC3249665.
  2. Day CS, Gelberman R, Patel AA, Vogt MT, Ditsios K, Boyer MI. Basal joint osteoarthritis of the thumb: A prospective trial of steroid injection and splinting. J Hand Surg Am. 2004;29:247–51.
Created by:
John Kiel on 18 June 2019 23:51:05
Authors:
Last edited:
28 October 2020 14:18:35
Categories: