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Carpometacarpal Arthritis
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Other Names
- Basilar Thumb Arthritis
- CMCJ Arthritis
Background
- This page refers to degenerative arthritis of the Carpometacarpal Joint
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
- Biconcave-convex saddle joint
- Articulation of 1st Metacarpal and Trapezium
- There are also lesser articulations with Trapezoid, Scaphoid
- 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
- Fractures
- Dislocations
- Tendinopathies
- Ligament Injuries
- Neuropathies
- Arthropathies
- Nail Bed Injuries
- Pediatric Considerations
- Other
Clinical Features
- General: Physical Examination Hand
- History
- Patients report pain, laxity and weakness
- Trouble with pinching or grasping
- Physical Exam
- Swelling, crepitus
- Thumb CMC Grind Test typically positive, involves axial load and circumduction
Evaluation
Radiographs
- Standard Radiographs Hand or Standard Radiographs Wrist
- Typically sufficient to make diagnosis
- Roberts View
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
- Carpometacarpal Joint Injection
- Eaton Stage I: 80% of individuals with relief at 18 months following CSI[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
External
- Sports Med Review Hand Pain: https://www.sportsmedreview.com/by-joint/hand/
References
- ↑ 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.
- ↑ 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:
18 October 2022 17:00:26
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