Carpometacarpal Arthritis

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
- Phalanx Fractures (Hand)
- Metacarpal Fractures
Dislocations
Tendinopathies
Ligament Injuries
- Gamekeepers Thumb (UCL)
- Radial Collateral Ligament of the Thumb Injury (RCL)
Neuropathies
Arthropathies
Nail Bed Injuries
Pediatric Considerations
- Proximal Phalanx Avulsion Fracture (Thumb)
- Middle and Distal Phalanx Avulsion Fracture
Other
- Dupuytrens Contracture
- Intrinsic Plus

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

Wrist XR demonstrating severe carpometacarpal osteoarthritis of the thumb

Ultrasound guided CMC injection

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

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:

John Kiel

Last edited:

18 October 2022 17:00:26

Categories:

Arthropathies | Finger | Hand | Upper Extremity

[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.

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