Carpometacarpal Arthritis
Other Names
- Basilar Thumb Arthritis
- CMCJ Arthritis
- CMC-1 OA
- Carpometacarpal Arthritis
Background
- This page refers to degenerative arthritis of the thumb/first Carpometacarpal Joint
History
- First discussed by French anatomist Charles Prosper Ollier in 1883 (need citation)
Epidemiology
- Symptomatic prevalence of 7% of females, 2% for males over 50[1]
- Very common, affecting up 11% of men and 33% of women[2]
- Second most common arthritis of hand behind DIPJ
- One study reported radiographic prevalence in 40% of women, 25% of men over age 75[3]
Introduction
- See: Osteoarthritis Main
General
- A very common location of osteoarthritis and cause of thumb pain
- Generally considered a degenerative condition due to trauma and overuse
- Diagnosis is clinical combined with radiographs
- Treatment is often conservative but can be surgical in refractory cases
Anatomy of the first Carpometacarpal Joint
- 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
Etiology
- Trauma
- Overuse
Pathophysiology
- Laxity of the anterior oblique ligament or "beak" ligament leads to increased stress on CMCJ
- With degeneration, the AOL retreats distally on the metacarpal, volar recess
- Subsequently, cartilage loss, bony impingement and pain
- Periarticular ganglion cysts are often seen as degeneration procedes
Risk Factors
- Men in 50s, Women in 60s
- Caucasions
- Ehler-Danlos syndrome
- Increased BMI
Differential Diagnosis
Differential Diagnosis Finger And Hand Pain
- Fractures
- Dislocations
- Tendinopathies
- Extensor Tendon Injuries of the Hand
- Central Slip Extensor Tendon Injury
- Flexor Tendon Injuries of the Hand
- Boutonniere Deformity
- Swan Neck Deformity
- Jersey Finger
- Mallet Finger
- Trigger Finger
- De Quervains Tenosynovitis
- Volar Plate Avulsion Injury
- Sagittal Band Injury
- Mannerfelt Lesion (FPL Rupture)
- Ligament Injuries
- Neuropathies
- Arthropathies
- Nail Bed Injuries
- Pediatric Considerations
- Other
Clinical Features
History
- Patients report pain, laxity and weakness
- Also swelling, reduced motion, instability
- Trouble with pinching or grasping
Physical Exam: Physical Examination Hand
- Swelling, crepitus
Special Tests
- Thumb CMC Grind Test: involves axial load and circumduction
- Thumb MP Extension Test: extend the thumb against resistance
- Lever Test Thumb: grasp metacarpal, move thumb in radial/ulnar directions
Evaluation
Radiographs
- Standard Radiographs Hand
- Typically sufficient to make diagnosis
- Findings
- Roberts View
MRI
- May be useful to evaluate the anterior oblique ligament
- Especially in patients not responding to conservative therapy
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
- Thumb Spica Brace
- Shown to have benefit for up to 1 year[7]
- NSAIDS
- Physical Therapy
- Carpometacarpal Joint Injection
- Eaton Stage I: 80% of individuals with relief at 18 months following CSI[8]
- Eaton Stage IV: Only 25% have relief at 18 months
Operative
- Indications
- When conservative measures fail
- The greater the Eaton Stage, the more likely they will need surgery
- Approach depends on stage of the disease
- Surgical options
- Arthroscopy
- 1st Metacarpal osteotomy
- Implant and spacers
- Ligament reconstruction
- Arthrodesis
- Arthroplasty
Rehabilitation and Return to Play
Rehabilitation
- Needs to be updated
Return to Play
- Not commonly seen in athletes
Prognosis and Complications
Prognosis
- Surgical
- Favorable outcomes when volar ligament reconstruction is used to treat painful, unstable, non-arthritic thumbs[9]
Complications
- Chronic pain
- MCP Hyperextension deformity
See Also
Internal
External
- Sports Med Review Hand Pain: https://www.sportsmedreview.com/by-joint/hand/
References
- ↑ Bijlsma, Johannes WJ, Francis Berenbaum, and Floris PJG Lafeber. "Osteoarthritis: an update with relevance for clinical practice." The Lancet 377.9783 (2011): 2115-2126.
- ↑ 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.
- ↑ Armstrong AL, Hunter JB, Davis TR. The prevalence of degenerative arthritis of the base of the thumb in post-menopausal women. J Hand Surg Br 1994; 19:340-341.
- ↑ Image courtesy of orthoinfo.aaos.org
- ↑ Roemer, Frank W., and Ali Guermazi. "Osteoarthritis year 2012 in review: imaging." Osteoarthritis and Cartilage 20.12 (2012): 1440-1446.
- ↑ Model, Zina, et al. "Evaluation of physical examination tests for thumb basal joint osteoarthritis." Hand 11.1 (2016): 108-112.
- ↑ Tsehaie, Jonathan, et al. "Outcome of a hand orthosis and hand therapy for carpometacarpal osteoarthritis in daily practice: a prospective cohort study." The Journal of hand surgery 43.11 (2018): 1000-1009.
- ↑ 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.
- ↑ Collins E. Magnetic resonance imaging technology in evaluating the presence and integrity of the anterior oblique ligament of the thumb. orthopaedic Reviews 2012; 4:e23
Created by:
John Kiel on 18 June 2019 23:51:05
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Last edited:
23 May 2025 12:39:40
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