Base of thumb arthrtitis/carpo-metacarpal-joint (CMCJ) osteoarthritis

Degenerative arthritis – osteoarthritis – at the base of the thumb is extremely common and age related. It might appear as a dull ache at the base of your thumb for many years with exacerbations of the pain when you load the thumb in pinching or opening a jar.

This degeneration starts at the primary joint of the thumb, but spreads to the adjacent joints due to the abnormal subsequent loading of these joints. Joint cartilage regeneration is not possible – once it is worn away it is does not regenerate.

This degeneration also places more stress on the surrounding ligaments and they struggle to contain the joint, so the thumb can’t be maintained in its position to complete tasks and may appear unsightly. The base of the thumb appears squared off and cannot extend away from the palm.


  • Management
Management

All management is aimed at providing sustained symptomatic relief and is personally tailored according to what the individual patient’s concerns are.

Non-operative management

First line therapy is rest and anti-inflammatories, as well as referral to a hand therapist for lifestyle modification and a splint, which has been shown to be very effective. If this is inadequate, we offer the patient an intra-articular steroid injection to relieve the inflammation and pain associated with the degeneration.

Operative management

Advanced disease or failure of non-operative management will require surgery. There are many options but the most reliable results are achieved with a trapezium (the offending bone) excision with or without a ligament reconstruction and tendon interposition, specifically in older, less active patients with advanced disease.

Young patients who place higher demands on their hands do better with a fusion of the MCP joint. In younger patients with early disease there are other alternative surgical options available. Arthroplasty (joint replacement) is now available but is still not proven to be better than trapezium excision.

95% of patients achieve a good or excellent result with this surgery. The thumb is immobilised in a splint post-surgery for the first 4 weeks. It is highly recommended that hand therapy be undertaken post-surgery for optimal recovery. Most patients are very comfortable and free of pain 3-4 months post the surgery, with no limitation on their activities related to the thumb function.

Conditions Managed



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