Advertisement

The Thumb pp 143-155 | Cite as

Arthritis of the Carpometacarpal Joint

  • Seok-Whan Song
  • Joo-Yup Lee
Chapter

Abstract

Osteoarthritis of the carpometacarpal (CMC) joint of the thumb is very common due to inherent wide range of motion of the joint. As high compressive and shear forces occur across the thumb CMC joint during pinch motion, ligament instability can lead to the subsequent development of arthritic changes. Patients with CMC joint arthritis usually suffer pain and weakness of the thumb which significantly alter their hand functions. This review will briefly introduce the pathophysiology and clinical features of the CMC arthritis and will discuss the possible surgical options including ligament reconstruction, extension osteotomy, simple trapeziectomy, interposition arthroplasty, trapezium excision and ligament reconstruction procedures, arthrodesis, and prosthetic arthroplasty. Clinical outcomes after different surgical procedures are also presented.

Keywords

Thumb Arthritis Carpometacarpal 

References

  1. 1.
    Haara MM, Heliovaara M, Kroger H, Arokoski JP, Manninen P, Karkkainen A, et al. Osteoarthritis in the carpometacarpal joint of the thumb. Prevalence and associations with disability and mortality. J Bone Joint Surg Am. 2004;86-A:1452–7.CrossRefGoogle Scholar
  2. 2.
    Barron OA, Glickel SZ, Eaton RG. Basal joint arthritis of the thumb. J Am Acad Orthop Surg. 2000;8:314–23.CrossRefGoogle Scholar
  3. 3.
    Cicuttini FM, Spector TD. The epidemiology of osteoarthritis of the hand. Rev Rhum Engl Ed. 1995;62:3S–8S.PubMedGoogle Scholar
  4. 4.
    Fontana L, Neel S, Claise JM, Ughetto S, Catilina P. Osteoarthritis of the thumb carpometacarpal joint in women and occupational risk factors: a case-control study. J Hand Surg Am. 2007;32:459–65.CrossRefGoogle Scholar
  5. 5.
    Eaton RG, Lane LB, Littler JW, Keyser JJ. Ligament reconstruction for the painful thumb carpometacarpal joint: a long-term assessment. J Hand Surg Am. 1984;9:692–9.CrossRefGoogle Scholar
  6. 6.
    Strauch RJ, Behrman MJ, Rosenwasser MP. Acute dislocation of the carpometacarpal joint of the thumb: an anatomic and cadaver study. J Hand Surg Am. 1994;19:93–8.CrossRefGoogle Scholar
  7. 7.
    Pagalidis T, Kuczynski K, Lamb DW. Ligamentous stability of the base of the thumb. Hand. 1981;13:29–36.CrossRefGoogle Scholar
  8. 8.
    Harvey FJ, Bye WD. Bennett’s fracture. Hand. 1976;8:48–53.CrossRefGoogle Scholar
  9. 9.
    Pellegrini VD Jr. Osteoarthritis of the trapeziometacarpal joint: the pathophysiology of articular cartilage degeneration. I. Anatomy and pathology of the aging joint. J Hand Surg Am. 1991;16:967–74.CrossRefGoogle Scholar
  10. 10.
    Matullo KS, Ilyas A, Thoder JJ. CMC arthroplasty of the thumb: a review. Hand (N Y). 2007;2:232–9.CrossRefGoogle Scholar
  11. 11.
    Klinefelter R. Metacarpophalangeal hyperextension deformity associated with trapezial-metacarpal arthritis. J Hand Surg Am. 2011;36:2041–2; quiz 2043.CrossRefGoogle Scholar
  12. 12.
    Oheb J, Lansinger Y, Jansen JA, Nguyen JQ, Porembski MA, Rayan GM. Radiographic assessment of the robert and lateral views in trapeziometacarpal osteoarthrosis. Hand Surg. 2015;20:251–9.CrossRefGoogle Scholar
  13. 13.
    Saltzherr MS, van Neck JW, Muradin GS, Ouwendijk R, Luime JJ, Coert JH, et al. Computed tomography for the detection of thumb base osteoarthritis: comparison with digital radiography. Skeletal Radiol. 2013;42:715–21.CrossRefGoogle Scholar
  14. 14.
    Dumont C, Lerzer S, Vafa MA, Tezval M, Dechent P, Sturmer KM, et al. Osteoarthritis of the carpometacarpal joint of the thumb: a new MR imaging technique for the standardized detection of relevant ligamental lesions. Skeletal Radiol. 2014;43:1411–20.CrossRefGoogle Scholar
  15. 15.
    Burton RI. Basal joint arthrosis of the thumb. Orthop Clin North Am. 1973;4:331–8.PubMedGoogle Scholar
  16. 16.
    Eaton RG, Littler JW. Ligament reconstruction for the painful thumb carpometacarpal joint. J Bone Joint Surg Am. 1973;55:1655–66.CrossRefGoogle Scholar
  17. 17.
    Eaton RG, Glickel SZ. Trapeziometacarpal osteoarthritis. Staging as a rationale for treatment. Hand Clin. 1987;3:455–71.PubMedGoogle Scholar
  18. 18.
    Badia A. Trapeziometacarpal arthroscopy: a classification and treatment algorithm. Hand Clin. 2006;22:153–63.CrossRefGoogle Scholar
  19. 19.
    Weiss S, LaStayo P, Mills A, Bramlet D. Prospective analysis of splinting the first carpometacarpal joint: an objective, subjective, and radiographic assessment. J Hand Ther. 2000;13:218–26.CrossRefGoogle Scholar
  20. 20.
    Joshi R. Intraarticular corticosteroid injection for first carpometacarpal osteoarthritis. J Rheumatol. 2005;32:1305–6.PubMedGoogle Scholar
  21. 21.
    Jahangiri A, Moghaddam FR, Najafi S. Hypertonic dextrose versus corticosteroid local injection for the treatment of osteoarthritis in the first carpometacarpal joint: a double-blind randomized clinical trial. J Orthop Sci. 2014;19:737–43.CrossRefGoogle Scholar
  22. 22.
    Tomaino MM. Treatment of Eaton stage I trapeziometacarpal disease with thumb metacarpal extension osteotomy. J Hand Surg Am. 2000;25:1100–6.CrossRefGoogle Scholar
  23. 23.
    Gervis WH. Excision of the trapezium for osteoarthritis of the trapezio-metacarpal joint. J Bone Joint Surg Br. 1949;31B:537–9, illust.CrossRefGoogle Scholar
  24. 24.
    Dhar S, Gray IC, Jones WA, Beddow FH. Simple excision of the trapezium for osteoarthritis of the carpometacarpal joint of the thumb. J Hand Surg Br. 1994;19:485–8.CrossRefGoogle Scholar
  25. 25.
    Hollevoet N, Kinnen L, Moermans JP, Ledoux P. Excision of the trapezium for osteoarthritis of the trapeziometacarpal joint of the thumb. J Hand Surg Br. 1996;21:458–62.CrossRefGoogle Scholar
  26. 26.
    Downing ND, Davis TR. Trapezial space height after trapeziectomy: mechanism of formation and benefits. J Hand Surg Am. 2001;26:862–8.CrossRefGoogle Scholar
  27. 27.
    De Smet L, Sioen W, Spaepen D, van Ransbeeck H. Treatment of basal joint arthritis of the thumb: trapeziectomy with or without tendon interposition/ligament reconstruction. Hand Surg. 2004;9:5–9.CrossRefGoogle Scholar
  28. 28.
    Gray KV, Meals RA. Hematoma and distraction arthroplasty for thumb basal joint osteoarthritis: minimum 6.5-year follow-up evaluation. J Hand Surg Am. 2007;32:23–9.CrossRefGoogle Scholar
  29. 29.
    Freedman DM, Eaton RG, Glickel SZ. Long-term results of volar ligament reconstruction for symptomatic basal joint laxity. J Hand Surg Am. 2000;25:297–304.CrossRefGoogle Scholar
  30. 30.
    Koff MF, Shrivastava N, Gardner TR, Rosenwasser MP, Mow VC, Strauch RJ. An in vitro analysis of ligament reconstruction or extension osteotomy on trapeziometacarpal joint stability and contact area. J Hand Surg Am. 2006;31:429–39.CrossRefGoogle Scholar
  31. 31.
    Glickel SZ, Gupta S. Ligament reconstruction. Hand Clin. 2006;22:143–51.CrossRefGoogle Scholar
  32. 32.
    Burton RI, Pellegrini VD Jr. Surgical management of basal joint arthritis of the thumb. Part II. Ligament reconstruction with tendon interposition arthroplasty. J Hand Surg Am. 1986;11:324–32.CrossRefGoogle Scholar
  33. 33.
    Vermeulen GM, Slijper H, Feitz R, Hovius SE, Moojen TM, Selles RW. Surgical management of primary thumb carpometacarpal osteoarthritis: a systematic review. J Hand Surg Am. 2011;36:157–69.CrossRefGoogle Scholar
  34. 34.
    Vitale MA, Taylor F, Ross M, Moran SL. Trapezium prosthetic arthroplasty (silicone, Artelon, metal, and pyrocarbon). Hand Clin. 2013;29:37–55.CrossRefGoogle Scholar
  35. 35.
    Zschock-Holle A, Reik M, Wolfle O, Sauerbier M. [Treatment of basal joint osteoarthritis by Swanson’s trapezium implant arthroplasty]. Handchir Mikrochir Plast Chir. 2015;47:7–16.CrossRefGoogle Scholar
  36. 36.
    Lanzetta M, Foucher G. A comparison of different surgical techniques in treating degenerative arthrosis of the carpometacarpal joint of the thumb. A retrospective study of 98 cases. J Hand Surg Br. 1995;20:105–10.CrossRefGoogle Scholar
  37. 37.
    Umarji SI, Arnander MW, Evans DM. The use of Swanson silastic interposition arthroplasty in revision thumb-base surgery for failed trapeziectomy; a case series of 10 patients. J Hand Surg Eur Vol. 2012;37:632–6.CrossRefGoogle Scholar
  38. 38.
    Pendse A, Nisar A, Shah SZ, Bhosale A, Freeman JV, Chakrabarti I. Surface replacement trapeziometacarpal joint arthroplasty—early results. J Hand Surg Eur Vol. 2009;34:748–57.CrossRefGoogle Scholar
  39. 39.
    Colegate-Stone TJ, Garg S, Subramanian A, Mani GV. Outcome analysis of trapezectomy with and without pyrocarbon interposition to treat primary arthrosis of the trapeziometacarpal joint. Hand Surg. 2011;16:49–54.CrossRefGoogle Scholar
  40. 40.
    Carroll RE. Arthrodesis of the carpometacarpal joint of the thumb. A review of patients with a long postoperative period. Clin Orthop Relat Res. 1987;220:106–10.Google Scholar
  41. 41.
    Fulton DB, Stern PJ. Trapeziometacarpal arthrodesis in primary osteoarthritis: a minimum two-year follow-up study. J Hand Surg Am. 2001;26:109–14.CrossRefGoogle Scholar
  42. 42.
    Eaton RG, Littler JW. A study of the basal joint of the thumb. Treatment of its disabilities by fusion. J Bone Joint Surg Am. 1969;51:661–8.CrossRefGoogle Scholar
  43. 43.
    Leach RE, Bolton PE. Arthritis of the carpometacarpal joint of the thumb. Results of arthrodesis. J Bone Joint Surg Am. 1968;50:1171–7.CrossRefGoogle Scholar
  44. 44.
    Stark HH, Moore JF, Ashworth CR, Boyes JH. Fusion of the first metacarpotrapezial joint for degenerative arthritis. J Bone Joint Surg Am. 1977;59:22–6.CrossRefGoogle Scholar
  45. 45.
    Kenniston JA, Bozentka DJ. Treatment of advanced carpometacarpal joint disease: arthrodesis. Hand Clin. 2008;24:285–94, vi–vii.CrossRefGoogle Scholar
  46. 46.
    Davis TR, Brady O, Dias JJ. Excision of the trapezium for osteoarthritis of the trapeziometacarpal joint: a study of the benefit of ligament reconstruction or tendon interposition. J Hand Surg Am. 2004;29:1069–77.CrossRefGoogle Scholar
  47. 47.
    Davis TR, Pace A. Trapeziectomy for trapeziometacarpal joint osteoarthritis: is ligament reconstruction and temporary stabilisation of the pseudarthrosis with a Kirschner wire important? J Hand Surg Eur Vol. 2009;34:312–21.CrossRefGoogle Scholar
  48. 48.
    Wajon A, Carr E, Edmunds I, Ada L. Surgery for thumb (trapeziometacarpal joint) osteoarthritis. Cochrane Database Syst Rev. 2009;(2):CD004631.Google Scholar
  49. 49.
    Wolf JM, Delaronde S. Current trends in nonoperative and operative treatment of trapeziometacarpal osteoarthritis: a survey of US hand surgeons. J Hand Surg Am. 2012;37:77–82.CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  • Seok-Whan Song
    • 1
  • Joo-Yup Lee
    • 2
  1. 1.Department of Orthopedic SurgeryYeouido St. Mary’s Hospital, The Catholic University of KoreaSeoulSouth Korea
  2. 2.Department of Orthopedic SurgerySt. Paul’s Hospital, The Catholic University of KoreaSeoulSouth Korea

Personalised recommendations