Trapeziometacarpal osteoarthritis

Editor-In-Chief: Prab R Tumpati, MD
Obesity, Sleep & Internal medicine
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Trapeziometacarpal osteoarthritis
X-ray of osteoarthritis of the CMC joint
Synonyms	Basal joint arthritis, thumb arthritis
Pronounce	N/A
Specialty	Rheumatology, Orthopedic surgery
Symptoms	Pain at the base of the thumb, swelling, stiffness, decreased range of motion
Complications	N/A
Onset	Typically after age 40
Duration	Chronic
Types	N/A
Causes	Degenerative joint disease, overuse, genetic predisposition
Risks	Age, female gender, manual labor, previous injury
Diagnosis	Physical examination, X-ray
Differential diagnosis	Rheumatoid arthritis, gout, tenosynovitis
Prevention	N/A
Treatment	NSAIDs, splinting, corticosteroid injection, surgery
Medication	N/A
Prognosis	Variable, can be managed with treatment
Frequency	Common in older adults
Deaths	N/A

Anatomy of the hand

Trapeziometacarpal osteoarthritis with subluxation

Forces after trapeziectomy

Arthrodesis of the thumb

X-ray of trapeziometacarpal joint replacement

Osteotomy of the thumb

Trapeziometacarpal osteoarthritis is a degenerative joint disease affecting the carpometacarpal joint (CMC) of the thumb. This condition is characterized by the deterioration of the articular cartilage and changes in the surrounding bone structure, leading to pain, stiffness, and reduced function of the thumb.

Anatomy

Anatomy of the hand showing the location of the trapeziometacarpal joint.

The trapeziometacarpal joint is located at the base of the thumb, where the trapezium bone of the wrist meets the first metacarpal bone of the thumb. This joint is a saddle joint, allowing for a wide range of motion, including flexion, extension, abduction, adduction, and opposition.

Pathophysiology

In trapeziometacarpal osteoarthritis, the cartilage that cushions the joint wears down over time, leading to bone-on-bone contact. This results in pain and inflammation. As the condition progresses, osteophytes (bone spurs) may form, and the joint may become deformed.

Symptoms

Common symptoms of trapeziometacarpal osteoarthritis include:

• Pain at the base of the thumb, especially during pinching or gripping activities.
• Swelling and tenderness around the joint.
• Reduced range of motion.
• Weakness in the thumb.
• A grinding sensation in the joint.

Diagnosis

Diagnosis is typically made based on clinical examination and patient history. X-rays can be used to confirm the diagnosis by showing joint space narrowing, subchondral sclerosis, and osteophyte formation.

Treatment

X-ray showing subluxation in trapeziometacarpal osteoarthritis.

Treatment options for trapeziometacarpal osteoarthritis include:

Non-surgical

• Activity modification and rest.
• Use of splints to immobilize the thumb.
• Nonsteroidal anti-inflammatory drugs (NSAIDs) for pain relief.
• Corticosteroid injections to reduce inflammation.

Surgical

• Trapeziectomy: Removal of the trapezium bone.
• Arthrodesis: Fusion of the joint to eliminate movement and pain.
• Joint replacement: Replacement of the joint with a prosthesis.
• Osteotomy: Realignment of the bones to improve joint function.]]

Diagram showing forces after trapeziectomy.

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X-ray of thumb arthrodesis.

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X-ray of trapeziometacarpal joint replacement.

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X-ray showing osteotomy of the thumb.

Prognosis

The prognosis for individuals with trapeziometacarpal osteoarthritis varies. Non-surgical treatments can provide relief for many patients, but surgery may be necessary for those with severe symptoms. Surgical outcomes are generally favorable, with most patients experiencing significant pain relief and improved function.

See also

• Osteoarthritis
• Carpometacarpal joint
• Thumb

References

• "Trapeziometacarpal Osteoarthritis." American Society for Surgery of the Hand. Accessed October 2023.
• "Osteoarthritis of the Thumb." Arthritis Foundation. Accessed October 2023.]]