Thumb Carpo-Metacarpal Arthritis
Degenerative arthritis (osteoarthritis) of the thumb carpo-metacarpal joint (CMC) is a common problem, which usually affects women beginning around the fifth decade of life. Arthritis is a condition where the articular cartilage or gliding surface of a joint becomes worn and degraded. This may ultimately result in a painful and stiff joint.
Frequently Asked Questions
What causes Thumb Carpo-Metacarpal Arthritis?
The actual degenerative process of osteoarthritis is not completely understood. While it is primarily a "wear and tear" process, there are other factors that play a role in degenerative arthritis. These include previous trauma or injury, genetic predisposition, repetitive stress over long periods of time, or laxity of the joint.
What are the symptoms of Thumb Carpo-Metacarpal Arthritis?
People with arthritis of the thumb typically complain of pain or an aching feeling at the base of the thumb. These symptoms may be aggravated by the weather, grasping, pinching or when severe may be present at rest or at night. Other symptoms include weakness, clumsiness or deformity of the thumb.
What can be done?
The initial treatment for carpo-metacarpal arthritis is usually non-surgical. While oral non-steroidal anti-inflammatory medications (NSAIDS) may be slightly helpful, the most effective initial treatment is a cortisone injection into the arthritic joint. Properly done, in the office, pain relief should be very good and long lasting. Younger patients and those that do heavy repetitive work with the hand may have recurrent symptoms. If the symptoms return after two or three successful steroid injections then surgery should be considered.
A procedure called 1st CMC or Basilar joint arthroplasty is the best surgical option. Unlike joint replacement in the hip and knee, where the arthritic joint is replaced by metal, plastic and cement, Basilar joint arthroplasty does not use an implant. There is no metal or plastic to wear out, no cement to loosen. Thumb arthroplasty involves removing the small arthritic bone called the trapezium and using a tendon to act as a cushion between the arthritic thumb bone and the rest of the wrist bones. The usual result is relief of pain, as well as restoration of range of motion and strength.
Surgical treatment consists of a short procedure done in the operating room on an out patient basis (you go home the same day). After the operation, the thumb is placed in some type of splint for approximately a month, followed by hand therapy.