First Carpometacarpal Joint Osteoarthritis

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Thumb-base osteoarthritis (first CMC joint) is a very common condition that predominantly affects postmenopausal women.

Aetiology

The first CMCJ is highly mobile which is probably linked to an increased rate of degeneration. There is also an association with hypermobility

Epidemiology

Increases with age, most common in postmenopausal women. The female to male ratio is 6:1.1

Assessment

• Base of thumb pain
• Activity related particularly gripping, using taps and door knobs, unscrewing lids, turning keys, sewing.
• Thumb weakness

Examination

In advanced stages thenar muscle wasting combined with subluxation and adduction of the 1st metacarpal can lead to a characteristic "squaring" joint deformity"

• Deformity at the base of the first MCPJ.
• Adduction of the 1st metacarpal may occur which is visualised by a reduced 1st web space and hyperextension of MCPJ.
• Palpate for tenderness, crepitation, and subluxation
• Range of motion
• Power, pincer strength may be reduced
• Grind test: Hold the 1st metacarpal, move the thumb in a circular motion, and apply axial compression

Differential Diagnoses

Differential Diagnosis

• Scaphoid Fracture (missed)
• Non-union of scaphoid fracture
• De Quervain Tendinopathy
• Scaphoid impaction syndrome
• Intersection Syndrome
• Flexor carpi radialis tendinopathy
• Dorsal pole of lunate impingement on distal radius (gymnasts)
• Scapholunate dissociation
• First Carpometacarpal Joint Osteoarthritis
• Scaphotrapeziotrapezoid (STT) Joint Osteoarthritis
• Osteoarthritis of the radiocarpal joint
• Ganglia
• Radial sensory nerve entrapment in the forearm
• Crystal-induced arthritis
• C6 radicular syndrome

Investigations

Xray Inflammatory and rheumatological blood tests if required.

Management

Treatment options are limited, and the available evidence is poor.

Activity Modification

Hand Therapy

Steroid Injection

Corticosteroid injections can be useful to manage pain flares.

Hypertonic Dextrose Injection

Steroid slightly more effective at one month, dextrose slightly more effective at six months.

Surgery

Literature Review

Literature Review

Reviews from the last 7 years: review articles, free review articles, systematic reviews, meta-analyses, NCBI Bookshelf

Articles from all years: PubMed search, Google Scholar search.

TRIP Database: clinical publications about evidence-based medicine.

Other Wikis: Radiopaedia, Wikipedia Search, Wikipedia I Feel Lucky, Orthobullets,