Thumb Arthritis

By admin On Mar 12, 2024

Ovid: 5-Minute Orthopaedic Consult

Editors: Frassica, Frank J.; Sponseller, Paul D.; Wilckens, John H.

Title: 5-Minute Orthopaedic Consult, 2nd Edition

> Table of Contents > Thumb Arthritis

Thumb Arthritis

Darryl B. Thomas MD

Dawn M. LaPorte MD

Basics

Description

Degenerative joint disease commonly
presents in the hand and is associated with pain, swelling, loss of
motion, and, later, deformity.
Frequently, the thumb is the earliest site of involvement, with the CMC joint affected 1st, especially in osteoarthritis.
The 1st CMC joint is considered the most important joint of the hand.
Thumb arthritis, which may be unilateral or bilateral, occurs as commonly in the nondominant hand as in the dominant one.
It generally affects more females than males (1).
Various forms of arthritis affect the thumb, including:
- Osteoarthritis
- Rheumatoid arthritis
- Gout

Epidemiology

Incidence

The incidence is highest in persons ≥55 years old.

Risk Factors

Increased body mass index (1)

Diagnosis

Signs and Symptoms

Joint pain
Warmth
Swelling
Stiffness
Crepitus
Triggering (catching of tendon, with snapping and locking), most noticeably during activities such as pinching and grabbing

Physical Exam

Perform a careful and thorough
examination of the hand and thumb, with attention to ROM of the joints
(CMC, MCP, IP) and associated swelling, erythema, and soft-tissue
masses.
Test for “snuffbox” tenderness and tendinitis (Finkelstein test).

Tests

Lab

No serum laboratory tests are needed.

Imaging

Plain radiographs reveal a loss of joint space, sclerosis, spur formation, and subchondral cysts.

Pathological Findings

Rheumatoid arthritis: Hypertrophic
synovitis that eventually destroys joint cartilage, compresses or
disrupts tendons, compresses adjacent nerves, and dislocates and erodes
the joint
Osteoarthritis: Loss of articular
cartilage associated with spur formation and loss of motion, but not
associated with tendon ruptures or triggering as frequently as in
rheumatoid arthritis

Differential Diagnosis

Ligamentous injuries
Tendon injuries (e.g., de Quervain tenosynovitis)
Scaphoid fractures

Treatment

General Measures

Supportive measures include rest, heat, analgesics, splint immobilization, and NSAIDs.
Intra-articular corticosteroid injections may be helpful during flare-ups.
Activity limitation or modification
Rheumatologic or orthopaedic consultation for those with symptoms refractory to nonoperative management

Special Therapy

Physical Therapy

A hand therapist can fashion a splint to immobilize the thumb while preserving wrist ROM.
Therapy often is helpful after surgery to reduce swelling and regain motion and function.

Medication

NSAIDs
Intra-articular steroid injection, although not shown to be effective versus placebo in CMC arthritis (2)

Surgery

MCP joint:
- Early surgical treatment may involve synovectomy of the joint and tendon advancement or tendon transfer.
- If the joint is grossly unstable, or the articular surface is destroyed, arthrodesis (fusion) may be indicated.
CMC joint:
- Treatment may involve arthroplasty, consisting of resection of the trapezium and replacement with the patient’s own tendon.
- If arthroplasty fails, arthrodesis may be performed.

Follow-up

Prognosis

The prognosis is fairly good.
Arthrodesis is the most reliable pain relief procedure, but it results in permanent limited motion.
Interpositional tendon arthroplasty is the most common and overall most effective procedure for CMC arthritis.
- Patients enjoy decreased pain and improved quality of life (3).

P.451

Complications

Surgery may be complicated by:
- Damage to the radial sensory nerve
- Wound infection
- Nonunion
- Chronic subluxation
- An unstable joint

Patient Monitoring

Patients must be followed at 4–12-week intervals for assessment of function and for detecting postoperative wound complications.

References

1. Haara
MM, Heliovaara M, Kroger H, et al. Osteoarthritis in the
carpometacarpal joint of the thumb. Prevalence and associations with
disability and mortality. J Bone Joint Surg 2004;86A:1452–1457.

2. Meenagh
GK, Patton J, Kynes C, et al. A randomised controlled trial of
intra-articular corticosteroid injection of the carpometacarpal joint
of the thumb in osteoarthritis. Ann Rheum Dis 2004;63:1260–1263.

3. Angst
F, John M, Goldhahn J, et al. Comprehensive assessment of clinical
outcome and quality of life after resection interposition arthroplasty
of the thumb saddle joint. Arthritis Rheum 2005;53:205–213.

Additional Reading

Siegel D, Jupiter JB. Osteoarthritis of the hand and wrist. In: Jupiter JB, ed. Flynn’s Hand Surgery, 4th ed. Baltimore: Williams & Wilkins, 1991:407–417.

Tomaino MM, King J, Leit M. Thumb basal joint arthritis. In: Green DP, Hotchkiss RN, Pederson WC, et al. eds. Green’s Operative Hand Surgery, 5th ed. Philadelphia: Elsevier Churchill Livingstone, 2005: 461–485.

Miscellaneous

Codes

ICD9-CM

716.95 Arthritic hand

FAQ

Q: How is thumb arthritis diagnosed?

A:
Patients present with complaints of pain and possibly deformity. They
are tender over the affected joint(s) and may have limited ROM and
crepitus at the joint with motion. The diagnosis is confirmed with
plain radiographs showing decreased joint space and possibly sclerosis,
osteophyte formation, and/or cystic change.

Q: How is thumb CMC arthritis treated?

A:
The 1st line of treatment is with splint immobilization and
anti-inflammatory medication. The splint used is a hand-based
thumb-keeper splint and is to be worn as much as possible during daily
activity. If symptoms persist, a corticosteroid injection may be
helpful. For patients with persistent or recurrent severe pain,
surgical treatment is warranted, using CMC arthroplasty and tendon
interposition.