Thumb Carpal-Metacarpal Joint Osteoarthritis
Osteoarthritis involves the wear of the cartilage (soft, white coating over bone ends where two or more bones
come together) in joints. Once the cartilage is entirely worn, then bone on the two sides of a joint come
together and there is bone-on-bone contact. Osteoarthritis in the wrist most commonly affects the joint at the
base of the thumb (the thumb carpal-metacarpal joint or CMC joint) where it connects to the wrist.
Thumb CMC joint osteoarthritis presents with localized pain in this joint. The joint is located deep to the
muscles at the base of the palm on the thumb side of the hand. This pain may sometimes be confused with
carpal tunnel syndrome. Careful history and examination will help distinguish thumb CMC joint osteoarthritis
from carpal tunnel syndrome. There is point tenderness over the thumb CMC joint with osteoarthritis. There is
also pain when compression force is applied to the thumb thereby loading the thumb CMC joint. There may be
visible enlargement of the thumb CMC joint due to swelling and bone spurs. CMC joint osteoarthritis is not
associated with finger numbness or tingling since there is no involvement of median nerve which is affected in
carpal tunnel syndrome.
With pure thumb CMC joint osteoarthritis, physical exam findings and nerve conduction tests will be negative
for carpal tunnel syndrome and Guyon's canal syndrome. But, it is possible for thumb CMC joint osteoarthritis
to coexist with carpal tunnel syndrome and/or Guyon's canal syndrome.
The treatment of thumb CMC joint osteoarthritis includes the use of splints to protect and immobilize the joint. A
person should refrain from forceful use of the hand. NSAID medications can be used. Occasional local steroid
injections may provide temporary relief. Local heat can also provide temporary relief.
A variety of surgeries can be done for extremely painful cases that are inadequately treated with nonsurgical
measures. It is possible to fuse the thumb CMC joint. This is a way to surgically join the bones across the joint
in order to eliminate motion at the worn joint. It is also possible to remove the bone called the trapezium located
at the base of the thumb. A rolled up piece of tendon can be inserted in its place. This is called an "anchovy"
procedure. There are also trapezium prostheses that can be used to replace the trapezium bone.
QwiTM Gloves and the Qwi Solution are not beneficial for the prevention or treatment of thumb CMC joint
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X-ray of a normal left hand. The black arrow
points toward a normal thumb CMC joint with
no osteoarthritis. Notice the smooth borders
around the bones and also the space
between the bones. This space is occupied
by normal articular cartilage.
X-ray a hand with severe osteoarthritis involving the
thumb CMC joint as indicated by the black arrow.
Notice how there is no space between the bones
because all of the articular cartilage has been worn
away. There is also a white stripe of bone on either
side of the worn joint. This is called subchondral
sclerosis and represents hard, dense bone that
develops beneath joints whose cartilage has worn
away thereby transferring more stress to the
underlying bone. The joint margins are no longer
smooth. Instead, there are bony prominences at the
joint margins. These are called bone spurs or