Basal joint arthritis
by Nathan Wei, MD, FACP, FACR
Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.
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This term “basal joint arthritis” refers to arthritis affecting the joint at the base of the thumb.
Arthritis at the joint of the base of the thumb (technical term, "carpo-metacarpal joint")is a frequent condition, which causes symptoms which can adversely affect both strength and function of the hand. The condition occurs most commonly in women past the age of 40 and often affects both hands.
The type of arthritis that usually causes this problem is osteoarthritis. It affects joint formed by the thumb metacarpal bone and a wrist bone called the trapezium. The base of the metacarpal is shaped like the end of a club and the trapezium is shaped like a saddle. The ends of these bones are covered with cartilage, which cushions and allows freedom of movement. Osteoarthritis leads to wearing away of cartilage and subsequent pain and loss of function.
This joint which governs thumb apposition is the most important joint when it comes to hand function.
Thumb apposition allows the thumb to oppose the fingers for pinching and grasping.
The stability of the joint is due to several small ligaments, which permit motion but constrain the joint as well. If the ligaments loosen enough to allow excessive sliding of the joint, a wearing away of cartilage occurs. Over time the joint surfaces are destroyed and bony spurs develop around the joint.
Repetitive motion such as twisting, turning, or gripping objects with the thumb and fingers can worsen this condition.
Inflammation may develops and this accelerates destruction of the joint. Eventually the joint subluxes (goes out of place).
Patients who have arthritis at the base of the thumb usually notice pain associated with pinching activities such as turning keys or opening car doors. Tenderness in the fleshy part of the thumb may also be experienced and there may be an aching at the base of the thumb following excessive use or occur with weather changes.
As the disease progresses the patient will often avoid using the thumb for activities that cause pain and over time this disuse can lead to weakness, muscle loss and a tendency to drop things.
Swelling at the base of the thumb due to inflammation of the joint is usually seen. Bony spurs and subluxation will cause a "squared-off" appearance. Tenderness and a "crunching" sensation can be noted.
A diagnostic maneuver known as a "grind test" or "torque test" is sometimes done. In this test, the first metacarpal is grasped, pushed downward and rotated. Pain and a crunching sensation indicate that arthritis is present.
X-rays will confirm the presence and severity of osteoarthritis.
Symptoms and the adverse effects on the ability to perform daily tasks will best determine treatment.
Early on, anti-inflammatory medication, glucocorticoid injections into the joint, or splinting of the wrist and thumb may be helpful.
It is important that the splints used for this condition extend up on the thumb all the way. Most "drug-store" wrist splints leave the thumb free and may worsen the discomfort at the joint. When these conservative methods of treatment are no longer beneficial to the patient, surgery may be warranted.
Arthroscopic debridement of the joint followed by the injection of viscosupplement (lubricant) has been used with success by some. The advantage of this procedure is that it is minimally invasive compared with other surgical procedures.
A variety of surgical techniques can be used. All of them remove the destroyed joint surfaces, and create a substitute joint. The procedure is referred to as an arthroplasty.
Usually, one or more incisions are made in the forearm and over the arthritic joint. In general, most techniques involve removing all or part of the small wrist bone - the trapezium. In most cases, the space created by removing the trapezium will be filled in with tendon material from the forearm. Also, an adjacent tendon is used to stabilize the base of the first metacarpal.
Strength recovery may take up to one year depending on the amount of weakness prior to surgery.
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