CMC 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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Osteoarthritis often affects the carpometacarpophalangeal (CMC) joint of the thumb.
This is the joint at the base of the thumb. Osteoarthritis at this location is a major cause of morbidity in patients with OA.
Pain is aggravated by movements involving thumb apposition (pinching) and grip will be weak. Over time the supporting ligaments become lax leading to more biomechanical dysfunction. The thumb takes on a"squared-off" appearance.
This disorder is not only painful, it also greatly affects activities of daily living.
Treatment involves the use of topical agents (including topical non-steroidal anti-inflammatory drugs, oral anti-inflammatory agents, and splints designed to immobilize the thumb.
Ultrasound-guided glucocorticoid (steroid) injections are also used.
We described a technique where this joint can undergo arthroscopic debridement followed by an injection of hyaluronan (a special joint lubricant). Our experience with this technique has been excellent.
In patients who fail to respond to more conservative measures, different surgical procedures may be attempted. The most common is called tendon interposition surgery (“anchovy procedure”) where a tendon from the forearm is rolled up and place in the CMC joint to act as a spacer.
Physical and occupational therapy is also valuable for this condition.
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