CMC arthritis
Moderator(s): Steven Kelham
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8/11/2018 at 12:25:31 PM GMT
Posts: 4
CMC arthritis

Arthritis of CMC Joint

Etiology

-          Most commonly involved arthritic joint in the hand; 1st CMCJ primarily; more common in women (up to 1/3 of women over age 40, will have x-ray changes)

-          May exist in a localized form or exists as a systemic form of arthritis

-          Primary form is most common in post-menopausal women

-          Systemic form may be due to RA or gout;

Diagnostics

-          Appropriate baseline lab panel; CBC, ESR, CRP, ANA, RF, Uric Acid

-          X-ray;  Degenerative changes of the CMCJ often with radial subluxation of the metacarpal relative to the trapezium; May have diffuse changes throughout the carpus

Physical Exam

-          Visible deformity of the thumb metacarpal in relation to the carpus

-          Axial compression of metacarpal on trapezium gives painful grinding sensation (pos Grind Test); neg Finklesteins Test

-          localized tenderness over volar aspect of thumb;  no triggering during thumb flexion;  no pain w/ forced wrist flexion

-          A small amount of local anesthetic injected into CMC joint w/ a resolution of pain will confirm the Dx

Treatment

-          Based on severity of the disease at presentation

-          Treat the underlying cause if other than primary OA

-          Palliative treatment with bracing and therapeutic injections and or NSAIDS

-          OT/PT; Activity modifications

-          Surgical: Ligament Reconstruction Tendon Interposition (LRTI) or Thumb basilar joint arthroplasty

Steven Kelham, DHSc, PA-C

Director, Southeast Region