CMC arthritis
Moderator(s): Sam Dyer, Steven Kelham
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CMC arthritis 0 S. Kelham 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
by S. Kelham
Saturday, August 11, 2018