CMC arthritis, or thumb basal joint arthritis, is a condition that affects the joint at the base of the thumb, where the thumb meets the hand. This joint, known as the carpometacarpal (CMC) joint, is responsible for allowing the thumb to move in various directions and provide grasping strength. As the CMC joint is one of the most used joints in our hand, it is prone to wear and tear.
Unfortunately, when the cartilage in the joint wears down, it leads to a condition called CMC arthritis. The condition can cause a lot of pain and limited movement in the thumb, making it hard to perform daily activities. Here, we will discuss the causes, symptoms, and treatment options for CMC arthritis.
History and Definition
Carpometacarpal (CMC) arthritis is a degenerative condition that affects the joint between the thumb metacarpal bone and the trapezium bone in the hand. It is characterized by high compressive forces and inflammation in the joint, which can lead to pain and difficulty with grasping and pinching. The condition is more common in women than in men and typically develops in middle age, becoming more prevalent with age. The anterior oblique ligament, which helps to support the joint, has been shown to play a role in the progression of CMC arthritis.
In 1967, Richard Eaton and William Littler developed a surgical procedure to reinforce the joint capsule and address refractory CMC arthritis. They also described a radiographic classification system for the condition, which has since been modified to include scaphotrapezial arthritis. This modified Eaton-Littler classification is now widely used to diagnose and track the progression of CMC arthritis.
Symptoms
CMC (carpometacarpal) arthritis is a condition that affects the joint at the base of the thumb. Symptoms of CMC arthritis include:
- Pain and stiffness in the joint at the base of the thumb
- Swelling and tenderness in the joint
- Limited range of motion in the thumb
- Weakness in the thumb
- A popping or grinding sensation in the joint
- A visible bump or deformity in the joint
- Difficulty gripping or pinching objects
It’s important to note that symptoms may vary from person to person and may be gradual in onset. If you are experiencing symptoms like these and are concerned about CMC arthritis, it is best to consult with a doctor or a plastic surgeon for surgery for proper diagnosis and treatment.
Causes
CMC (carpometacarpal) arthritis is caused by wear and tear on the joint at the base of the thumb. The most common cause of CMC arthritis is age-related degeneration of the joint. As we age, the cartilage that cushions the joint between the bones of the thumb and wrist can wear down, leading to inflammation and pain. Other causes of CMC arthritis include:
- Trauma or injury to the joint, such as a fracture or sprain
- Repetitive motions, such as those involved in activities like gardening or knitting
- Rheumatoid arthritis or other inflammatory conditions can affect the joint
- Overuse of the joint, as in some sports or in jobs that require frequent gripping or pinching
- Genetic predisposition or hereditary factors
It is important to note that CMC arthritis can be caused by a combination of factors and that the condition may develop gradually over time.
Diagnosis
The diagnosis of CMC (carpometacarpal) arthritis typically begins with a physical examination and a review of the patient’s medical history. During the physical examination, a doctor will check for signs of pain, tenderness, and limited range of motion in the joint at the base of the thumb. They may also examine the joint for visible deformities or bumps and may assess the patient’s grip strength.
In addition to the physical examination, a doctor may use imaging tests such as an X-ray, MRI or CT scan to confirm the diagnosis of CMC arthritis. These tests can show the extent of cartilage loss and bone damage in the joint, as well as any other abnormalities that may be contributing to the patient’s symptoms.
The doctor may also order laboratory tests, such as blood tests, to rule out other conditions that can cause similar symptoms.
It is important to note that the diagnosis of CMC arthritis can be challenging since the condition can be similar to other conditions that affect the hand and wrist. Therefore, it’s important to consult with a doctor or a plastic surgeon for surgery who has experience in diagnosing and treating hand and wrist conditions, to rule out other possibilities and to get a proper diagnosis.
After a proper diagnosis, the doctor can recommend a treatment plan that is tailored to the patient’s individual needs and goals.
Treatment
Non-Surgical
Treatment for CMC (carpometacarpal) arthritis typically begins with non-surgical options, such as:
- Medications: Over-the-counter pain relievers, such as ibuprofen or acetaminophen, can help to reduce pain and inflammation in the joint. Your doctor may also prescribe stronger pain medications or anti-inflammatory drugs if needed.
- Physical therapy: A physical therapist can teach exercises and stretches to help improve the range of motion and strength in the thumb and wrist. They may also use modalities such as ultrasound, heat or cold therapy, to reduce pain and inflammation.
- Splinting or bracing: A splint or brace can help to immobilize the joint and reduce pain, especially at night.
- Corticosteroid injections: A doctor may inject a corticosteroid medication into the joint to reduce inflammation and pain.
- Occupational therapy: an occupational therapist can help patients with daily activities and provide them with adaptive devices to make tasks easier and less painful.
Surgical
If non-surgical options do not provide adequate relief, surgery may be considered. The most common surgical procedure for CMC arthritis is called a trapeziectomy. This procedure involves removing the trapezium bone, which is the bone at the base of the thumb that is affected by arthritis. After the bone is removed, the surgeon will reconstruct the joint using a tendon or a piece of bone from another part of the body.
Recovery from surgery varies depending on the patient and the type of surgery performed, but in general, patients can expect:
- Pain and swelling for several weeks after surgery.
- Physical therapy to help regain strength and range of motion in the thumb and wrist.
- Wearing a splint or brace for several weeks to protect the joint and limit motion.
- Recovery time can vary from several weeks to several months.
It’s important to note that while surgery can be effective in reducing pain and improving function, it may not completely restore normal function or eliminate all symptoms. And as with any surgery, there are risks such as infection, bleeding, or nerve injury. Therefore, it’s important to discuss the potential risks and benefits of surgery with your doctor before deciding on the best course of treatment for you.
Risk Factors
CMC (carpometacarpal) arthritis is a condition that affects the joint at the base of the thumb and several risk factors can increase the likelihood of developing this condition, including:
- Age: The risk of CMC arthritis increases as we get older, due to the natural wear and tear on the joints.
- Gender: CMC arthritis is more common in women than in men.
- Repetitive motions: Activities that involve repetitive gripping or pinching motions, such as gardening or knitting, can increase the risk of CMC arthritis.
- Trauma or injury: A history of trauma or injury to the joint, such as a fracture or sprain, can increase the risk of CMC arthritis.
- Rheumatoid arthritis: People who have rheumatoid arthritis or other inflammatory conditions that affect the joints are at a higher risk of developing CMC arthritis.
- Overuse: Certain sports or jobs that require frequent use of the thumb can increase the risk of CMC arthritis.
- Genetics: Some people may have a genetic predisposition to CMC arthritis.
Complications
CMC (carpometacarpal) arthritis is a condition that affects the joint at the base of the thumb and if left untreated, it can lead to several complications, such as:
- Loss of motion: The joint at the base of the thumb can become stiff, making it difficult to move the thumb and wrist.
- Weakness: The muscles in the thumb and wrist can become weak, making it difficult to grip or pinch objects.
- Deformity: Over time, the joint can become deformed, leading to a visible bump or a change in the shape of the joint.
- Chronic pain: Pain and inflammation in the joint can become chronic, causing pain and discomfort even when the joint is not in use.
- Loss of function: The joint may become so damaged that it is no longer able to support the thumb and the hand, leading to a loss of function.
- Osteoarthritis: CMC arthritis can progress to osteoarthritis, a degenerative joint disease that affects the entire joint and can lead to joint destruction and even disability.
- Arthritis in other joints: People with CMC arthritis may develop arthritis in other joints, such as the wrist, fingers and other thumb joints.
Early diagnosis and treatment can help prevent complications and slow the progression of CMC arthritis.
When to See a Doctor
It’s important to see a doctor or an orthopedic specialist if you suspect that you have CMC (carpometacarpal) arthritis. Some signs that you should see a doctor include:
- Pain and stiffness in the joint at the base of the thumb
- Limited range of motion in the thumb
- Weakness in the thumb
- A popping or grinding sensation in the joint
- A visible bump or deformity in the joint
- Difficulty gripping or pinching objects
- Swelling and tenderness in the joint
If you are experiencing any of these symptoms, it’s important to see a doctor as soon as possible. The longer you wait, the more likely the condition will progress, which can lead to chronic pain and loss of function.
It’s also important to see a doctor if you have a history of trauma or injury to the joint or if you have a history of rheumatoid arthritis or other inflammatory conditions that affect the joints.
In general, it’s a good idea to see a doctor if you are experiencing pain or other symptoms in your thumb or wrist that are not improving or are interfering with your daily activities. A doctor can perform a proper examination and order the necessary tests to confirm the diagnosis and recommend the best course of treatment.
Step-by-Step Guide to CMC Arthritis Treatment
CMC (carpometacarpal) arthritis is a condition that affects the joint at the base of the thumb and it can be treated with a combination of non-surgical and surgical options. Here is a step-by-step guide on how treatment for CMC arthritis typically proceeds:
Consultation
The first step in treating CMC arthritis is to see a doctor or a plastic surgeon for surgery who is experienced in diagnosing and treating hand and wrist conditions. They will perform a physical examination, review your medical history, and take any necessary imaging tests such as an X-ray, MRI or CT scan to confirm the diagnosis.
Non-Surgical Treatment
Your doctor will likely recommend non-surgical options such as over-the-counter pain relievers, physical therapy, splinting or bracing, corticosteroid injections, and occupational therapy. These treatments can help to reduce pain and inflammation in the joint, improve the range of motion and strength, and make daily activities easier.
Surgical Treatment
If non-surgical options do not provide adequate relief, your doctor may recommend surgery. The most common surgical procedure for CMC arthritis is called a trapeziectomy, which involves removing the trapezium bone and reconstructing the joint.
Pre-Surgery Preparation
Before surgery, your doctor will give you detailed instructions on how to prepare for the procedure, such as discontinuing certain medications, avoiding certain foods or drinks, and arranging for transportation home after the surgery.
Surgery
The surgery itself is typically performed under general anesthesia and takes about an hour to complete.
Recovery
After surgery, you will need to rest and limit the use of your hand and thumb to allow the joint to heal. You will likely need to wear a splint or brace for several weeks to protect the joint and limit motion, and you will have physical therapy to help regain strength and range of motion in the thumb and wrist. Your doctor will provide you with detailed instructions on how to care for your hand and what to expect during the recovery period.
Follow-Up Care
Once you have recovered from the surgery, your doctor will likely schedule follow-up appointments to monitor your progress and make any necessary adjustments to your treatment plan.
Treatment plans will vary depending on your case and the severity of your arthritis, so you may have to wait sometime before you find the right treatment. It’s also important to follow your doctor’s instructions and attend all scheduled appointments to ensure the best outcome.
Conclusion
In conclusion, CMC Arthritis is a painful and debilitating condition that can severely limit one’s mobility and quality of life. However, with proper medical intervention and lifestyle modifications such as physical therapy exercises, heat/cold treatments, OT splints, and medications to reduce inflammation, the effects of this condition can be managed. With appropriate care, individuals with CMC Arthritis can maintain a good quality of life.
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Dr. Colin Hong has been providing plastic surgery services for over 35 years and is one of the most sought-after specialists in Toronto. His clinic offers a wide range of cosmetic, plastic, and reconstructive surgeries at an affordable cost.
If you are interested in scheduling a consultation to discuss CMC Arthritis with Dr. Hong, please contact his office at (416) 222-6986 or send an email to info@drcolinhong.com. Please include your full name, phone number and email address so that we can get back to you as soon as possible. Before setting up an appointment, it is necessary to obtain a referral from your family doctor.
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