Basal joint arthritis Discussion

Degenerative arthritis of the basal joint (thumb carpometacarpal joint) commonly develops as a result of normal use and the natural aging process. Nonoperative treatment options include rest, splinting, therapy, oral anti-inflammatory medication, and intraarticular steroid injection. Pain and progressive loss of motion may occur with conservative management due to progressive arthritis. Progressive joint deterioration and subluxation may occur, often resulting in a predictable deformity: basal joint adduction contracture and secondary metacarpophalangeal hyperextension. These contractures are rarely fully corrected even with surgery, and are a recognized cause of unsatisfactory surgical result. Staging also involves radiographs criteria, as one of four stages:

I Joint space widening; Subluxation equal or less than 1/3
II Capsular calcification less than 2mm; Subluxation greater than 1/3
III Capsular calcification greater than 2 mm; Joint space narrowing
IV Cysts, Sclerosis, Lipping, Osteophytes

In addition, involvement of the scaphotrapezial, scaphotrapezoidal and index metacarpal - trapezial joints affect treatment recommendations. Surgical options include either soft tissue reconstruction or arthroplasty. Total joint reconstruction requires trapeziectomy and soft tissue reconstruction, and often involves partial trapezoid excision and debridement of the index metacarpal base. Surgery has the risks of persistent soreness, painful neuroma, instability of the thumb, weakness and numbness. Postoperative immobilization and therapy is essential. Surgery usually requires approximately three months for recovery and soreness may persist for a year after successful surgery. An average of one out of three patients have some persistent symptoms of weakness, deformity or pain despite surgery.

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