Up to 15% of the population older than 30 suffers from carpometacarpal osteoarthritis. 33% in post- menopausal women, 5-11% in the male population. 1 to 3 ratio of males to females. There is a weak to modest association between radiographic arthritis and symptomatic disease with rates reported about 28%. The thumb CMC joint has been reported as the most painful joint when compared to other joints of the hand with similar joint disease.
The human hand consists of 27 bones;
- The carpal bones of the wrist account for 8
- The metacarpal bones of the palmar area consist of 5
- The digital bones of the fingers account for 14
Carpal bones are:
Proximal/Middle/ Distal Phalanges on fingers 2 through 5.
Proximal and Distal Phalanges on the Thumb.
The Thumb is one of the joints most commonly affected by arthritis because of the anatomy and range of motion.
The thumb is a bi-concave and called a convex saddle joint. As opposed to the other joints in the fingers, the thumb allows flexion/extension, adduction/abduction and limited rotation.
This carpometacarpal joint of the thumb is stabilized by 16 ligaments. The most important of which is the deep anterior oblique ligament. Rupture or severe damage of this ligament will eventually lead to arthritis in this joint. Ligament laxity can also cause hypermobility of this region wearing away the cartilage, leading to arthritis.
The thumb CMC joint experiences great forces more than 13 times the force transmitted at the tip of the thumb.
Therefore, the anatomy, ligamentous disruption or laxity or excessive forces can all predispose to osteoarthritis of the joint.
Women have more arthritis in this area than men. It has been shown the articular surface in this area is different in women and therefore can explain the higher incidence of carpometacarpal joint osteoarthritis in women.
Presentation of Thumb Osteoarthritis
- Most common symptom is pain. Pain localized to the base of the thumb exacerbated by palpation or simple tasks like turning a doorknob or turning a key. The pain may be reproduced by resisted pinch or grip.
- Swelling at the base of the thumb
- Aching after prolonged use
- Limited motion
- Loss of strength when gripping or pinching
On physical exam there can be heat, bony nodules (due to osteophytes), grinding on motion and pain when the joint is taken through a normal range of motion either actively or passively.
Classification and Diagnosis of Osteoarthritis of the Carpometacarpal Joint of the Thumb
Diagnosis is by physical exam, x ray and MRI if ligament involvement is suspected.
The early stages are more amenable to medical therapy (Stage 1 or 2).
The latter stages are associated with significant arthrosis and are more responsive to surgery (Stage 3 or 4).
- Stage 1- Early narrowing of the joint space
- Stage 2- Narrowing of the joint space. Osteophytes <2mm Scaphotrapezial joint normal on x ray
- Stage 3- Marked narrowing of the joint space with cysts and sclerosis. Osteophytes >2mm. Scaphotrapezial joint normal on x ray
- Stage 4- Stage 3 changes with associated scaphotrapezial joint involvement
- Activity Modification
- Soft or Hard Bracing
- NSAID such as Motrin or Voltaren
- Creams such as capsasin/ voltaren gel, rubs
- Physical Therapy and Occupational Therapy
- Steroid Injections to the joint- This injection is to provide reduced inflammation therefore reducing pain. Steroids should not be used repeatedly as over time will degenerate cartilage and bone
Over time, if the patient cannot be controlled with conservative therapy, surgical consideration may be entertained.
The goal of surgery is dependent on the stage of the disease.
Techniques are different in the earlier stages vs. the later stage where removal of the joint is the common procedure.
There is current debate as to what procedures provide the best outcomes and to date, there is little evidence to support one technique over the other.
Some of the surgical procedures:
- Joint fusion- the bones in the affected area are permanently fused and the joint can bear weight but there is no flexibility
- Osteotomy- the bones in the affected area are repositioned
- Trapeziectomy- this bone is removed
- Joint replacement
Platelet Rich Plasma is an autologous concentration of growth factors, cytokines and bio-active proteins. Platelets are a source of inflammatory mediators and modulators. There is growing evidence demonstrating the protective effects of PRP and the potential to heal cartilage defects. In addition, the fibrinogen in PRP may be activated to form a matrix to heal cartilage defects found in osteoarthritis.
A great number of studies have demonstrated the positive effects of intraarticular PRP administration into the arthritic hip and knee. The improvement is evident by 4-6 weeks and is usually maintained for 6-18 months.
Recent treatment options for thumb base arthritis are recommending PRP for early to moderate stages of the disease.
- Platelet Rich Plasma versus Corticosteroid Intra-Articular Injections for the Treatment of Trapeziometacarpal Arthritis: A Prospective Randomized Controlled Clinical Trial
Cartilage 2021 Jan;12(1): 51-61 PMID 30343590
Purpose: The purpose of this study was to investigate the superiority of ultrasound guided intra-articular platelet rich plasma injections compared with corticosteroid injections for the treatment of symptomatic thumb arthritis.
Conclusion- Our study has shown that PRP injections significantly improve pain and function from mild to moderate thumb arthritis in both the mid and long term and achieve significantly better results in the long term compared with traditional treatment with intraarticular steroid injections.
- A Comparative Study for Different Types of Thumb Base Osteoarthritis Injections: A Randomized Controlled Interventional Study
Ortop Traumatol Rehabil 2020 Dec 31; 22(6): 447-454 PMID 33506798
Purpose: We conducted our study to compare the effectiveness of Platelet Rich Plasma versus Hyaluronic Acid versus corticosteroids in thumb carpometacarpal joint osteoarthritis based on clinical and functional outcome measures
Conclusion: The three types of injections produced good results in thumb base OA regarding improving pain and hand function but only HA had a long- lasting effect. The limitations for this study may be the follow up period which needs to be longer.
- Platelet Rich Plasma for Thumb Carpometacarpal Joint Osteoarthritis in a Professional Pianist: Case Based Review
Rheumatol 2019 Dec; 39 (12): 2167-2175 PMID. 31608418
Purpose: A 59-year-old male professional pianist presented with chronic, mild onset, of right thumb base pain involving a progressive lack of pinch strength in his right hand and severe difficulties with playing.
Outcome: At 12 months follow up, no recurrences or complications were identified with the musician returning to his previous level of performance. This case- based review study documents the clinical efficacy of PRP treatment.
Juventix Regenerative Medical is an industry leader in the regenerative medical field. Our Platelet Rich Plasma Kits are FDA approved and designed for safety and effectiveness. They are cost effective and very easy to use. Our kits provide consistency of concentrated product when obtained from the same source.
Juventix Regenerative Medical offers a patent pending LED Photo- Activator to activate the platelets and begin the regenerative process. The activation, a critical step in the release of cytokines and growth factors, is accomplished with light and not with the addition of other chemicals such as Calcium Chloride or Thrombin.
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Dr. Robert McGrath