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Thumb Basilar Joint Arthritis

synonyms: thumb cmc arthritis, thumb carpometacarpal arthritis. treziometacarpal arthritis

Basilar Joint Arhtritis ICD-9

  • ICD-9 = 715.14 (osteoarthritis localized primary hand)

Basilar Joint Arhtritis Etiology / Epidemiology / Natural History

  • Degeneration of the deep anterior oblique ligaments (beak ligament) leads to the development of osteoarthritis of the TM joint.
  • Common
  • Women >> men.
  • Natural history: severe thumb pain may gradually improve as the disease worsens and thumb CMC motion decreases.

Basilar Joint Arhtritis Anatomy

  • Major stabilizers of the trapeziometacarpal joint = anterior oblique (beak) ligament, dorsal radial ligament.

Basilar Joint Arhtritis Clinical Evaluation

  • Tenderness along the thumb trapeziometacarpal joint. Pain and weakenss with pinch and gripping activities.
  • Decreased radial and palmar thumb abduction.
  • Night pain common.
  • Grind Test: axial compression, flexion, extension and circumduction reproduces patients symptoms.
  • Evaluate for MCP hyperextensibility. MCP hyperextension greater the 20° may compromise LRTI outcomes. Consider fusion.
  • Allen's test indicated to determine patency of ulnar artery if surgery involving the radial artery is considered.

Basilar Joint Arhtritis Xray / Diagnositc Tests

  • Posteroanterior (PA) 30° oblique stress view , a lateral view, and a Robert's (pronated anteroposterior [AP]) view.

Basilar Joint Arhtritis Classification / Treatment

  • Eaton Littler Staging of Basalar joint arthritis (Eaton RG, J Hand Surg 1984;9A:692).
  • Initial treatment = NSAIDs, corticosteriod injection, splinting, activity modifications.
  • Stage I (Normal joint with the exception of possible widening from synovitis) = Ligament reconstruction or metacarpal extension osteotomy
  • Stage II (Joint space narrowing with debris and osteophytes less than 2 mm in size.) = LRTI, or trapeziometacarpal fusion or implant arthroplasty.
  • Stage III (Joint space narrowing with debris and osteophytes greater than 2 mm in size) Treatment = LRTI, or trapeziometacarpal fusion or implant arthroplasty.
  • Stage IV (Scaphotrapezoidal joint space involvement in addition to narrowing of the trapeziometacarpal joint) Treatment = LRTI with complete trapezium excision.

    Basilar Joint Arhtritis Associated Injuries / Differential Diagnosis

    LRTI Complications

    • Continued pain. (generally from unaddressed scaphotrapezial or scaphotrapezoidal disease).
    • Instability
    • Thumb metacarpal subsidence
    • Poor grip strength
    • Numbness (sensory branch of Radial nerve injury).

    LRTI Follow-up care

    • Post-op: thumb spica splint, elevation, NWB
    • 7-10 Days: wound check, place in short arm thumb spica cast
    • 4 Weeks: remove k-wires. Removable thumb spica splint, with gentle assisted range-of-motion (AROM) exercises.
    • 6 Weeks: Wean out of splint. Begin strengthening exercises.
    • 3 Months: assess outcomes, Xrays to assess arthroplasty space height.
    • 6 Months: assess outcomes
    • 1Yr: assess outcomes. Functional improvement can occur up to 1 year postoperatively.

    Basilar Joint Arhtritis Review References

    Ascension Pyrosphere (T)

    SBI Artelon

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