You are here

Thumb Basilar Joint Arthritis M19.049 715.14

thumb basilar joint arthritis xray

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

 

Basilar Joint Arhtritis ICD-10

 

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 = LRTIwith complete trapezium excision.

Basilar Joint Arhtritis Associated Injuries / Differential Diagnosis

  • DeQuervain's disease
  • Carpal Tunnel Syndrome
  • Stenosing flexor tenosynovitis
  • Scaphotrapezial arthritis
  • Subsesamoid arthritis

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

Disclaimer

The information on this website is intended for orthopaedic surgeons.  It is not intended for the general public. The information on this website may not be complete or accurate.  The eORIF website is not an authoritative reference for orthopaedic surgery or medicine and does not represent the "standard of care".  While the information on this site is about health care issues and sports medicine, it is not medical advice. People seeking specific medical advice or assistance should contact a board certified physician.  See Site Terms / Full Disclaimer