How to Diagnose & Treat Carpometacarpal Joint Arthritis in the Hand

Image by Zacke Feller Licensed via Unsplash

Osteoarthritis is a degenerative condition in which the protective cartilage around a joint wears away, leaving the bones to rub against one another. The CMC joint is the basal joint found at the base of the thumb. This joint enables the thumb to pivot, swivel, and move in gripping or pinching motions. Thus, CMC joint arthritis, also known as CMC osteoarthritis, is a condition where osteoarthritis develops where the thumb meets the hand.

Your CMC joint makes it possible to pinch, grip, and snap your fingers. If you’re having trouble with this joint, you may find it painful or difficult to complete simple actions like turning a key in a lock, gripping and turning a door knob, or snapping your fingers. Other symptoms include:

• Pain when you move the thumb.
• Weakness that makes it difficult to pinch or grip items with your thumb.
• Stiffness and limited range of motion in the thumb.
• Swelling and tenderness at the base of the thumb.
• An aching feeling in the thumb after prolonged use.

You may also notice a visible manifestation of this condition. The base of the thumb can appear enlarged or out of joint. You may also develop a bump over the basal joint.

Carpometacarpal osteoarthritis is more common in women than men, and it usually occurs in individuals over 40 years of age. Carpometacarpal osteoarthritis affects as many as 11% of men and 33% of women in their 50s and 60s. Sustaining prior injuries to the joint or using the thumb in repetitive movements increases the likelihood of developing CMC joint arthritis. Carpometacarpal osteoarthritis is more common in individuals who suffer from obesity, malformed joints, and joint ligament laxity.

Your doctor will begin with a visual examination of your hand and thumb to look for swelling, bumps, or a bony prominence over the CMC joint. They may manipulate your CMC joint by holding your thumb and hand to move the joint around. This is known as a CMC grind test. If you’re suffering from CMC osteoarthritis, your doctor may hear a grinding noise or notice a gritty feeling as the bones rub against one another.

Your doctor will also ask you about your individual symptoms. They’ll want to know if the CMC grind test causes any pain or discomfort. They’ll also inquire about any swelling, pain, or weakness you’ve experienced. If certain motions and activities agitate your CMC joint, this will give your doctor valuable clues as to the source of your discomfort. Tell your doctor if you’ve suffered any previous thumb or hand injuries.

If the physical examination suggests CMC osteoarthritis, your doctor may order an X-ray of your hand. This can show where the joint has worn away. An X-ray will also alert your doctor to any bone spurs or narrowing of the joint space around the thumb.

You can treat CMC joint arthritis with short-term nonsurgical options or through a surgical procedure that can provide lasting results.

Nonsurgical Treatments

Pain associated with CMC osteoarthritis can often be managed nonsurgically, particularly for patients in the early stages of the disease. Nonsurgical treatment typically includes a combination of the following:

• Rest for the hand and thumb.
• Physical therapy exercises to strengthen the hand and thumb.
• Use of anti-inflammatory medications.
• Intra-articular injection of corticosteroids.
• Splinting or bracing of the thumb.
• Heat therapy.
• Icing the joint for five to 15 minutes at a time.

Carpometacarpal osteoarthritis is a long-term condition, so patients must find lasting ways to manage it. This typically includes adjusting daily activities to make them easier on the thumb joint. Pen grips, jar openers, spring-action scissors, and doorknob extensions can all help ease stress on the CMC joint.

While the above treatments may provide temporary relief, they cannot cure the condition. Some options, like corticosteroid injections, may relieve pain for several months at a time. As the joint arthritis progresses, you may need to consider surgical treatments instead.

Surgical Treatment

There are several surgical treatment options that can relieve pain from CMC joint arthritis.

• Ligament reconstructionA portion of the damaged ligament is removed, and a piece of the flexor tendon is inserted in its place. This stabilizes the joint and may prevent the progression of the disease.
• Ligament reconstruction and tendon interpositionAll or part of the trapezium bone is removed, and a cushion of tissue is inserted to keep the bones from rubbing on one another. Another tendon is detached and repositioned to stabilize the joint.
• Arthrodesis (fusion)The bones in the thumb joint are reshaped and secured with a metal pin such that they fuse together. This reduces pain and still allows the patient to pinch, though it may reduce the range of motion in the thumb.
• Arthroplasty (total joint replacement)All or part of the damaged CMC joint is removed and replaced with an artificial implant.
• Hematoma and distraction arthroplastyThe trapezium bone is removed, and the surgeon inserts a temporary wire that immobilizes the thumb. The wire is later removed once the joint has healed.

If you’re suffering from any hand pain, it’s important to diagnose and treat it as soon as possible. Our experts at The Hand and Wrist Institute can assess your condition and work with you to develop a treatment plan to relieve your symptoms and restore functionality in your hand. Contact us to make your appointment now.