Arthritis, Golden CO
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Arthritis – Base of the Thumb
In a normal joint, cartilage covers the end of the bones and serves as a shock absorber to allow smooth, pain-free movement. In osteoarthritis (OA, or “degenerative arthritis”) the cartilage layer wears out, resulting in direct contact between the bones and producing pain and deformity. One of the most common joints to develop OA in the hand is the base of the thumb. The thumb basal joint, also called the carpometacarpal (CMC) joint, is a specialized saddle-shaped joint that is formed by a small bone of the wrist (trapezium) and the first bone of the thumb (metacarpal). The saddle shaped joint allows the thumb to have a wide range of motions, including up, down, across the palm, and the ability to pinch.
OA at the base of the thumb is more commonly seen in women over the age of 40. The exact cause is unknown, but genetics, previous injuries such as fractures or dislocations, and generalized joint laxity may predispose to-wards development of this type of arthritis.
The most common symptom is pain at the base of the thumb. The pain can be aggravated by activities that require pinching, such as opening jars, turning door knobs or keys, and writing. Severity can also progress to pain at rest and pain at night. In more severe cases, progressive destruction and mal-alignment of the joint occurs, and a bump develops at the base of the thumb as the metacarpal moves out of the saddle joint. This shift in the joint can cause limited motion and weakness, making pinch difficult. The next joint above the CMC may compensate by loosening, causing it to bend further back (hyperextension).
Signs and Symptoms
How is the diagnosis made?
The diagnosis is made by history and physical evaluation. Pressure and movement such as twisting will produce pain at the joint. A grinding sensation may also be present at the joint . X-rays are used to confirm the diagnosis, although symptom severity often does not correlate with x-ray findings.
Less severe thumb arthritis will usually respond to non-surgical care. Arthritis medication, splinting and limited cortisone injections may help alleviate pain. A hand therapist might provide a variety of rigid and non-rigid splints which can be used while sleeping or during activities.
Patients with advanced disease or who fail non-surgical treatment may be candidates for surgical reconstruction. A variety of surgical techniques are available that can successfully reduce or eliminate pain. Surgical procedures include removal of arthritic bone and joint reconstruction (arthroplasty), joint fusion, bone realignment, and even arthroscopy in select cases. A consultation with your hand surgeon can help decide the best option for you.
Arthritis- MP joint
Arthritis is the wearing away of the cartilage at a joint. Cartilage is the coating layer of tissue on the end of a bone that acts as a shock-absorber. Loss of cartilage can lead to joint destruction and a shift in the finger position towards the small finger side, which is called ulnar drift (See Figure 2). When arthritis affects the MP joints, the condition is called MP joint arthritis.
The MP joints are often affected by arthritis either from routine wear and tear, an injury, or medical conditions.
The most common medical condition causing arthritis at the joint is termed rheumatoid arthritis. Rheumatoid arthritis affects the inner coating of the joint, called the synovium, and can result in the loss of the cartilage between the joints. The cause of rheumatoid arthritis is not known. Other conditions that can cause loss of the cartilage include previous injuries and other medical conditions such as gout, psoriasis, or infection.
Arthritis literally means “inflamed joint.” Normally a joint consists of two smooth, cartilage-covered bone surfaces that fit together as a matched set and that move smoothly against one other. Arthritis results when these smooth surfaces become irregular and don’t fit together well anymore and essentially “wear out.” Arthritis can affect any joint in the body, but it is most noticeable when it affects the hands and fingers. Each hand has 19 bones, plus 8 small bones and the two forearm bones that form the wrist. Arthritis of the hand can be both painful and disabling. The most common forms of arthritis in the hand are osteoarthritis, post-traumatic arthritis (after an injury), and rheumatoid arthritis. Other causes of arthritis of the hand are infection, gout, and psoriasis.
Arthritis means an inflamed joint. A joint normally consists of two cartilage-covered bone surfaces that glide smoothly against one another. When joints become inflamed, the joint swells and does not move smoothly. Over time, the gliding surface wears out. There are many types of arthritis. Rheumatoid arthritis is just one type. Wear and tear arthritis (osteoarthritis), gouty arthritis, and psoriatic arthritis are three other common types. Rheumatoid Arthritis is considered a systemic disease. That is, it can affect many parts of the body. Patients often awaken with stiff and swollen joints. Early on, many patients feel tired. Two thirds of patients with rheumatoid arthritis have wrist and hand problems.
This content was modified from http://handcare.assh.org/, courtesy of the American Society of Surgery for the Hand.
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