Carpometacarpal of thumb

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Karim Bakri, Steven Lawrence Moran. Osteoarthritis of the thumb carpometacarpal joint has a reported radiographic prevalence of 7 percent in men and 15 percent in women. Many patients remain minimally symptomatic; however, a subset of patients develop debilitating pain, weakness, and instability that severely limit hand function.

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The carpometacarpal CMC joints are five joints in the wrist that articulate the distal row of carpal bones and the proximal bases of the five metacarpal bones. The carpometacarpal joint of the thumb pollexalso known as the first carpometacarpal joint, or the trapeziometacarpal joint TMC because it connects the trapezium to the first metacarpal bone, plays an irreplaceable role in the normal functioning of the thumb. The most important joint connecting the wrist to the metacarpus, osteoarthritis of the TMC is a severely disabling condition; up to twenty times more common among elderly women than in average.

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We present the results of a prospective study of 31 thumbs in 30 patients affected by primary osteoarthritis at the thumb carpometacarpal CMC1 joint who were treated with denervation of the involved joint. For every operated hand, the Kapandji score, key-pinch strength, grip strength and pain on a visual analogue scale were evaluated preoperatively and postoperatively at 2 weeks, 6 weeks, 3 months, 6 months and 1 year. The Kapandji score and key-pinch strength improved significantly in all patients.

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Arthritis occurs when the cartilage — the flexible tissue that covers and protects the joints - wears out. Without this cushioning, the bones in the joint grind together wearing the joint down. Carpometacarpal CMC joint arthritis is arthritis at the base of your thumb, where your thumb and wrist meet.

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Clinical History: A 21 year-old male crashed his all-terrain vehicle 10 days ago and radiographs revealed dorsoradial dislocation of the thumb CMC joint. What are the findings? Successive coronal STIR images of the wrist and base of the thumb.

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The thumb joint at the base of the thumb is the most mobile in the hand. The thumb can move up and down, in and out, and rotate slightly to touch the fingers. We move our thumbs hundreds of times each day.

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Thumb carpometacarpal CMC osteoarthritis OA is a widespread, disabling disease of undetermined etiology that is far more prevalent in woman than in men. Although recent studies suggest genetics, increased BMI and environmental factors such as hand use are likely associated with the development of thumb CMC OA, there is strong empirical and experimental data indicating that altered biomechanics plays a central role in the disease, and, importantly in its treatment. CMC OA is far more prevalent in women than men, and women have flatter joint surfaces, smaller areas of cartilage contact, and higher contact pressures.

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Osteoarthritis of the carpometacarpal CMC joint of the thumb is characterized by articular degeneration owing to compression and rotational shear forces on the trapezium. As the disease progresses, the thumb metacarpal may become dorsoradially subluxated on the trapezium, resulting in hyperextension deformity of the metacarpophalangeal MP joint. The thumb CMC joint is the most frequently affected joint of the hand to develop localized osteoarthritis.

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Metrics details. Osteoarthritis OA in the thumb carpometacarpal joint CMCJ is a prevalent disease which may lead to structural damage, severe pain and functional limitations. Evidence-based treatment recommendations state that all patients with hand OA should be offered non-pharmacological treatment.

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Osteoarthritis of the hand is a common disorder. Although the distal interphalangeal joint is most commonly involved, the basilar joint of the thumb — the carpometacarpal joint — is the most common joint in the hand to require surgery as a result of osteoarthritis. Multiple operative procedures are available and surgeons continue to search for the best approach. For this discussion, I have asked several surgeons to express their preferences, indications and results.


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