Abstract and Introduction
Abstract
This review seeks to provide insight and relevance to recent data published on the surgical treatment of thumb carpometacarpal (CMC) arthritis. Although a number of critical reviews have discussed this issue, no study has conclusively demonstrated one procedure superior to others in terms of patient outcomes. We review the surgical options for thumb CMC arthritis, including arthroscopic approaches, trapeziectomy with or without adjunctive procedures (e.g., LR, TI, and LRTI), volar ligament reconstruction, extension osteotomy, and arthrodesis. This review provides insight into each technique's merits and potential pitfalls.
Introduction
The precise mechanisms by which osteoarthritis occurs in the first carpometacarpal (CMC) joint are poorly understood. The joint has a unique shape that affords movements in multiple planes. Factors characterizing first CMC arthritis include changes in the shape of joint surfaces and deterioration of its ligamentous supports, followed by eburnation of cartilage and the formation of bone spurs.
Carpometacarpal osteoarthritis is common, with prevalence reported as high as 15% in adults over 30. As many as one-third of postmenopausal women are affected by the condition. Pain is typically the main complaint. Diagnosis is based on history, physical examination, and radiographs. Conservative treatment includes activity modification, splinting, nonsteroidal antiinflammatory medication administration, and steroid injection. If these measures prove inadequate, surgical intervention should be considered.