Skip to main content

Advertisement

SpringerLink
Log in

Trapeziometacarpal joint arthritis

  • Hand and Wrist (DA Osei, Section editor)
  • Published:
Current Reviews in Musculoskeletal Medicine Aims and scope Submit manuscript

Abstract

Trapeziometacarpal (TM) joint arthritis is a common cause of radial-sided wrist pain that preferentially affects women. It is diagnosed by a thorough history, physical examination, and radiographic evaluation. While radiographs are used to determine the stage of disease, treatment is dependent on symptom severity. Nonoperative treatment frequently consists of activity modification, non-steroidal anti-inflammatory drugs (NSAIDs), splinting, and corticosteroid injections. After failure of conservative treatment, various surgical options exist depending on the stage of disease. This article reviews the literature supporting the various surgical treatment options. Special consideration is given to the comparison of trapeziectomy with and without tendon interposition and ligament reconstruction.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Armstrong AL, Hunter JB, Davis TR. The prevalence of degenerative arthritis of the base of the thumb in post-menopausal women. J Hand Surg Br. 1994;19:340–1.

    Article  PubMed  CAS  Google Scholar 

  2. Dahaghin S, Bierma-Zeinstra S, Ginai A, et al. Prevalence and pattern of radiographic hand osteoarthritis and association with pain and disability (the Rotterdam study). Ann Rheum Dis. 2005;64:682–7.

    Article  PubMed  CAS  Google Scholar 

  3. Eaton RG, Littler JW. Ligament reconstruction for the painful thumb carpometacarpal joint. J Bone Joint Surg Am. 1973;55:1655–66.

    PubMed  CAS  Google Scholar 

  4. Glickel SZ. Clinical assessment of the thumb trapeziometacarpal joint. Hand Clin. 2001;17:185–95.

    PubMed  CAS  Google Scholar 

  5. Kubik III NJ, Lubahn JD. Intrarater and interrater reliability of the Eaton classification of basal joint arthritis. J Hand Surg Am. 2002;27:882–5.

    Article  PubMed  Google Scholar 

  6. Dela Rosa TL, Vance MC, Stern PJ. Radiographic optimization of the Eaton classification. J Hand Surg Br. 2004;29:173–7.

    Article  Google Scholar 

  7. Spaans AJ, van Laarhoven CM, Schuurman AH, van Minnen LP. Interobserver agreement of the Eaton-Littler classification system and treatment strategy of thumb carpometacarpal joint osteoarthritis. J Hand Surg Am. 2011;36:1467–70.

    Article  PubMed  CAS  Google Scholar 

  8. Day CS, Gelberman R, Patel AA, et al. Basal joint osteoarthritis of the thumb: a prospective trial of steroid injection and splinting. J Hand Surg Am. 2004;29:247–51.

    Article  PubMed  Google Scholar 

  9. Swigart CR, Eaton RG, Glickel SZ, Johnson C. Splinting in the treatment of arthritis of the first carpometacarpal joint. J Hand Surg Am. 1999;24:86–91.

    Article  PubMed  CAS  Google Scholar 

  10. Barron OA, Glickel SZ, Eaton RG. Basal joint arthritis of the thumb. J Am Acad Orthop Surg. 2000;8:314–23.

    PubMed  CAS  Google Scholar 

  11. Pollard MA, Cermak MB, Buck WR, Williams DP. Accuracy of injection into the basal joint of the thumb. Am J Orthop. 2007;36:204–6.

    PubMed  Google Scholar 

  12. Heyworth BE, Lee JH, Kim PD, et al. Hylan vs corticosteroid vs placebo for treatment of basal joint arthritis: a prospective, randomized, double-blinded clinical trial. J Hand Surg Am. 2008;33:40–8.

    Article  PubMed  Google Scholar 

  13. Eaton RG, Lane LB, Littler JW, Keyser JJ. Ligament reconstruction for the painful thumb carpometacarpal joint: a long-term assessment. J Hand Surg Am. 1984;9:692–9.

    PubMed  CAS  Google Scholar 

  14. Lane LB, Henley DH. Ligament reconstruction of the painful, unstable, nonarthritic thumb carpometacarpal joint. J Hand Surg Am. 2001;26:686–91.

    Article  PubMed  CAS  Google Scholar 

  15. Pellegrini Jr VD, Parentis M, Judkins A, et al. Extension metacarpal osteotomy in the treatment of trapeziometacarpal osteoarthritis: a biomechanical study. J Hand Surg Am. 1996;21:16–23.

    Article  PubMed  Google Scholar 

  16. Shrivastava N, Koff MF, Abbot AE, et al. Simulated extension osteotomy of the thumb metacarpal reduces carpometacarpal joint laxity in lateral pinch. J Hand Surg Am. 2003;28:733–8.

    Article  PubMed  Google Scholar 

  17. Tomaino MM. Treatment of Eaton stage I trapeziometacarpal disease with thumb metacarpal extension osteotomy. J Hand Surg Am. 2000;25:1100–6.

    Article  PubMed  CAS  Google Scholar 

  18. Hobby JL, Lyall HA, Meggitt BF. First metacarpal osteotomy for trapeziometacarpal osteoarthritis. J Bone Joint Surg Br. 1998;80:508–12.

    Article  PubMed  CAS  Google Scholar 

  19. Furia JP. Arthroscopic debridement and synovectomy for treating basal joint arthritis. Arthroscopy. 2010;26:34–40.

    Article  PubMed  Google Scholar 

  20. Gervis WH. Excision of the trapezium for osteoarthritis of the trapezio-metacarpal joint. J Bone Joint Surg Br. 1949;31B:537–9. illust.

    PubMed  CAS  Google Scholar 

  21. Gervis WH, Wells T. A review of excision of the trapezium for osteoarthritis of the trapezio-metacarpal joint after twenty-five years. J Bone Joint Surg Br. 1973;55:56–7.

    PubMed  CAS  Google Scholar 

  22. Dhar S, Gray IC, Jones WA, Beddor FH. Simple excision of the trapezium for osteoarthritis of the carpometacarpal joint of the thumb. J Hand Surg Br. 1994;19:485–8.

    Article  PubMed  CAS  Google Scholar 

  23. Kuhns CA, Emerson ET, Meals RA. Hematoma and distraction arthroplasty for thumb basal joint osteoarthritis: a prospective, single-surgeon study including outcomes measures. J Hand Surg Am. 2003;28:381–9.

    Article  PubMed  Google Scholar 

  24. Gray KV, Meals RA. Hematoma and distraction arthroplasty for thumb basal joint osteoarthritis: minimum 6.5-year follow-up evaluation. J Hand Surg Am. 2007;32:23–9.

    Article  PubMed  Google Scholar 

  25. Kaarela O, Raatikainen T. Abductor pollicis longus tendon interposition arthroplasty for carpometacarpal osteoarthritis of the thumb. J Hand Surg Am. 1999;24:469–75.

    Article  PubMed  CAS  Google Scholar 

  26. Froimson AI. Tendon interposition arthroplasty of carpometacarpal joint of the thumb. Hand Clin. 1987;3:489–505.

    PubMed  CAS  Google Scholar 

  27. Burton RI, Pellegrini Jr VD. Surgical management of basal joint arthritis of the thumb. Part II. Ligament reconstruction with tendon interposition arthroplasty. J Hand Surg Am. 1986;11:324–32.

    PubMed  CAS  Google Scholar 

  28. Tomaino MM, Pellegrini Jr VD, Burton RI. Arthroplasty of the basal joint of the thumb. Long-term follow-up after ligament reconstruction with tendon interposition. J Bone Joint Surg Am. 1995;77:346–55.

    PubMed  CAS  Google Scholar 

  29. • Wolf JM, Delaronde S. Current trends in nonoperative and operative treatment of trapeziometacarpal osteoarthritis: a survey of US hand surgeons. J Hand Surg Am. 2012;37:77–82. This 2012 study surveyed members of the American Society for Surgery of the Hand (ASSH) to determine what procedures are used in different common clinical scenerios. This article shows that corticosteroid injections are commonly used as conservative treatment of CMC arthritis. Further, trapeziectomy with LRTI is the preferred procedure for patients with Eaton Stage III CMC arthritis.

    Article  PubMed  Google Scholar 

  30. Kadiyala RK, Gelberman RH, Kwon B. Radiographic assessment of the trapezial space before and after ligament reconstruction and tendon interposition arthroplasty. J Hand Surg Br. 1996;21:177–81.

    Article  PubMed  CAS  Google Scholar 

  31. Thompson JS. Complications and salvage of trapeziometacarpal arthroplasties. Instr Course Lect. 1989;38:3–13.

    PubMed  CAS  Google Scholar 

  32. Soejima O, Hanamura T, Kikuta T, et al. Suspensionplasty with the abductor pollicis longus tendon for osteoarthritis in the carpometacarpal joint of the thumb. J Hand Surg Am. 2006;31:425–8.

    Article  PubMed  Google Scholar 

  33. Davis TR, Brady O, Barton NJ, et al. Trapeziectomy alone, with tendon interposition or with ligament reconstruction? J Hand Surg Br. 1997;22:689–94.

    Article  PubMed  CAS  Google Scholar 

  34. Downing ND, Davis TR. Trapezial space height after trapeziectomy: mechanism of formation and benefits. J Hand Surg Am. 2001;26:862–8.

    Article  PubMed  CAS  Google Scholar 

  35. •• Gangopadhyay S, McKenna H, Burke FD, Davis TR. Five- to 18-year follow-up for treatment of trapeziometacarpal osteoarthritis: a prospective comparison of excision, tendon interposition, and ligament reconstruction and tendon interposition. J Hand Surg Am. 2012;37:411–7. This level I 2012 article is a randomized controlled study comparing outcomes in patients treated with simple trapeziectomy, trapeziectomy with PL interposition, and LRTI. At a minimum of 5 years, there were no difference in subjective and objective outcomes of thumb pain, function, and strength. This article's significance is that trapeziectomy with PL interposition and LRTI do not offer any benefit over simple trapeziectomy.

    Article  PubMed  Google Scholar 

  36. •• Salem H, Davis TR. Six year outcome excision of the trapezium for trapeziometacarpal joint osteoarthritis: is it improved by ligament reconstruction and temporary Kirschner wire insertion? J Hand Surg Eur Vol. 2012;37:211–9. This 2012 article is a randomized prospective study comparing simple trapeziectomy with LRTI with temporary K-wire stabilization. At an average of 6. 2 years, the study found not significant differences between the groups in any objective or subjective outcome measure. This article demonstrates no significant value of LRTI with K-wire stabilization.

    Article  PubMed  CAS  Google Scholar 

  37. Wajon A, Carr E, Edmunds I, Ada L. Surgery for thumb (trapeziometacarpal joint) osteoarthritis. Cochrane Database Syst Rev. 2009;4:CD004631.

    PubMed  Google Scholar 

  38. Carroll RE, Hill NA. Arthrodesis of the carpo-metacarpal joint of the thumb. J Bone Joint Surg Br. 1973;55:292–4.

    PubMed  CAS  Google Scholar 

  39. Schroder J, Kerkhoffs GM, Voerman HJ, Marti RK. Surgical treatment of basal joint disease of the thumb: comparison between resection-interposition arthroplasty and trapezio-metacarpal arthrodesis. Arch Orthop Trauma Surg. 2002;122:35–8.

    PubMed  CAS  Google Scholar 

  40. Hartigan BJ, Stern PJ, Kiefhaber TR. Thumb carpometacarpal osteoarthritis: arthrodesis compared with ligament reconstruction and tendon interposition. J Bone Joint Surg Am. 2001;83–A:1470–8.

    PubMed  Google Scholar 

  41. Taylor EJ, Desari K, D'Arcy JC, Bonnici AV. A comparison of fusion, trapeziectomy and silastic replacement for the treatment of osteoarthritis of the trapeziometacarpal joint. J Hand Surg Br. 2005;30:45–9.

    Article  PubMed  CAS  Google Scholar 

  42. Raven EE, Kerkhoffs GM, Rutten S, et al. Long term results of surgical intervention for osteoarthritis of the trapeziometacarpal joint: comparison of resection arthroplasty, trapeziectomy with tendon interposition and trapezio-metacarpal arthrodesis. Int Orthop. 2007;31:547–54.

    Article  PubMed  CAS  Google Scholar 

  43. Vermeulen GM, Slijper H, Feitz R, et al. Surgical management of primary thumb carpometacarpal osteoarthritis: a systematic review. J Hand Surg Am. 2011;36:157–69.

    Article  PubMed  Google Scholar 

  44. Swanson AB. Silicone rubber implants for replacement of arthritis or destroyed joints in the hand. Surg Clin North Am. 1968;48:1113–27.

    PubMed  CAS  Google Scholar 

  45. Lovell ME, Nuttall D, Trail IA, et al. A patient-reported comparison of trapeziectomy with Swanson Silastic implant or sling ligament reconstruction. J Hand Surg Br. 1999;24:453–5.

    Article  PubMed  CAS  Google Scholar 

  46. Lanzetta M, Foucher G. A comparison of different surgical techniques in treating degenerative arthrosis of the carpometacarpal joint of the thumb. A retrospective study of 98 cases. J Hand Surg Br. 1995;20:105–10.

    Article  PubMed  CAS  Google Scholar 

  47. Martou G, Veltri K, Thoma A. Surgical treatment of osteoarthritis of the carpometacarpal joint of the thumb: a systematic review. Plast Reconstr Surg. 2004;114:421–32.

    Article  PubMed  Google Scholar 

  48. Badia A, Sambandam SN. Total joint arthroplasty in the treatment of advanced stages of thumb carpometacarpal joint osteoarthritis. J Hand Surg Am. 2006;31:1605–14.

    PubMed  Google Scholar 

  49. van Cappelle HG, Elzenga P, van Horn JR. Long-term results and loosening analysis of de la Caffiniere replacements of the trapeziometacarpal joint. J Hand Surg Am. 1999;24:476–82.

    Article  PubMed  Google Scholar 

  50. Wachtl SW, Guggenheim PR, Sennwald GR. Cemented and non-cemented replacements of the trapeziometacarpal joint. J Bone Joint Surg Br. 1998;80:121–5.

    Article  PubMed  CAS  Google Scholar 

  51. Nilsson A, Liljensten E, Bergstrom C, Sollerman C. Results from a degradable TMC joint Spacer (Artelon) compared with tendon arthroplasty. J Hand Surg Am. 2005;30:380–9.

    Article  PubMed  Google Scholar 

  52. Birman MV, Strauch RJ. Update on nonautogenous interposition arthroplasty for thumb basilar joint arthritis. J Hand Surg Am. 2011;36:2056–9.

    Article  PubMed  Google Scholar 

  53. Choung EW, Tan V. Foreign-body reaction to the Artelon CMC joint spacer: case report. J Hand Surg Am. 2008;33:1617–20.

    Article  PubMed  Google Scholar 

  54. Robinson PM, Muir LT. Foreign body reaction associated with Artelon: report of 3 cases. J Hand Surg Am. 2011;36:116–20.

    Article  PubMed  Google Scholar 

  55. Giuffrida AY, Gyuricza C, Perino G, Weiland AJ. Foreign body reaction to artelon spacer: case report. J Hand Surg Am. 2009;34:1388–92.

    Article  PubMed  Google Scholar 

  56. Diao E. Foreign-body reaction to the Artelon CMC joint spacer. J Hand Surg Am. 2009;34:1158–9. author reply 1159–60.

    Article  PubMed  Google Scholar 

  57. Clarke S, Hagberg W, Kaufmann RA, et al. Complications with the use of Artelon in thumb CMC joint arthritis. Hand. 2011;6:282–6.

    Article  PubMed  Google Scholar 

  58. Brogan DM, Kakar S. Metacarpophalangeal joint hyperextension and the treatment of thumb basilar joint arthritis. J Hand Surg Am. 2012;37:837–8.

    Article  PubMed  Google Scholar 

  59. Moineau G, Richou J, Liot M, Le Nen D. Prognostic factors for the recovery of hand function following trapeziectomy with ligamentoplasty stabilisation. Orthop Traumatol Surg Res. 2009;95:352–8.

    Article  PubMed  CAS  Google Scholar 

  60. Klinefelter R. Metacarpophalangeal hyperextension deformity associated with trapezial-metacarpal arthritis. J Hand Surg Am. 2011;36:2041–2. quiz 2043.

    Article  PubMed  Google Scholar 

  61. • Poulter RJ, Davis TR. Management of hyperextension of the metacarpophalangeal joint in association with trapeziometacarpal joint osteoarthritis. J Hand Surg Eur Vol. 2011;36:280–4. This 2011 article studies the management of thumb MCP joint hyperextension deformity associated with CMC reconstruction. This study found that outcomes for MCP deformities less than to 30° did not improve with surgical stabilization. The few thumb MCP deformities greater than 35° treated with correction showed correction of deformity at 1 year but the clinical improvement was not significant.

    Article  PubMed  CAS  Google Scholar 

Download references

Disclosure

TJ Patel: none; PK Beredjiklian: receives payment for development of educations presentations and has stock/stock options with Trimed, Inc.; JL Matzon: none.

Author information

Authors and Affiliations

  1. University of Medicine & Dentistry of NJ, 42 East Laurel Road, UDP 3900, Stratford, NJ, 08084, USA

    Tejas J. Patel

  2. Rothman Institute, 925 Chestnut Street, Philadelphia, PA, 19107, USA

    Pedro K. Beredjiklian & Jonas L. Matzon

Authors
  1. Tejas J. Patel
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Pedro K. Beredjiklian
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jonas L. Matzon
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jonas L. Matzon.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Patel, T.J., Beredjiklian, P.K. & Matzon, J.L. Trapeziometacarpal joint arthritis. Curr Rev Musculoskelet Med 6, 1–8 (2013). https://doi.org/10.1007/s12178-012-9147-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12178-012-9147-6

Keywords

Search

Navigation