Arnold-Peter C. Weiss, MD; Avi D. Goodman, MD

Disclosures

J Am Acad Orthop Surg. 2018;26(16):562-571. 

In This Article

Abstract and Introduction

Abstract

The thumb basal joint is the second most common site of osteoarthritis in the hand, and osteoarthritis of this joint can contribute to painful movement and debilitating function. To achieve a high degree of prehensile and manipulative function, this highly mobile joint is constrained by both the saddle morphology of the trapezium and a stout complement of ligamentous constraints. The disease proceeds progressively with several wear patterns. Substantial new biomechanical and longitudinal clinical studies have changed some of the prevailing opinions on the process of serial degenerative changes. Diagnosis is made with a thorough clinical examination and radiographic staging, as described by Eaton and Littler. Thumb basal joint arthritis can be initially managed with medications, orthoses, and steroid injections; however, it frequently progresses despite these interventions. Surgical management commonly consists of trapeziectomy with or without interposition or suspension, arthroplasty with implant, volar ligament reconstruction, osteotomy, or arthrodesis; none of these techniques has been proved to be superior to the others.

Introduction

The thumb basal joint is the second most common site of osteoarthritis (OA) in the hand after the distal interphalangeal (IP) joint of the index finger, with radiographic evidence in up to 40% of women aged ≥80 years; thumb basal joint arthritis most commonly affects the nondominant hand.[1] Despite this high prevalence, the disease is not always clinically significant, and most patients never seek treatment. However, when symptomatic, loss of thumb function can impart up to a 50% impairment to the upper extremity.[2] The literature suggests a range of etiologies contributing to the degeneration, including ligamentous laxity, genetics, overuse, and trauma. A progressive disease, the arthritis proceeds in a stepwise fashion in characteristic wear patterns, occasionally ending in pantrapezial arthritis.

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