History
- Degenerative changes in the trapeziometacarpal joint
- Post menopausal women
- May be "triggered" by trauma episode
- Thumb "weakness" and pain at base of thumb with pinching movement
- Patient may report local thumb / wrist crepitus during flare-ups
Clinical
- Axial pressure and rotation reproduces pain at base of thumb
- Hyperextension (compensatory) of MCPJ
- Prominent base of thumb MC (shouldering) (local muscle wasting plus synovitis
- Palpable axial grind and instability (of trapeziometacarpal joint)
Rannou F, Dimet J, Boutron I, Baron G, Fayad F, Macé Y, et al. Splint for base-of-thumb osteoarthritis: a randomized trial. Ann Intern Med2009;150:661-9
DDx
- Scaphoid injury
- Scapho-lunate ligament rupture
- Old thumb (MC) fracture
- Tendonitis
Management
- NSAIDs for flare-ups
- Splinting (purpose made in OT clinic) helps symptoms and reduces need for theatre
- Follow up with GP (not emergency medicine or fracture clinic)
- No strong evidence for intra-articular steroid injections (scapho-trapezio-trapezoid)
- Arthrodesis may eventually be considered
References
Rannou F, Dimet J, Boutron I, Baron G, Fayad F, Macé Y, et al. Splint for base-of-thumb osteoarthritis: a randomized trial. Ann Intern Med2009;150:661-9