CMC     ARHRITIS                                                    KANDIL NOTES

INTRODUCTION

  • Carpometacarpal Arthritis, aka CMC arthritis, is arthritis of the joint between the trapezium and first metacarpal bones of the thumb

  • It is also known as basilar thumb arthritis

  • The classification system of CMC arthritis is characterized by the Eaton and Littler classification system, where the higher grade denotes worse arthritis severity

  • It is the second most common arthritis in the hand

  • More common in women

  • CAUSES

  • May be due to weakness and attenuation of the beak ligament (anterior oblique ligament) of the thumb, which leads to instability and degeneration of the CMC joint

  • SIGNS AND SYMPTOMS

  • Pain at the base of thumb

  • Weakness with grasping or pinching objects

  • TREATMENT​​

  • First line of treatment for mild CMC arthritis is thumb spica bracing and anti-inflammatories

  • If first line treatments fail, steroid injections can be considered

  • For advanced CMC arthritis that fails conservative management, surgery can be considered. Surgery consists of multiple options including debridement, osteotomy, fusion, and most commonly trapeziectomy and ligament reconstruction and tendon interposition (LRTI)

        PREVENTION

  • Avoiding repetitive grasping and pinching may improve CMC arthritis symptoms and potentially slow progression

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