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Thumb and Finger Joint
ArthritisSean A. Blake, D.O., D.P.T.
Board Certified Orthopaedic Surgeon
Hand Fellowship Trained Hand Surgeon
Outline
• Historical Context
• Anatomy
• Pathophysiology
• Signs and Symptoms
• Diagnosis
• Treatment—non-operative vs. operative
Aristotle(384-322 B.C.)• The joints, moreover, of the
fingers are well constructed for prehension and for pressure. One of these also, and this not long like the rest but short and thick, is placed laterally. For were it not placed all prehension would be as impossible, as were there no hand at all. For the pressure of this digit is applied from below upwards; and arrangement which is essential, if the grasp is to be firm and hold like a tight clamp. As for the shortness of this digit, the object is to increase its strength, so that it may be able, through but one, to counterbalance its more numerous opponents…
Introduction
• Opposable thumb distinguishes humans from lower primates and other mammals
• Stable foundation on which many gross and fine motor activities of humans are conducted
Anatomy
TrapeziumTrapezoid
Scaphoid
CapitateHamate
Lunate
Pisiform
Triquetrum
Thumb
Trapezium
Saddle Joint• 1st MC and trapezium have reciprocal
concave/convex surfaces
• Flexion/Extension
• Palmar ABduction/ADduction
• Radial ABduction/ADduction
• Opposition
Line of Pull at Basal Thumb Joint
Ligaments
• Thumb joint relies
heavily on static
ligamentous
restraints
• Up to 16
ligaments have
been identified
Stabilizing Ligaments
• The major stabilizers are:– Palmar
Oblique Ligament
(1o stabilizer of TMJ)
– Dorsoradial Ligament
– Dorsal Expansion of the APL Tendon
Biomechanics
• Thumb joint reactive force is 13 x applied
pinch force
Pathophysiology
• The constant multi-
planar forces to which
this biomechanically
unique joint is subjected
over the course of work
and recreation can lead
to arthritis
Definition
• Thumb basal joint arthritis is one the most
common forms of OA affecting the hand
• Occurs when the cushioning cartilage
wears away from the adjoining ends of the
bones
Sequence
• Begins with synovitis and microscopic
cartilage wear
• Progressive cartilage degradation
Pathophysiology
• Cartilage covers ends of bones acting as a
cushion and allowing bones to glide
smoothly against each other
• Cartilage deteriorates and the smooth
surface roughens
• Bones rub against each other, resulting in
friction and joint damage
Osteophytes
(Bone Spurs)• Joint damage results
in new bone growth
along the sides of
the existing bone
(bone spurs or
osteophytes)
• Produce noticeable
lumps on your thumb
joint
Risk Factors
• Female
• > 40 years old
• Certain hereditary conditions, including
joint ligament laxity and malformed joints
• Previous fractures and sprains
• RA
• Certain activities and jobs that put high
stress on the joint
Prevalence
• 1 out of every 3 women
• 1 out of every 8 men
Thumb Basal Joint Arthritis
• The diagnosis is usually made from the
history and physical exam alone
• X-rays are used to stage the severity of
the disease
Thumb Basal Joint Arthritis
• Hand pain
• Swelling
• Decreased strength
• Decreased ROM
Problems
• Difficulty doing simple household tasks
– Turning doorknobs
– Opening jars
– Writing
Symptoms• PAIN
– w/ gripping, grasping or pinching an object
between thumb and index finger
– Using thumb to apply force when turning a
key, pulling a zipper or opening a jar
Symptoms
• Eventually pain occurs when the thumb is
not in use
Other Signs and Symptoms
• Enlarged, bony or out-of-
joint appearance
– Shoulder sign
• Concomitant carpal
tunnel syndrome
– Up to 50% incidence
Fingers Arthritis
• Nodularity of knuckles
• Pain
• Stiffness
• Constant soreness,
sometimes relentless
• Nodularity of middle
knuckle called
Bouchard’s nodule
• Nodularity of knuckle at
the finger tip is called
Heberden’s nodule
Finger Arthritis
• Begins with synovitis
and microscopic
cartilage wear
• Progressive cartilage
degradation
Finger Arthritis
• Cartilage deteriorates and
the smooth surface
roughens
• Bones rub against each
other, resulting in friction
and joint damage
Treatments• Splinting
• Oral Medication
• Steroid Injections
• Surgery
Splints• Decrease pain
• Encourage proper positioning
• Rest the joint
• Wear at night or throughout the day and night depending
on patient needs
Medications
• Acetaminophen (Tylenol, others)
• NSAIDs (ibuprofen, Advil, Motrin, Aleve,
others)
• Arthritic anti-inflammatory , Celebrex
Injections
• Long-acting
corticosteroid
injection into basal
thumb joint
• Provide temporary
pain relief and reduce
inflammation
Surgery
• Arthroplasty
(joint replacement)
• All done on an
outpatient basis
• No General
Anesthesia
required
• All done with a
nerve block
Silicone Finger Arthroplasty
Summary
• Thumb basal joint arthritis is an extremely
debilitating disease
• There are various non-operative and
operative treatment modalities all aimed at
eliminating pain
• Goal of any treatment is to treat pain,
improve function and quality of every day
life
Thank you!