From the Guidelines
The patient's X-ray findings indicate no acute injuries, and conservative management is recommended for the trace bilateral first carpometacarpal joint degeneration, prioritizing exercises, hand orthoses, and topical nonsteroidal anti-inflammatory drugs (NSAIDs) as per the 2019 American College of Rheumatology guideline 1. The report shows no fractures or dislocations, which is reassuring. There is trace (very minimal) degeneration at the first carpometacarpal joints, which is where the thumb connects to the wrist. This is a common early sign of osteoarthritis in this joint. The soft tissues appear normal with no concerning findings such as swelling or calcifications. For mild carpometacarpal joint degeneration, the following management options are recommended:
- Exercises to improve function and muscle strength, as well as to reduce pain, should be considered for every patient, aiming at improving joint mobility, muscle strength, and thumb base stability 1
- Hand orthoses for first carpometacarpal (CMC) joint OA are strongly recommended 1
- Topical nonsteroidal anti-inflammatory drugs (NSAIDs) for knee OA can be considered, although the evidence for hand OA is less clear 1 If pain persists, follow-up with a healthcare provider is warranted as more advanced treatments like corticosteroid injections might be considered. These degenerative changes often develop gradually with age and use, representing normal wear and tear rather than an acute injury. It is essential to note that surgery is an effective treatment for severe thumb base OA and should be considered in patients with marked pain and/or disability when conservative treatments have failed, although this is not currently indicated for this patient 1.
From the Research
Diagnosis and Symptoms
- The patient has trace bilateral first carpometacarpal joint degeneration, which is a common site of osteoarthritis, particularly in postmenopausal women 2.
- Symptoms of osteoarthritis in the first carpometacarpal joint may include tenderness, stiffness, crepitus, swelling, and pain on wringing movements or other motions that cause abduction of the thumb 2.
- The patient's unremarkable soft tissues suggest that there is no significant inflammation or injury in the surrounding tissues.
Treatment Options
- Conservative medical therapy may be unsatisfactory in severe cases of osteoarthritis, and intra-articular corticosteroids and local anesthetic may only provide transient relief 2.
- Surgical therapy, including excision of the trapezium or arthrodesis of the trapeziometacarpal joint, may be effective in treating osteoarthritis of the first carpometacarpal joint 2, 3.
- Abduction wedge osteotomy of the base of the first metacarpal may also be an effective treatment option, particularly in cases where the arthritis is confined to the carpometacarpal joint 3.
- Other treatment options, such as arthroscopic synovectomy, arthroplasty, and arthrodesis, may also be considered, although long-term data on their effectiveness is limited 4, 5.
- A novel approach involving intra-articular incobotulinumtoxinA (BoNTA) injection has also shown promise in providing significant and prolonged pain relief and enhanced functionality in patients with carpometacarpal osteoarthritis 6.