From the Guidelines
The recommended treatment for carpometacarpal (CMC) subluxation typically begins with conservative measures, including rest, ice, anti-inflammatory medications, and immobilization with a thumb spica splint for 4-6 weeks, as strongly recommended by the 2019 American College of Rheumatology/Arthritis Foundation guideline for the management of osteoarthritis of the hand, hip, and knee 1.
Key Considerations
- Physical therapy focusing on strengthening the thenar muscles and improving joint stability is also beneficial once acute pain subsides.
- Corticosteroid injections may provide temporary relief for persistent pain.
- For patients who don't respond to conservative treatment after 3-6 months or who have severe instability, surgical options should be considered, including ligament reconstruction, joint fusion (arthrodesis), or trapeziectomy with or without tendon interposition.
Treatment Approach
- The choice of treatment depends on the severity of subluxation, the patient's age, activity level, and hand dominance.
- Early intervention is important as untreated CMC subluxation can lead to progressive joint degeneration, chronic pain, and decreased hand function over time.
- Patients should be advised to avoid activities that aggravate symptoms during the recovery period.
Evidence-Based Recommendations
- Hand orthoses are strongly recommended for patients with first CMC joint OA, as stated in the 2019 American College of Rheumatology/Arthritis Foundation guideline 1.
- The guideline also conditionally recommends kinesiotaping for patients with knee and/or first CMC joint OA, and conditionally recommends against modified shoes and lateral and medial wedged insoles for patients with knee and/or hip OA 1.
Important Considerations for Treatment
- The treatment approach should be individualized to the patient's requirements, taking into account the localization of OA, risk factors, type of OA, presence of inflammation, severity of structural change, level of pain, disability, and restriction of quality of life, as well as comorbidity and co-medication 1.
- Education concerning joint protection and an exercise regimen involving both range of motion and strengthening exercises are recommended for all patients with hand OA 1.
From the Research
Treatment Options for CMC Subluxation
- The treatment for carpometacarpal (CMC) subluxation may involve various approaches, including conservative management and surgical interventions 2, 3, 4.
- Conservative management may include closed reduction and immobilization, while surgical options may involve ligament reconstruction, open reduction with direct repair, and percutaneous pinning 3, 4.
- Ligament reconstruction techniques, such as open ligament reconstruction with or without temporary Kirschner-wire fixation, arthroscopic debridement with capsular shrinkage, metacarpal extension osteotomy, internal proprietary anchors, and arthrodesis, may be used to stabilize the CMC joint 2.
Postoperative Rehabilitation
- Postoperative rehabilitation following CMC arthroplasty may involve the use of a plaster splint or long thumb spica orthosis, with varying time frames for use 5.
- Therapy programs may be developed in collaboration with the referring surgeon, and may include active flexion/extension of the wrist and thumb, although the timing of these interventions may vary widely 5.
- Few respondents in a survey of therapists reported using a published evidence-based treatment program to guide therapy following thumb CMC arthroplasty surgery 5.
Outcomes and Complications
- Optimal management of CMC joint dislocations is crucial in restoring pinch and grasp strength, and preventing significant complications 3, 4.
- Good surgical outcomes have been achieved in the treatment of CMC joint dislocations, with significant pain relief and restoration of joint stability 3.
- However, long-term clinical outcome reporting is needed to develop a standardized approach to treatment 3.