What are the symptoms and treatment options for Carpometacarpal (CMC) joint arthritis?

From the Guidelines

Carpometacarpal (CMC) joint arthritis should be managed through a combination of conservative and surgical approaches, prioritizing conservative measures such as activity modification, splinting, and over-the-counter anti-inflammatory medications as the first line of treatment. The symptoms of CMC joint arthritis include pain, stiffness, swelling, and loss of normal joint function, particularly at the thumb base 1.

Conservative Management

Conservative management options include:

• Activity modification to avoid painful movements
• Splinting to stabilize the joint, particularly at night or during flare-ups
• Over-the-counter anti-inflammatory medications like ibuprofen (400-800mg three times daily) or naproxen (250-500mg twice daily) for pain relief
• Topical NSAIDs such as diclofenac gel applied 3-4 times daily for localized relief with fewer systemic side effects
• Corticosteroid injections into the joint for temporary relief during severe flares
• Hand therapy focusing on strengthening the surrounding muscles while avoiding aggravating movements

Surgical Options

For patients with persistent severe pain unresponsive to conservative measures, surgical options include:

• Trapeziectomy (removal of the trapezium bone)
• Joint fusion
• Joint replacement These treatments address the underlying cause of pain—cartilage deterioration and bone-on-bone contact that occurs as the cushioning between joint surfaces wears away, typically due to aging, previous injury, or repetitive stress 1.

Treatment Prioritization

Early intervention with conservative measures can help manage symptoms and potentially slow progression of joint damage. The 2019 American College of Rheumatology guideline for the management of osteoarthritis of the hand, hip, and knee provides recommendations for the comprehensive management of OA, including the use of pharmaceutical and nonpharmaceutical interventions 1.

From the Research

Symptoms of Carpometacarpal (CMC) Joint Arthritis

• Pain and stiffness in the thumb and wrist area
• Swelling and tenderness in the affected joint
• Limited range of motion and difficulty gripping or grasping objects
• Weakness in the thumb and wrist

Treatment Options for CMC Joint Arthritis

• Medications:
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce pain and inflammation 2
  • Corticosteroid injections to reduce pain and inflammation 3, 4
• Injections:
  • Hyaluronic acid injections to lubricate the joint and reduce pain 4
  • Ketorolac injections to reduce pain and inflammation 4
• Conservative treatment modalities:
  • Splinting to support the joint and reduce pain 3
  • Physical therapy to improve range of motion and strength
  • Topical nonsteroidal anti-inflammatory drugs to reduce pain and inflammation 3, 4
• Nutraceuticals:
  • Glucosamine and chondroitin to reduce pain and inflammation 5
  • Avocado-soybean unsaponifiables (ASUs) to reduce pain and inflammation 5
  • Collagen hydrolysates (CHs) to reduce pain and inflammation 5

Important Considerations

• The use of NSAIDs in very old patients with CMC joint arthritis should be done with caution and under close monitoring due to the increased risk of adverse events 2
• The efficacy and safety of nutraceuticals in the treatment of CMC joint arthritis are still being studied, and more research is needed to fully understand their effects 5