Thumb and Finger Joint Arthritis Sean 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
Thumb
Trapezoid Trapezium Hamate Capitate
Scaphoid Pisiform
Lunate Triquetrum 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!