CMC Arthritis: Understanding, Conservative and Surgical Treatments, and Management

How to treat CMC arthritis?

Treating CMC arthritis involves a multi-faceted approach, primarily focusing on managing pain, preserving function, and slowing disease progression through conservative measures, and in some cases, surgical intervention.

Understanding CMC Arthritis

The carpometacarpal (CMC) joint of the thumb, also known as the trapeziometacarpal joint, is located at the base of the thumb where the first metacarpal bone meets the trapezium bone of the wrist. This saddle-shaped joint allows for the thumb's wide range of motion, including opposition, which is crucial for grasping and pinching. CMC arthritis occurs when the smooth cartilage covering the ends of these bones wears away, leading to bone-on-bone friction, inflammation, and pain. It is a common form of osteoarthritis, particularly prevalent in women over 40.

Common Symptoms Include:

• Pain at the base of the thumb, often exacerbated by pinching, gripping, or twisting motions (e.g., opening jars, turning keys).
• Stiffness, especially in the morning.
• Swelling and tenderness at the joint.
• A grinding or popping sensation (crepitus) with movement.
• Decreased strength and range of motion, making daily tasks difficult.
• A "squared" appearance at the base of the thumb due to bone spurs.

Conservative (Non-Surgical) Treatment Strategies

The initial approach to CMC arthritis is almost always conservative, aiming to alleviate symptoms and improve function without surgery.

Rest and Activity Modification:

• Avoiding aggravating activities: Identify and modify activities that worsen pain. This might involve changing grip patterns or using adaptive tools.
• Ergonomic adjustments: Optimize your workspace and daily routines to minimize stress on the thumb joint.

Splinting/Bracing:

• Thumb spica splints or braces: These devices support the CMC joint, limiting motion and providing stability, which can reduce pain and inflammation. They are often worn during activities or at night.

Pain Management (Medication):

• Over-the-counter pain relievers: Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen can reduce pain and inflammation. Acetaminophen may also be used for pain relief.
• Topical medications: Creams or gels containing NSAIDs or capsaicin can be applied directly to the painful joint.
• Prescription medications: In some cases, stronger oral NSAIDs or other pain medications may be prescribed.

Physical and Occupational Therapy:

• Exercise programs: A therapist can teach specific exercises to strengthen the muscles around the thumb and wrist, improve stability, and maintain range of motion. These often focus on the thenar muscles (at the base of the thumb) and forearm muscles.
• Joint protection techniques: Learning new ways to perform daily tasks that minimize stress on the thumb joint. This includes using larger grips, distributing force, and avoiding repetitive pinch motions.
• Adaptive equipment: Using tools like jar openers, key turners, or ergonomic utensils can significantly reduce thumb strain.
• Modalities: Application of heat or cold packs can help manage pain and stiffness.

Injections:

• Corticosteroid injections: A powerful anti-inflammatory medication injected directly into the joint can provide significant, though temporary, pain relief. Effects typically last for weeks to several months.
• Hyaluronic acid injections: While less commonly used for CMC arthritis than for larger joints like the knee, these "lubricating" injections may be considered to improve joint fluid quality.

Surgical Treatment Options

Surgery is considered when conservative treatments fail to provide adequate pain relief or functional improvement, and the arthritis significantly impacts quality of life. The choice of surgical procedure depends on the severity of the arthritis, the patient's age, activity level, and surgeon's preference.

Common Surgical Procedures Include:

• Trapeziectomy: This is the most common surgical procedure for CMC arthritis. It involves removing the trapezium bone, which eliminates the bone-on-bone grinding. The space left by the removed bone is often filled with a rolled-up piece of tendon (ligament reconstruction and tendon interposition, LRTI) or left empty.
• Arthrodesis (Fusion): This procedure involves fusing the first metacarpal bone to the trapezium bone, eliminating motion at the joint. While it provides excellent pain relief and stability, it sacrifices some range of motion, particularly thumb opposition. It is generally reserved for younger, active individuals who require strong pinch and grip.
• Arthroplasty (Joint Replacement): Involves replacing the damaged joint surfaces with an artificial implant. While less common than trapeziectomy, advancements in implant design are making this a more viable option for some patients, aiming to preserve motion and reduce pain.

Post-Surgical Rehabilitation:

• Following surgery, a period of immobilization (typically with a cast or splint) is necessary, followed by a structured rehabilitation program with a hand therapist. This is crucial for regaining strength, range of motion, and function.

Lifestyle and Self-Management

Beyond specific treatments, adopting certain lifestyle strategies can support joint health and manage symptoms.

• Anti-inflammatory diet: Consuming foods rich in omega-3 fatty acids, antioxidants, and anti-inflammatory compounds (e.g., fruits, vegetables, whole grains, lean proteins) may help reduce systemic inflammation.
• Weight management: While less directly impactful on hand joints than weight-bearing joints, maintaining a healthy weight reduces overall inflammatory load on the body.
• Stress management: Chronic stress can exacerbate pain perception. Techniques like mindfulness, meditation, or yoga can be beneficial.

When to Seek Professional Help

Consult a healthcare professional, such as a hand specialist, orthopedic surgeon, or rheumatologist, if you experience:

• Persistent thumb pain that interferes with daily activities.
• Increasing stiffness, swelling, or loss of motion.
• Failure of over-the-counter medications or self-care strategies to provide relief.
• Any signs of joint deformity or instability.

Prevention and Long-Term Management

While you cannot prevent the aging process that contributes to osteoarthritis, you can manage risk factors and optimize joint health:

• Early intervention: Addressing symptoms early can help slow progression and manage pain effectively.
• Ergonomic awareness: Be mindful of how you use your hands in daily tasks and work, adopting ergonomic principles.
• Regular, appropriate exercise: Maintain strength and flexibility in your hands and wrists without overstressing the joints.
• Listen to your body: Avoid pushing through pain, which can worsen joint damage.
• Regular medical follow-ups: For diagnosed CMC arthritis, periodic check-ups with your healthcare provider can help monitor the condition and adjust treatment as needed.