Imaging and management of thumb carpometacarpal joint osteoarthritis

Abstract

Primary osteoarthritis (OA) involving the thumb carpometacarpal (CMC) joint is a common and frequently debilitating disease. Clinical examination and radiographs are usually sufficient for diagnosis; however, familiarity with the cross-sectional anatomy is useful for diagnosis of this condition. The most widely used classification system for the radiographic staging of thumb carpometacarpal joint OA was first presented by Eaton and Littler, ranging from mild (stages I and II) to severe (stage IV) disease. If conservative treatment fails, surgical treatment is considered. A variety of surgical techniques have been developed and implemented for the management of this pervasive and disabling condition. The purpose of this article is to review the anatomy of the basal joints of the thumb, pathophysiology, preoperative imaging, and various surgical techniques that are utilized in the treatment of OA of the basal joints of the thumb with emphasis on normal postoperative radiographic findings and possible postoperative complications.

Arthroscopic Synovectomy Combined with Autologous Fat Grafting in Early Stages of CMC Osteoarthritis of the Thumb

“…The conservative therapy consisted of splinting, nonsteroidal anti-inflammatory treatment, and/or corticoid injection. Diagnosis was clinical and according to the Eaton/ Littler radiological classification, 13,14 but this therapy option was limited to patients with Eaton/Littler stages, 1 and 2. Three patients underwent additional simultaneous surgical treatments: three carpal tunnel releases, 1 trigger thumb, and 1 tenolysis for de Quervain's disease.…”

Radiologic Update on Arthroplasties in the Wrist and Hand

“…46 OA may be primary from repetitive motion, ligamentous laxity, and hypermobility, or it may be secondary to prior trauma. 47 OA due to laxity has a higher incidence in women likely due to a hormonal contribution. 48 The Eaton and Littler staging system is used to classify severity of first CMC joint OA.…”

“…50 An additional option for early disease is a closing wedge osteotomy of the dorsoradial aspect of the first metacarpal bone. 47…”

Classifications in Brief: The Eaton-Littler Classification of Thumb Carpometacarpal Joint Arthrosis

“…Arthroscopic evaluation of the CMC joint and advanced imaging studies have been described but have not reached widespread use [2,17,21]. Badia [2] proposed a threestage arthroscopic classification system of the thumb CMC joint that he thought could be used to guide surgical decision making.…”

“…He emphasized that arthroscopic evaluation of the thumb CMC joint allows for direct assessment of structures not observed well on radiographs, such as synovium, articular cartilage, and the joint capsule and that this observation is useful in circumstances where the extent of arthrosis is difficult to ascertain using only radiographs. Although not routinely used in the evaluation of patients with basilar thumb pain, MRI and ultrasound can be used to provide tridimensional diagnostic information of the thumb CMC joint including the integrity of the anterior oblique ligament [17]. Saltzherr et al [21] described higher interobserver reliability for thumb CMC and scaphotrapezial arthrosis on CT imaging compared with radiographs, which could influence surgical decision making.…”