gms | German Medical Science

Objectives/Interrogation: Thumb carpometacarpal joint (CMC) arthritis is a common hand degenerative joint disease, predominantly affecting women leading to pain, laxity, and weakness of the CMC joint. Surgical treatment is highly varied from partial or total trapezium excision alone, combined or not with suspensionplasty (SS) or ligament reconstruction and tendon interposition (LRTI).

Methods: Between March 2015 to June 2016, 20 patients, were operated for CMC joint arthritis, 3 with LR alone for Eaton stage I but hypermobile CMC and 17 with LRTI using flexor carpi radialis tendon. Partial trapeziectomy(PT) was performed in 9 patients with Eaton stage II and III and total trapeziectomy(TT) in 8 patients with Eaton IV arthritis. Each patient was assessed clinically at 2, 3, 6, 12, and 24 months after surgery. The assessment included pain (VAS score), thumb pinch strength, and thumb CMC joint range of motion. Standard anteroposterior and lateral radiographs of the thumb were also obtained and used to assess CMC joint subluxation or collapse.

Results and Conclusions: Follow-up ranged from 2 to 3 years. All patients were free of symptoms at the final evaluation. Those who underwent LR report pain relief 2 weeks post-operatively while PT and TT groups report an average pain plateau at 2 and 3 months respectively. Thumb pinch strength and range of motion showed improvement in accordance with pain relief. Height of the trapezial space only remained the same in LR group whareas PT group patients retained more space than those of the TT group.

Diagnosis of thumb carpometacarpal joint arthritis in an earlier Eaton stage might indicate a less invasive operation. A less invasive technique shows faster recovery in pain and function. Ligament reconstruction successfully stabilizes first metacarpal relative to the second metacarpal. The height of the trapezial space is best preserved the less trapezium is excised.