Thumb and Finger Joint

ArthritisSean 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

TrapeziumTrapezoid

Scaphoid

CapitateHamate

Lunate

Pisiform

Triquetrum

Thumb

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!