Surgical management of carpometacarpal joint arthritis of the thumb: a current concepts review

Abstract

The thumb carpometacarpal (CMC) joint is the hand joint second most affected by arthritis. It is significantly more prevalent in females,  articularly post-menopausal women. Clinical assessment of the thumb CMC arthritis is enhanced by the arthritic quintet examination, which includes the following five elements: inspection for thenar atrophy, palpation for joint line tenderness, assessment of range of motion, grind test for crepitus and pain, and evaluation of grip and pinch strength. This structured approach improves diagnostic  accuracy and ensures standardised evaluation. The diagnosis of CMC joint arthritis is based on a combination of history and clinical examination, supported by radiography. The Eaton and Littler classification and its modified versions remain widely adopted in staging thumb CMC arthritis. The surgical indications depend not solely on the radiological findings but on the clinical symptoms, such as functional deficits and pain. The primary indication for surgery is intolerable pain with minimal response to non-surgical management. Surgery aims to diminish pain and improve function without any complications. High-quality research is lacking, and a recent Cochrane review update failed to show that any operative procedure demonstrated superiority over another in terms of pain, function, patient global assessment, range of movement, or strength. Trapezium-sparing surgical strategies aim to preserve native anatomy while alleviating pain and restoring stability. Denervation of the CMC joint improves pain and function, but there is a lack of information in the literature on reliable longterm results. CMC joint arthroscopic-assisted techniques show improvement in pain, a smaller effect on grip strength, and no effect on pinch strength. A Wilson closing wedge osteotomy of the thumb metacarpal shows pain relief, patient satisfaction, and an increase in both grip and pinch strength. CMC joint arthrodesis indicated in younger patients who perform manual labour has a high non-union rate. Spacers have a high complication rate. The new generation arthroplasty implants have a ten-year survival rate in excess of 90%. Trapeziectomy, with or without tendon interposition, remains one of the most commonly performed operations. Variations include simple trapeziectomy, trapeziectomy with ligament reconstruction, and trapeziectomy with a suspension device (TightRope). Trapeziectomy alone had fewer complications than the other procedures.