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J Am Acad Orthop Surg, Vol 16, No 7, July 2008, 418-423.
© 2008 the American Academy of Orthopaedic Surgeons
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Basal Joint Arthritis of the Thumb

Michael S. Shuler, MD, Shai Luria, MD and Thomas E. Trumble, MD

Dr. Shuler is Hand and Microvascular Surgery Fellow, Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA. Dr. Luria is Hand and Microvascular Surgery Fellow, Department of Orthopaedics and Sports Medicine, University of Washington. Dr. Trumble is Professor and Chief, Hand and Microvascular Surgery Service, Department of Orthopaedics and Sports Medicine, University of Washington.

Focused Review articles review recently published original research, emphasizing the quality of research or methodology of these studies and providing summary information on the usefulness of the results for the practice of evidence-based medicine.

None of the following authors or a member of their immediate families has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Shuler, Dr. Luria, and Dr. Trumble.

Reprint requests: Dr. Trumble, Department of Orthopaedics and Sports Medicine, University of Washington, 1959 NE Pacific Street, PO Box 356500, Seattle, WA 98195-6500.

The carpometacarpal joint of the thumb is the second most common site of arthritis in the hand. Patients in whom conservative treatment fails benefit from surgical intervention, although no consensus exists as to the best method to provide maximum pain relief and functional outcomes. The pathophysiology of carpometacarpal arthritis is loss of the integrity of the palmar oblique ligament, which allows for dorsal subluxation of the metacarpal on the trapezium. Most treatments revolve around resection or replacement of the arthritic carpometacarpal joint and restoration of the palmar oblique ligament. A critical appraisal of the current evidence-based research offers no guidance in treatment in the early stages of carpometacarpal arthritis; however, several evidence-based studies exist for more advanced stages. Although these studies exhibit limitations in regard to validated outcomes, power analysis, and blinded assessment, their conclusions question the clinical benefits of ligament reconstruction and tendon interposition. Further research is needed to delineate the best treatment of early stages of arthritis as well as the clinical significance of metacarpal subluxation and subsidence. Further, a standardized set of outcome tools is needed for the interpretation and comparison of data in regard to clinical outcomes. 






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Copyright © 2008 by the American Academy of Orthopaedic Surgeons.