The Problem of Trapeziometacarpal Degenerative Arthritis

Abstract

Trapeziometacarpal arthritis commonly afflicts women older than 40 years of age. This may be due to the inherent shallowness of the saddle joint and the laxity of the volar ligaments. Compressive forces across this joint may be as high as 120 kg during strong grasp; hence, it is not surprising that it is frequently the site of osteoarthritis. Pain and swelling over the trapeziometacarpal joint are the earliest symptoms. As the disease progresses, subluxation of the metacarpal base and, later, collapse deformity of the thumb develop. Surgical treatment is indicated if all nonsurgical treatment fails. A bewildering array of surgical techniques is available to treat trapeziometacarpal arthritis, each having its proponents. Each of these procedures provides some degree of pain relief in a majority of patients. However, none of them fulfills the criteria of an ideal arthroplasty. Criteria for good results in the literature differ among authors. Quantitative analysis of objective measurements, e.g., grasp and pinch, although valuable in comparing the results of different techniques, vary so much among individuals that they provide inadequate information about the functional status of the hand. Range of motion of the operated thumb is frequently omitted, while compensatory motion at the distal joints is not given proper credit. No procedure can claim absolute superiority over another. In comparison with other techniques, interpositional arthroplasty, using the flexor carpi radialis tendon, is less complex and radical yielding satisfactory results when compared both objectively and subjectively.