Article
Arthroscopic Treatment of Thumb Basal Joint Arthritis
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Authors
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Abhijeet Wahegaonkar
- Sancheti Institute for Orthopedics & Rehabilitation, Jehangir Hospital, Pune, India
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Anup Bansode
- The Hand Surgery Clinics, Sahyadri Hospital, Pune, India
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Satish Mane
- The Hand Surgery Clinics, Sahyadri Hospital, Pune, India
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Chaitanya Karande Patil
- The Hand Surgery Clinics, Sahyadri Hospital, Pune, India
| Published: | February 6, 2020 |
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Outline
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Objectives/Interrogation: Thumb carpometacarpal (CMC) joint arthritis is a common problem in clinical practice in the Western and other populations, with a variety of treatment options. However, it is not very common in the Indian sub-continent.
Patients, usually women, complain of pain, particularly with pinch and grip, which can interfere with daily activities.
When non-operative means of treatment fail, surgery is an option. Surgical options have included reconstruction of the ligaments about the thumb with or without removal of the joint surface, arthroscopic shrinkage of the ligaments or debridement, corrective osteotomy to redistribute contact forces in early stages of arthritis, arthroscopic and open procedures, thumb carpometacarpal (CMC) fusion, and excision of all or part of the trapezium with or without interposition of any materials.
Recent advances in small joint arthroscopy have established the role of this technique in the treatment of Grade II and early Grade III CMC arthritis of the thumb.
Arthroscopic treatment is relatively new and is performed only in select centers in the Indian sub-continent. It allows for joint visualization and treatment and staging of disease in a minimally invasive fashion with the ability to revise the surgery to complete trapeziectomy if necessary with progression of symptoms.
In this paper, which is the first report of arthroscopic treatment of thumb CMC arthritis, we describe our experience of arthroscopic debridement and ligament shrinkage in the treatment of CMC arthritis of the thumb in the Indian population.
Methods: We reviewed 12 patients who underwent arthroscopic debridement and thermal shrinkage in Eaton Stage II & III CMC arthritis of the thumb. We measured the grip and pinch strength and the range of motion.
Results and Conclusions: The minimum follow up was 1 year. All patients had a satisfactory reduction in their pain levels. There was a statistically significant improvement in the post-operative pain scores and the pinch strength while the ROM remained mostly unchanged. 3 patients had radiological deterioration of the arthritic changes with pain only on strenuous activities. There were no complications and all patients were satisfied with their outcomes.
Thumb arthroscopy and arthroscopically assisted treatment of the thumb CMC arthritis combined with thermal shrinkage of the capsule and ligaments is a safe and effective technique for Eaton stage II & III arthritis.
