Abstract
Pain and dysfunction from arthritis of the carpometacarpal joints are common complaints. These joints are susceptible to the development of arthritis from various conditions that share the ability to damage joint cartilage. Osteoarthritis is the most common form of arthritis that results in carpometacarpal joint pain. It occurs more often in female patients, and although the thumb is most frequently affected, arthritis may develop in the other carpometacarpal joints as well, especially after trauma. Rheumatoid arthritis, posttraumatic arthritis, and psoriatic arthritis are also common causes of carpometacarpal pain. Less frequent causes of arthritis-induced carpometacarpal pain include collagen vascular diseases, infection, and Lyme disease. Acute infectious arthritis is usually accompanied by significant systemic symptoms, including fever and malaise, and should be easily recognized; it is treated with culture and antibiotics rather than injection therapy. Collagen vascular diseases generally manifest as polyarthropathy rather than as monarthropathy limited to the carpometacarpal joint; however, carpometacarpal pain secondary to collagen vascular disease responds exceedingly well to intraarticular injection of the affected joints. Most patients presenting with carpometacarpal pain secondary to osteoarthritis or posttraumatic arthritis complain of pain that is localized to the dorsum of the wrist. Activity associated with flexion, extension, and ulnar deviation of the carpometacarpal joints exacerbates the pain, whereas rest and heat provide some relief. The pain is constant and is characterized as aching; it may interfere with sleep. Some patients complain of a grating or popping sensation with use of the joint, and crepitus may be present on physical examination. If the carpometacarpal joint of the thumb is affected, the patient will exhibit a positive Watson test. The test is performed by having the patient place the dorsum of the affected hand against a table with the fingers fully extended. The examiner then pushes the thumb toward the table. The test is positive if it reproduces the patient’s pain.
Keywords
arthritis pain, arthritis carpometacarpal joints, carpometacarpal joint pain, diagnostic sonography, ultrasound guided injection rheumatoid arthritis, osteoarthritis, gout, psoriatic arthritis, Watson test
ICD-10 CODE M18.9
The Clinical Syndrome
The carpometacarpal joints of the fingers are synovial plane joints that serve as the articulation between the carpals and the metacarpals and allow the bases of the metacarpal bones to articulate with one another. Movement of the joints is limited to a slight gliding motion, with the carpometacarpal joint of the little finger possessing the greatest range of motion. The primary function of these joints is to optimize the grip function of the hand. Most patients have a common joint space.
Pain and dysfunction from arthritis of the carpometacarpal joints are common complaints. These joints are susceptible to the development of arthritis from various conditions that share the ability to damage joint cartilage. Osteoarthritis is the most common form of arthritis that results in carpometacarpal joint pain. It occurs more often in female patients, and although the thumb is most frequently affected, arthritis may develop in the other carpometacarpal joints as well, especially after trauma. Rheumatoid arthritis, posttraumatic arthritis, and psoriatic arthritis are also common causes of carpometacarpal pain. Less frequent causes of arthritis-induced carpometacarpal pain include collagen vascular diseases, infection, and Lyme disease. Acute infectious arthritis is usually accompanied by significant systemic symptoms, including fever and malaise, and should be easily recognized; it is treated with culture and antibiotics rather than injection therapy. Collagen vascular diseases generally manifest as polyarthropathy rather than as monarthropathy limited to the carpometacarpal joint; however, carpometacarpal pain secondary to collagen vascular disease responds exceedingly well to the intraarticular injection technique described here.
Signs and Symptoms
Most patients presenting with carpometacarpal pain secondary to osteoarthritis or posttraumatic arthritis complain of pain that is localized to the dorsum of the wrist. Activity associated with flexion, extension, and ulnar deviation of the carpometacarpal joints exacerbates the pain, whereas rest and heat provide some relief. The pain is constant and is characterized as aching; it may interfere with sleep. Some patients complain of a grating or popping sensation with use of the joint, and crepitus may be present on physical examination. If the carpometacarpal joint of the thumb is affected, the patient will exhibit a positive Watson test. The test is performed by having the patient place the dorsum of the affected hand against a table with the fingers fully extended. The examiner then pushes the thumb toward the table. The test is positive if it reproduces the patient’s pain ( Fig. 53.1 ).
In addition to pain, patients suffering from arthritis of the carpometacarpal joint often experience a gradual reduction in functional ability because of decreasing pinch and grip strength that makes everyday tasks such as using a pencil or opening a jar quite difficult ( Fig. 53.2 ). With continued disuse, muscle wasting may occur, and adhesive capsulitis with subsequent ankylosis may develop.
