Shoulder Doctor
London
Consultant Shoulder
Elbow & Upper Limb Surgeon
www.shoulderdoctor.co.uk
0203 301 3750
A Patient’s Guide to:
Arthritis of the
Thumb
(CMC Joint)
Tony Kochhar
Consultant Shoulder and Upper Limb Surgeon
London Bridge Hospital
27 Tooley Street
London, SE1 2PR
CMC Joint Arthritis
Introduction
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Anatomy
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*'%1'<#%&'(3%*"(1/%,$*'%&'(3%+.=14%.%1'*,'$
2.==#7%'++'),*,'$9
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:"#)#%=,;.1#$*)%2.$%/#%,$6(3#74%)(2"%.)%0"#$
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Causes
4"21%:2'$)$%201"0#1#$%.;%1")%1"'<=9
G3*"3,*,)%,)%.%2'$7,*,'$%,$%0",2"%.%6',$*
!"#$%"&'()*+%",'-.",/'&0$11")/'2$3/'+),'%
+.,$8(=C9%H#;#$#3.*,<#%.3*"3,*,)%,)%.%2'$7,*,'$
,$%0",2"%.%6',$*%0#.3)%'(*4%()(.==&%)='0=&%'<#3
.%+#3,'7%'8%1.$&%&#.3)9%H'2*'3)%)'1#*,1#)
.=)'%7#)23,/#%*",)%).1#%2'$7,*,'$%.)%7#;#$#3.?
*,<#%.3*"3'),)9%F*%,)%.=)'%2.==#7%')*#'.3*"3,*,)9
I<#3%1.$&%&#.3)%*",)%,1/.=.$2#%,$%*"#
6',$*%1#2".$,2)%2.$%=#.7%*'%7.1.;#%'$%*"#
.3*,2(=.3%)(38.2#9%E,$2#%.3*,2(=.3%2.3*,=.;#
2.$$'*%"#.=%,*)#=8%<#3&%0#==4%*"#%7.1.;#%.77)
(+9%J<#$*(.==&4%*"#%6',$*%,)%$'%='$;#3%./=#%*'
2'1+#$).*#%8'3%*"#%,$23#.),$;%7.1.;#4%.$7
,*%/#;,$)%*'%"(3*9%H.1.;#%".)%'22(33#7%0#==
/#8'3#%*"#%+.,$%/#;,$)9%
Symptoms
4"21%(.)$%201"0#1#$%.;%1")%1"'<=%;))+%+#>)9
F$6(3&%*'%.%6',$*4%)(2"%.)%.%/.7%)+3.,$%'3
83.2*(3#4%2.$%2.()#%7.1.;#%*'%*"#%.3*,2(=.3
2.3*,=.;#9%G$%,$6(3&%*'%*"#%@A@%6',$*%'8%*"#
*"(1/4%#<#$%,8%,*%7'#)%$'*%,$6(3#%*"#%.3*,2(=.3
2.3*,=.;#%7,3#2*=&4%2.$%.=*#3%"'0%*"#%6',$*
0'3-)9%G8*#3%.%83.2*(3#%'8%*"#%*"(1/%1#*.2.3+.=4
*"#%/'$#%83.;1#$*)%1.&%"#.=%,$%)=,;"*=&
7,88#3#$*%+'),*,'$)9%:"#%6',$*)%1.&%*"#$%=,$#
(+%7,88#3#$*=&9%:",)%,)%.=)'%*3(#%0"#$%*"#%=,;.?
1#$*)%.3'($7%*"#%@A@%6',$*%.3#%7.1.;#7%/&
.%)+3.,$9%!"#$%.$%,$6(3&%3#)(=*)%,$%.%2".$;#
,$%*"#%0.&%*"#%6',$*%1'<#)4%*"#%,$6(3&%1.&
,$23#.)#%*"#%8'32#)%'$%*"#%.3*,2(=.3%2.3*,=.;#
)(38.2#)9%:",)%,)%),1,=.3%*'%.$&%1#2".$,2.=
7#<,2#%'3%1.2",$#3&9%F8%*"#%1#2".$,)1%,)%'(*
'8%/.=.$2#4%,*%*#$7)%*'%0#.3%'(*%8.)*#39
K.,$%,)%*"#%1.,$%+3'/=#1%0,*"%7#;#$#3.*,<#
+.32.(3(&'$4'+)5'6$()37'82(&'9+()'$##:.&'+3';.&3
'$=&%3#=.*#7%*'%.2*,<,*&9%L)(.==&4%'$2#%*"#
.2*,<,*&%;#*)%($7#30.&%*"#3#%,)%$'*%1(2"%+.,$4
/(*%.8*#3%3#)*,$;%8'3%)#<#3.=%1,$(*#)%*"#%+.,$
.$7%)*,88$#))%,$23#.)#9%M.*#34%0"#$%*"#%2'$7,?
*,'$%0'3)#$)4%+.,$%1.&%/#%+3#)#$*%#<#$%.*%3#)*9
:"#%1')*%$'*,2#./=#%+3'/=#1%0,*"%@A@%6',$*
+.32.(3(&'(&'32+3'(3'!"#$%"&',(4;#:13'3$'<.(9'+)5?
*",$;9%F*%2.()#)%.%)".3+%+.,$%.*%*"#%/.)#
'8%*"#%*"(1/%,$%*"#%*",2-%+.3*%'8%*"#%"##=%'8%*"#
".$79%!"#$%*"#%.3*,2(=.3%2.3*,=.;#%)*.3*)%*'%
0#.3%'88%*"#%6',$*%)(38.2#4%*"#%6',$*%1.&%1.-#%.%
)>(#.-,$;%)'($7%0"#$%1'<#79%H'2*'3)%3#8#3%*'%
*",)%)'($7%.)%23#+,*()9%:"#%6',$*%'8*#$%/#2'1#)%
)*,88%.$7%/#;,$)%*'%=')#%1'*,'$9%A'<,$;%*"#%
*"(1/%.0.&%83'1%*"#%+.=1%1.&%/#2'1#%%
,(4;#:137'82(&'(&'."4"..",'3$'+&'+'#$)3.+#3:."7
I)*#'.3*"3,*,)%1.&%2.()#%*"#%@A@%6',$*%'8%*"#%
*"(1/%*'%='')#$%.$7%*'%/#$7%/.2-%*''%8.3%
B"&+#3#N*#$),'$C9%F8%*"#%1,77=#%*"(1/%6',$*
-=>?'6$()3@'!"#$%"&'*"A",'+),'32"'4:.32"&3
*"(1/%6',$*%.=)'%/#2'1#)%"&+#3#N*#$7#74%*"#
7#8'31,*&%,)%$.1#7%.%*"(1/%)0.$%$#2-%
,"4$.%(357'C'&(%(1+.';)<".',"4$.%(35'&$%"3(%"&
$##:.&'()'9"$91"'0(32';)<".'+.32.(3(&7%
P?3.&)%0,==%/#%*.-#$%*'%)##%"'0%1(2"%*"#
6',$*%,)%7.1.;#79%:",)%*#)*%()(.==&%7#*#31,$#)
"'0%/.7%*"#%7#;#$#3.*,<#%.3*"3,*,)%".)%/#2'1#9
Q'0%1(2"%.3*,2(=.3%2.3*,=.;#%3#1.,$)%,$%*"#%%
6',$*%2.$%/#%#)*,1.*#7%0,*"%*"#%P3.&)9
Treatment
4"21%:2/%=)%(./)%;.0%565%7.#/1%201"0#1#$9
:"#%*3#.*1#$*%'8%7#;#$#3.*,<#%.3*"3,*,)%'8%*"#
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*"#%$'$)(3;,2.=%1#.$)%*'%2'$*3'=%*"#%)&1+*'1)
.$7%*"#%)(3;,2.=%+3'2#7(3#)%*".*%.3#%.<.,=./=#
*'%*3#.*%*"#%2'$7,*,'$9%E(3;#3&%,)%()(.==&%$'*
2'$),7#3#7%($*,=%*"#%)&1+*'1)%".<#%/#2'1#
,1+')),/=#%*'%2'$*3'=%0,*"'(*%,*9
@./$'0&#:2+%!0)21<)/1
Diagnosis
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,"3+(1",'2(&3$.5'$4'32"'9.$!1"%7'B9"#(;#&'+!$:3
.$&%,$6(3,#)%*".*%1.&%".<#%'22(33#7%*'%*"#
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'*"#3%3#.)'$)%0"&%*"#%2'$7,*,'$%#N,)*)9
O'=='0,$;%*"#%",)*'3&4%*"#%7'2*'3%0,==%#N.1,$#
&'(3%".$7%.$7%+')),/=&%'*"#3%6',$*)%,$%&'(3
/'7&9%:"#%7'2*'3%0,==%$##7%*'%)##%"'0%*"#
1'*,'$%'8%*"#%@A@%6',$*%".)%/##$%.88#2*#79
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6$()3';.&3'!"#$%"&'9+()4:17'82(&'%+5'$)15
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3#+#*,*,<#%;3,++,$;%0,*"%*"#%".$74%1.&%/#
$#2#)).3&%*'%"#=+%2'$*3'=%*"#%)&1+*'1)9
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*'%"#=+%3#7(2#%+.,$4%+3#<#$*%7#8'31,*&4%'3
-##+%.%*"(1/%7#8'31,*&%83'1%;#**,$;%0'3)#9
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()(.==&%'$=&%0#.3%*"#%)+=,$*%.*%$,;"*%.$7%0"#$
32"'6$()3'(&'*+.",':97'E3'&2$:1,'+1&$'!"'0$.)
*'%+3'*#2*%*"#%*"(1/%7(3,$;%"#.<&%'3%3#+#.*#7
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7'$#%0,*"%=#))%)*3.,$%'$%*"#%6',$*9
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*"#%6',$*4%.$7%2'3*,)'$#%,$6#2*,'$)%.3#%$'%
#N2#+*,'$9
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".$7)%8'3%"#.<&%0'3-%0,==%+3'/./=&%+3#8#3%.
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A'0&)0:"#%)(3;,2.=%*3#.*1#$*%8'3%.3*"3,*,)%'8%*"#%@A@
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91+&35'()&3"+,7'H"0".'+.3(;#(+1'6$()3&'+."'!"()<
7#<#='+#74%.$7%,$%*"#%8(*(3#%0#%1.&%)##%1'3#
)(3;#'$)%(),$;%*"#19
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)
C.3(;#(+1'6$()3&'+."'+G+(1+!1"'4$.'32"'>=>
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)
Rehabilitation
4"21%$".'+(%B%)C,):1%2;1)0%10)21<)/19
@./$'0&#:2+%D)"2=#+#121#./
:;&$3$+,)!"#2"+/('3#4)
:"#%*3.7,*,'$.=%'+#3.*,'$%8'3%*3#.*,$;%@A@
6',$*%.3*"3,*,)%,)%#N2,),'$%.3*"3'+=.)*&9%:",)
1#*"'7%".)%/##$%()#7%8'3%1.$&%&#.3)%.$7
".)%0,*")*''7%*"#%*#)*%'8%*,1#9%:"#%+(3+')#%'8
#N2,),'$%.3*"3'+=.)*&%,)%*'%3#1'<#%*"#%.3*"3,*,2
6',$*%)(38.2#)%'8%*"#%@A@%6',$*%.$7%3#+=.2#
*"#1%0,*"%.%2()",'$%'8%1.*#3,.=%*".*%0,==
F8%&'(%7'$5*%$##7%)(3;#3&4%3.$;#?'8?1'*,'$
#N#32,)#)%8'3%*"#%*"(1/%)"'(=7%/#%)*.3*#7%.)
+.,$%#.)#)9%S'(3%*"#3.+,)*%0,==%0'3-%0,*"
&'(%*'%'/*.,$%'3%23#.*#%.%)+#2,.=%*"(1/%)+=,$*
B1#$*,'$#7%#.3=,#3C%0"#$%$##7#79%:"#%+3';3.1
.7<.$2#)%*'%,$2=(7#%)*3#$;*"%#N#32,)#)%8'3%*"#
32:%!'+),';)<".&7'I"A3".(35'+),';)"'%$3$.
#N#32,)#)%.3#%()#7%*'%;#*%&'(3%".$7%.$7%*"(1/
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8'(3%*'%),N%0##-)9
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.8*#3%)(3;#3&9%K"&),2.=%'3%'22(+.*,'$.=%*"#3.+&
)#)),'$)%1.&%/#%$##7#7%.8*#3%)(3;#3&%8'3%(+
3$'"(<23'0""J&7'82"';.&3'4"0'3."+3%")3&'+."
()#7%*'%"#=+%2'$*3'=%*"#%+.,$%.$7%)0#==,$;%.8*#3
)(3;#3&9%E'1#%'8%*"#%#N#32,)#)%&'(5==%/#;,$
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1()2=#)%.3'($7%*"#%*"(1/%6',$*9%I*"#3%#N#32,)?
"&'+."':&",'3$'(%9.$G"';)"'%$3$.'#$)3.$1
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