Arthritis Pain in the Carpometacarpal Joints

THE CLINICAL SYNDROME

Pain and dysfunction from arthritis of the carpometacarpal joints is a common complaint encountered in clinical practice. The carpometacarpal joints are susceptible to the development of arthritis forma variety of conditions that have in common the ability to damage the joint cartilage. Osteoarthritis of the joint is the most common form of arthritis that results in carpometacarpal joint pain. It occurs ore commonly in females, and although the carpometacarpal joint of the thumb is most commonly affected, arthritis may also develop in the other carpometacarpal joints, especially after trauma. Rheumatoid arthritis, post-traumatic arthritis, and psoriatic arthritis are also common causes of carpometacarpal pain secondary to arthritis. Less common causes of arthritis-induced carpometacarpal pain include the collagen vascular diseases, infection, and Lyme disease. Acute infectious arthritis will usually be accompanied by significant systemic symptoms including fever and malaise and should be easily recognized by the astute clinician and treated appropriately with culture and antibiotics, rather than injection therapy. The collagen vascular diseases will generally present as a polyarthropathy rather than as a monoarhtropathy limited to the carpometacarpal joint, although carpometacarpal pain secondary to collage vascular disease responds exceedingly well to the intra-articular injection technique described here.

The carpometacarpal joints of the fingers are synovial plane joints that serve as the articulation between the carpals and the metacarpals and allow articulation of the bases of the metacarpal bones 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 the joint is to optimize the grip function of the hand. In most patients, there is a common joint space.

SIGNS AND SYMPTOMS

The majority of patients presenting with carpometacarpal pain secondary to osteoarthritis and post-traumatic arthritis pain will present with the complaint of pain that is localized to dorsum of the wrist. Activity associated especially with flexion, extension, and ulnar deviation of the carpometacarpal joints will exacerbate the pain, with rest and heat providing some relief. The pain is constant and characterized as aching in nature. The pain may interfere with sleep. Some patients complain of a grating or popping sensation with use of the joint, and crepitus maybe present on physical examination.

Arthritis of the carpometacarpal joints may cause pain and decrease grip strength.

In addition the aforementioned pain, patients suffering from arthritis of the carpometacarpal joint will often experience a gradual decrease in functional ability with decreasing pinch and grip strength, making everyday tasks such as using a pencil or opening a jar quite difficult. With continued disuse, muscle wasting may occur, and an adhesive capsulitis with subsequent ankylosis may develop.

Treatment

Initial treatment of the pain and functional disability associated with osteoarthritis of the carpometacarpal joints should include a combination of the nosteroidal anti-inflammatory drugs or cyclooxygenase-2 inhibitors and physical therapy. The local application of heat and cold may also be beneficial. Splinting the wrist in neural position may also help provide symptomatic relief and protect the joint from additional trauma. For patients who do not respond to these treatment modalities, an intra-articular injection of local anesthetic and steroid may be a reasonable next step.

Proper needle placement for injection of the carpometacarpal joints.

Intra-articular injection of the wrist is performed by placing the patient in a supine position, with the arm fully adducted at the patient’s die and the hand in neutral position with the palmar aspect resting on a folded towel. The use of physical modalities including local heat as well as gentle range of motion exercises should be introduced several days after the patient begins treatment for the pain and dysfunction of arthritis of carpometacarpal joints. Vigorous exercises should be avoided because they will exacerbate the patient’s symptomatology. Simple analgesics and nonsteroidal anti-inflammatory drugs may be used concurrently with this injection technique. This injection technique is extremely effective in the treatment of pain secondary to the aforementioned causes of arthritis of the wrist joint. Coexistent bursitis and tendonitis may also contribute to the patient’s pain and may require additional treatment with more localized injection of local anesthetic and methylprednisolone acetate.

Low intensity laser therapy as well as a coordinated wellness program is also effective in treating this disorder.

Low Intensity Laser Therapy (LILT)

The low intensity Laser (LILT) sends photons (light) into the injured tissues and can penetrate two to three inches to treat affected areas. It uses a natural enhancement of the cellular machinery that can and has been dynamically measured in published studies to promote healing without burning affected tissue. Once the photons find the injured tissues, they stimulate and energize the cells to repair and strengthen at a remarkable rate. The treatment does not hurt, takes about 30 minutes and is very cost advantageous.

Wellness Program

A wellness program whichindividualizes treatment for age, performance and function has been shown in pilot studies to improve the overall health and well being of the individuals evaluated. A well conceived dietary and supplementary regimen based on scientific age–related decline in certain necessary compounds can improve quality of life, correct the ravages of hormone imbalance, balance critical neurotransmitter function without resorting to powerful drugs for depression that often have unfavorable side-effect profiles and restore vitality and youth in daily exercise routines. Furthermore, when wellness products are utilized with success, individuals often seek less costly interventions including unnecessary surgeries and narcotic options to treat pain. For more information go to www.drpwellness.com.