CMC arthroplasty of the thumb: a review

Abstract

Arthritis of the first carpometacarpal (CMC) joint of the hand is a common and often debilitating disease. Diagnosis can be readily made with history, physical exam, and radiographic evaluation. Patients with advanced disease who have failed conservative treatment modalities have multiple surgical options including ligament reconstruction, resection arthroplasty, silicone implantation, tendon interposition, or total joint arthroplasty. This article will describe the variety of approaches to treatment as well as the author's preferred method.

Figures

Figure 1

Flow diagram for treatment of carpometacarpal arthritis [1].

Figure 2

Apex dorsal incision overlying the first extensor compartment.

Figure 3

Drill holes for the passing of the tendon graft. The first hole is centered on the articular surface and aimed straight down the medullary canal; the second is on the dorsal side of the thumb, perpendicular to the first drill hole as well as the plane of the thumb nail.

Figure 4

Artists rendition of the FCR tendon weave (compliments of Ian Duncan, MD).