Trapeziometacarpal (TMC) Arthritis

What is Trapeziometacarpal (TMC) Arthritis?

Trapeziometacarapal (TMC) joint arthritis, also known as carpometacarpal (CMC) joint arthritis or basilar thumb arthritis or rhizarthrosis, is a common form of arthritis that affects the first carpometacarpal (trapeziometacarpal) joint of the thumb. It is an inflammatory condition characterized by gradual wearing away of the cartilaginous surface of the TMC joint and the bones rubbing against each other causing inflammation and pain. It occurs most commonly in middle-aged, elderly, and postmenopausal women.

The TMC joint or CMC joint is formed by the first metacarpal bone of the thumb and the trapezium (carpal) bone of the wrist. The joint is located at the base of the thumb and attaches the base of the thumb to the wrist and the base of the fingers to the hand. The TMC joint is crucial for hand dexterity and strength and allows the hand to grasp objects with a strong grip.

Causes of Trapeziometacarpal (TMC) Arthritis

Some of the causes of TMC arthritis include:

• Advanced age
• Wear-and-tear
• Genetic or congenital anomalies
• Family history
• Trauma or previous joint fractures
• Inflammatory arthritis, such as rheumatoid arthritis and lupus

Signs and Symptoms of Trapeziometacarpal (TMC) Arthritis

Some of the signs and symptoms of TMC arthritis include:

• Tenderness, stiffness, and swelling at the base of the thumb
• Pain that gets worse after prolonged use of the thumb
• Enlarged and bony appearance at the base of the thumb 
• Limited motion of the thumb and feeling of loss of strength
• Grinding sensation with a grating sound when moving the thumb
• Difficulty in gripping or grasping objects or in pinching

Diagnosis of Trapeziometacarpal (TMC) Arthritis

Your doctor will assess your symptoms, take your medical history, and perform a thorough physical examination of your thumb. During the examination, your physician will maneuver the thumb and check for range of motion and strength. Your physician may notice grinding when maneuvering the thumb in a certain way. Imaging tests such as X-rays may also be ordered for detailed evaluation of the TMC joint to assess the severity of arthritis and to confirm the diagnosis. The imaging may exhibit bone spurs, joint space narrowing, or hyperextension of the metacarpophalangeal joint.

Treatment for Trapeziometacarapal (TMC) Arthritis

The treatment options for trapeziometacarpal (TMC) arthritis include both nonsurgical methods as well as surgical methods. Your doctor will determine the right option for you based on the severity of the condition.

Nonsurgical Treatment

• Activity Modification: Avoiding activities that trigger symptoms and changing ones habits
• Ice: Application of ice packs on the joints to decrease swelling and pain
• Physical Therapy: Regular exercise regimen to improve range of motion and strengthen joint muscles
• Anti-inflammatory Medication: Medications like naproxen and ibuprofen to relieve inflammation and pain
• Orthotics: Use of assistive devices such as thumb spica bracing to avoid mechanical stresses to the TMC joint
• Cortisone Injection: Injection of corticosteroid medication directly into the affected joint to relieve pain and swelling. Cortisone is a very effective anti-inflammatory medicine and long-term pain reliever.

Surgical Treatment

Trapeziectomy with Ligament Reconstruction and Tendon Interposition (LRTI): This is the most commonly employed surgery for the treatment of TMC arthritis. In this procedure, the trapezium bone is removed, and part of the joint is reconstructed with a donor tendon from the forearm. Excess donor tendon is then placed into the empty joint space to help keep the bones separated.