Abstract
Instability of the thumb CMC joint is thought to lead to degenerative changes within the joint. Many treatments have been described for the already degenerative joint, but few have focused on treatment of laxity of the joint. Previously, treatment of thumb CMC laxity was limited to invasive open stabilization procedures. Recent advances in small joint arthroscopy and thermal stabilization have made it possible to treat this clinical problem in a minimally invasive fashion. Symptoms of thumb CMC joint instability include pain especially with stress. Dynamic examination with fluoroscopy can aid in the diagnosis. Initial management should consist of conservative treatment with splinting and injections, but failure of nonoperative management should lead to consideration for surgery. Electrothermal stabilization has been used with success in the hand and wrist by affecting heat labile intramolecular bonds in collagen. Standard 1R and 1U portals can be used to allow treatment of the ligaments that comprise the thumb CMC joint. Further stabilization can be provided with a pin or a “tightrope” type implant. After a period of immobilization, early motion and strengthening is started and patients are generally able to resume normal activities with reduced pain due to the increased stability of the thumb CMC joint. Whether the progression of degenerative changes is slowed or halted has yet to be fully determined, but symptomatic relief can be expected with this type of treatment.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Eaton RG, Lane LB, Littler JW, et al. Ligament reconstruction for the painful thumb carpometacarpal joint: a long-term assessment. J Hand Surg Am. 1984;9:692–9.
Berger RA. A technique for arthroscopic evaluation of the first carpometacarpal joint. J Hand Surg Am. 1997;22:1077–80.
Arnoczky SP, Aksan A. Thermal modification of connective tissues: basic science consideration and clinical implications. J Am Acad Orthop Surg. 2000;8:305–13.
Hayashi K, Markel M. Thermal modification of joint capsule and ligamentous tissues. Tech Sports Med. 1998;6:120–5.
Hayashi K, Peters D, Thabit G, et al. The mechanism of joint capsule thermal modification in an invitro sheep model. Clin Orthop Relat Res. 2000;370:236–49.
Osmond C, Hecht P, Hayashi K, et al. Comparative effects of laser and radiofrequency on joint capsule. Clin Ortho Relat Res. 2000;375:286–94.
Culp RW, Rekant MS. The role of arthroscopy in evaluating and treating trapeziometacarpal disease. Hand Clin. 2001;17(2):315–9.
Gonzalez MH, Kemmler J, Weinzweig N, et al. Portals for arthroscopy of the trapeziometacarpal joint. J Hand Surg Br. 1997;22(5):574–5.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2015 Springer Science+Business Media New York
About this chapter
Cite this chapter
Stephenson, J.M., Culp, R.W. (2015). Thumb CMC Arthroscopic Electrothermal Stabilization (Without Trapeziectomy). In: Geissler, W. (eds) Wrist and Elbow Arthroscopy. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-1596-1_24
Download citation
DOI: https://doi.org/10.1007/978-1-4614-1596-1_24
Published:
Publisher Name: Springer, New York, NY
Print ISBN: 978-1-4614-1595-4
Online ISBN: 978-1-4614-1596-1
eBook Packages: MedicineMedicine (R0)