1. CALCIFICATION ON THUMB BASE (OSTHEOARTHRITIS OF CMC-1 JOINT)

Smooth surfaced cartilage covers both ends of bones. This cartilage structure provides bones to slide in the joint easily during the movement. Osteoarthritis arises by wearing and surface damaging of this cartilage. Hand osteoarthiritis is generally observed in the joint on thumb base. There is a joint which provides the thumb turning on its axis, pinch move and supporting other fingers on the basis of the thumb. We can clutch and take in our hands by virtue of this joint. After deformation of this joint, pain arises during thumb use in hand functions. Arthritis which affects the thumb base is observed more frequent in women than men and after the age of 40. Joint injury and fracture history increase the possibility of arthritis.

Pain during movements such as clutching and pinching; swelling and sensibility in the thumb base; feeling of pain and discomfort after long finger use; loss of force in clutching and pinching movements; enlarged joint view which resembles joint dislocation; limited joint movement may be detected.

Sensibility and swelling may exist in the thumb base during physical examination (figure 1). One of tests that is used during the physical examination is to move the thumb while holding the joint on the thumb base fixed. During this test, if there is sense of grit presence or sound of friction, bone rubbing is suspected.

Deformation of the joint in the direct graphy, spur like bulges in the bone and calcium residues may be observed.(Figure 2)

Thumb base arthritis may response to other treatments except the surgery in the beginning term. Cold application may be performed with ice for 5-15 minutes on the joint for several times. Taking anti inflammatory drugs such as asprine or ibuprofen helps to reduce the inflammation and the swelling. Using supportive brace enables joint resting and recovery by limiting the joint movement. Brace may protect either the thumb or the wrist. It may be used intermittently during the day or only in the night. (Figure 3)

As arthritis is a progressive disease, it may get worse in time. Intraarticular steroid injection may be done in progressive joint damages. Generally comfort is provided for a couple of months after this application. But injections are rarely repeated continuously during the disease. In cases of which non-surgical procedures are not useful, surgery is considered. There are many different surgical procedure. Surgical operation may be applied as ambulatory without need of hospitalization. One of surgical procedures is bone combining in the joint that limits the joint movement. Another option is to remove damaged part of the joint and restructuring by tissue transplantation or artificial substances from sinew (tendon). The best surgical option which is used frequently is the process known as 1. carpometacarpal arthroplasty, removal of arthritic bones from the are and placing sinews by changing their direction as to act like a buffer between the thumb and the wrist. This procedure provides comfort in articular movement as well as decreasing the pain compliant.

Plaster is applied for a couple of weeks after the surgery. Generally a rehabilitation program that involves a physical treatment specialist helps you to gain force and movement of your hand back. You may feel difficulty and discomfort at the beginning of the program, but these complaints decrease in time. Complete recovery takes a couple of months after the surgery.

Source: 1. Calcification on thumb base