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170: THUMB CARPOMETACARPAL JOINT OSTEOARTHRITIS

Eric Shamus, PhD, DPT, PT, CSCS; Reuben Escorpizo, DPT, MSc, PT

ICD-9-CM CODES

  • 715 Osteoarthrosis and allied disorders

  • 715.14 Osteoarthrosis localized primary involving hand

  • 715.24 Osteoarthrosis localized secondary involving hand

  • 715.9 Osteoarthrosis unspecified whether generalized or localized

  • 715.94 Osteoarthrosis unspecified whether generalized or localized involving hand

ICD-10-CM CODES

  • M18.9 Osteoarthritis of first carpometacarpal joint, unspecified

  • M19.049 Primary osteoarthritis, unspecified hand

  • M19.249 Secondary osteoarthritis, unspecified hand

PREFERRED PRACTICE PATTERNS

  • 4D: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated with Connective Tissue Dysfunction

  • 4F: Impaired Joint Mobility, Motor Function, Muscle Performance, Range of Motion, and Reflex Integrity Associated with Spinal Disorders

  • 4H: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated with Joint Arthroplasty

  • 4I: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated with Bony or Soft Tissue Surgery

PATIENT PRESENTATION

The patient is a 67-year-old woman who presents with pain at the base of the right thumb with decreased ability to knit. It is affecting her grip and ability to manipulate small objects. She complains of a constant pain, but feels better in warm water when she washes the dishes. The patient has an X-ray that showed an osteophyte with degenerative changes at the carpometacarpal joint. The opposite side is starting to bother her. There is visual enlargement of the joint.

KEY FEATURES

Description

  • Most common form of osteoarthritis (OA)

  • Degenerative

  • Commonly affects hand and weight-bearing joints

  • Can also affect interphalangeal joints and first metatarsophalangeal joint

  • Associated with increasing age, obesity, sex, and race/ethnicity

  • Associated with abnormal loading of the joints

  • Characterized by joint pain

  • Arthrosis

  • Osteoarthrosis

  • Polyarthrosis

  • Degenerative joint disease

FIGURE 170-1

Radiograph of thumb basilar osteoarthritis. There is irregular loss of the joint space between the proximal thumb metacarpal and the trapezium bone, together with bony sclerosis and bony cysts. There is also proximal and radial subluxation of the thumb metacarpal, indicative of carpometacarpal joint ligament laxity, caused by the progressive arthritis. (From Imboden J, Hellmann DB, Stone JH. Current Diagnosis & Treatment in Rheumatology. 2nd ed. http://www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

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Essentials of Diagnosis

  • Radiography is a standard method for diagnosis

  • Kellgren and Lawrence (KL) grade ≥2 (definite radiographic OA)1

  • Osteophytes, joint-space narrowing, sclerosis

  • Also cartilage lesions, bone marrow lesions, synovitis, effusion, and subchondral bone attrition/sclerosis

  • Erosion of articular cartilage

  • Synovial hyperplasia

  • Fibrosis

  • Inflammatory cell infiltration

  • Conventional radiograph is the most commonly used tool in OA

  • Diagnosis is made based on a careful history taking, physical examination, imaging studies, laboratory examination, and exclusion of other possible diseases

General Considerations

  • Low bone mineral density (BMD)

  • Repetitive joint use or loading

  • Joint alignment

  • Bone ...

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