[Trapeziometacarpal osteoarthritis].
Trapeziometacarpal osteoarthritis, usually defined as arthrosis of the trapeziometacarpal joint, is frequently observed in perimenopausal women and can induce a functional disability, severe in some cases. Most of the time, discomfort is moderate and resolves spontaneously within several months or several years and requires a medical therapy based on analgesics, anti-inflammatory drugs and nocturnal splinting aiming at reducing pain and joint deformity. The spontaneous evolution of the disease leads to joint stiffness in a position of variable deformity of the thumb, with adduction of the trapeziometacarpal joint and compensating hyperextension of the metacarpophalangeal joint allowing to keep a satisfying function despite a decrease in strength and dexterity. However, in the forms of the disease characterized by severe pain and long-lasting progression, a surgical treatment is appropriate since it enables the patients to relieve thumb pain and regain total joint mobility, even though joint deformity is not really corrected. In patients under 70, the most appropriate operation is trapezectomy which, at the cost of a 6-month period until complete recovery is achieved, makes it possible to avoid prosthetic surgery, associated with more uncertain long-term outcomes and risks of wear and loosening. In patients over 70 ans though, in the absence of peritrapezial arthrosis and provided that the trapezium is sufficiently high to constitute an appropriate receptacle for the prosthesis, prosthetic surgery remains an interesting alternative to trapezectomy since it requires a shorter recovery period. The surgical indication needs to be debated on a case-by-case basis; it should only be considered in case of intense pain and not be based on the importance of radiological involvement.
Roulot
Eric
E
Institut de la main, clinique Jouvenet, 6, square Jouvenet, 75016 Paris. eroulot@free.fr
D050824:Carpal Joints; D018450:Disease Progression; D006801:Humans; D010003:Osteoarthritis / Q000175:diagnosis / Q000628:therapy