• Wrist Thumb Brace Arthritis Icd 10

Arthritis at the base of thumb is a very common disorder encountered by the primary care physician and the hand specialist. It is referred to by many different names: basal joint arthritis, first CMC (carpometacarpal) arthritis, and trapezio-metacarpal arthritis.

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Did You Know?

It is the second most common arthritic problem encountered in the hand, behind distal interphalangeal joint arthritis. However, it is the most common site for which surgery is sought because of its profound impact on hand function. The joint is particularly susceptible to wear because of the tremendous physical stresses placed on it throughout life. Pinch pressures at the thumb tip are magnified approximately tenfold at the CMC joint. Women are affected more commonly than men, related to postmenopausal ligamentous laxity. The problem presents sometime in the fourth through sixth decades. It may be seen earlier in life, usually associated with prior trauma to the joint.

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Wrist Thumb Brace Arthritis Icd 10

Diagnosis

The differential diagnosis of CMC arthritis includes other common disorders at the radial aspect of the hand and wrist. DeQuervain’s tenosynovitis may mimic symptoms of CMC arthritis. Also, arthritis involving the radial styloid or the STT (scaphotrapezialtrapezoidal) joint may also cause pain similar to CMC arthritis. The diagnosis is made by history, physical exam, and radiographic findings. Patients typically complain of aching and pain involving the thenar aspect of the hand and base of the thumb. Pinching, removing jar lids, turning doorknobs or even the keys to the car may be problematic. Patients who are involved in jobs that require significant pinching and grasping activities may have exacerbation of the condition. During the physical exam, there is often some swelling or prominence noted at the dorsal base of the thumb. This is a sign of subluxation of the first metacarpal at the CMC joint. One of the definitive physical findings is that of a positive “grind test.” The first metacarpal is held firmly and pushed proximally to load the joint while manipulating the base of the metacarpal in different directions. This will reproduce the patient’s symptoms and also usually elicit some palpable crepitus in the joint. DeQuervain’s tenosynovitis on the other hand, results in specific tenderness more proximal, over first dorsal compartment tendons near the radial styloid. If after the history and physical exam, there still is some question regarding the diagnosis, radiographs should help confirm the problem. Three standard views of the thumb are usually sufficient to evaluate the joint.

The Findings

Typical findings are loss of joint space, spurring and osteophyte formation from the trapezium and metacarpal base. (Figure 1) There may be more extensive involvement around the trapezium, including the scaphotrapezial joint (pan trapezial arthritis). One thing to keep in mind is that radiographic findings do not always correlate well with physical findings or symptoms. We frequently see patients with incidental findings of end stage disease on x-rays that have no symptoms. Likewise very minimal or subtle findings on x-ray can be associated with significant pain and disability.