The carpometacarpal joint is responsible for one of man’s greatest advantages over nature – the opposable thumb. By giving our thumbs dexterity, this valuable joint has helped us achieve prolonged success.
Unfortunately, due to the intricate nature of the tissues involved, this valuable joint is also one of the most fragile in the human body.
The tissues within can become injured, deteriorate, and experience pain, loss of dexterity, and other complications. The best defense against the progression of a carpometacarpal injury is an understanding of the anatomy involved, the signs and symptoms of an injury, and the treatment options available.
Anatomy of the Carpometacarpal Joint
Our hands are made up of some of the most delicate structures within our bodies. The smallest injury to these structures can have a huge impact on the functionality of our hands. If treated improperly, these injuries can leave us with chronic pain or even complete dysfunction of the structures which were affected.
One of these structures, the carpometacarpal joint, is especially important to maintaining our hand dexterity as it is found within one of the most vital appendages on our bodies – the thumb.
The carpometacarpal joint is a convergent point for various soft tissues, bones, and muscles which work together to coordinate the movements within our thumbs. It is found at the base of the thumb and joins its structures to those of the palm and forearm.
This delicate weave of tissue is composed of 2 bones:
- First metacarpal: the bone which begins at the base of the palm and extends to the base of the thumb.
- Trapezium: a trapezoidal bone that sits between the wrist and the first metacarpal.
- Abductor pollicis: a muscle that extends from the base of the palm to the outside of the base of the thumbs. Allows for inward movement (towards the palm) of the thumb.
- Flexor pollicis brevis: a muscle that extends from the base of the back of the hand to the outside base of the thumb. Allows the thumb to bend at the end of the first metacarpal.
- Abductor pollicis brevis: located just under the flexor pollicis brevis providing stability to the flexions of the thumb.
- Opponens pollicis brevis: tucked under the flexor pollicis brevis and abductor pollicis brevis providing support to the movements induced by the abductor pollicis.
The carpometacarpal joint also includes a range of soft tissues including nerves, arteries, tendons, and cartilage. These tissues are the most fragile.
Cartilage provides cushion and lubrication allowing for a smooth interaction between the bones found in the thumb. Tendons attach the muscles to the bones. Arteries give these tissues a steady supply of blood. And nerves allow stimulation to the muscles to induce movements as well as communicate a feeling to the brain.
Together, these tissues form a cohesive structure that allows for the smooth range of movements of our thumbs. An acute injury or degenerative illness which impacts one of these tissues will upset the delicate balance and interplay between all of these tissues and create unwanted symptoms. If untreated, these symptoms can develop into much worse problems over time.
Symptoms and Signs of Carpometacarpal Joint Issues
Carpometacarpal injuries are not difficult to diagnose. At the onset, an individual with a carpometacarpal injury may feel pain, swelling, and tenderness. Over time, if the root cause isn’t addressed, these issues can develop into more severe symptoms such as:
- Reduced range of motion
- Instability or complete dysfunction of the thumb
- Loss of grip strength
- Degenerative illnesses such as arthritis
Causes of Carpometacarpal Joint Issues
There are two types of carpometacarpal injuries, those due to an acute injury or those which are brought on by the effects of aging.
Acute Injuries and Carpometacarpal Joint Issues
Acute injury-related carpometacarpal injuries occur after a high impact which overextends certain tissues within the carpometacarpal joint. Falling on your hand, catching a fast-moving projectile such as a baseball or football, or smashing the base of the thumb with a hammer or other blunt object. Acute injuries often lead to immediate symptoms such as swelling or thumb instability.
Age-Related Carpometacarpal Joint Issues
Age-related carpometacarpal injuries are incited by the degeneration of soft tissues due to an individual’s everyday use of the thumb.
Jobs that require extended load bearing on the thumb, a daily physical excursion that requires thumb flexion, and untreated thumb injuries in the past are a few of the factors which can provoke the breakdown of soft tissues within the carpometacarpal joint.
Whatever inciting factors, a carpometacarpal injury is a serious matter which should be diagnosed as soon as possible. The earlier a problem is detected, the better the chance of a complete recovery. The longer the individual waits to have their carpometacarpal-related pain treated, the worse the long-term effects will be.
Diagnosing Carpometacarpal Joint Pain
Carpometacarpal joint issues are diagnosed in the same ways as other soft-tissue-related injuries. Doctors will begin with a thorough examination of their patient’s medical history. Past injuries to the carpometacarpal joint and its surrounding tissues are a red flag as far as root causes of the pain a patient is experiencing.
A physical examination is soon to follow. Doctors will try to determine the source of a patient’s injury by recreating a patient’s pain. They will use a combination of palpation and extension/retraction exercises.
- Palpation: a doctor will apply light pressure to the carpometacarpal and its surrounding tissues.
- Extension and retraction: the doctor will try to gently extend the thumb to its outer limits of movement.
Additionally, doctors will use medical imaging to confirm their suspicions. These tests may include:
- X-rays: provide an image of the structure of the bones within the thumb. Doctors will look for abnormalities such as bone disfigurations and fractures which could have led to the induction of pain.
- CT scans: provide a view of the soft tissues such as arteries, tendons, cartilage, and muscles that surround the carpometacarpal joint. Every type of injury suggests its root cause in the soft tissues within our bodies. By using a CT scan, doctors can examine these soft tissues to find the causes.
Once a root cause has been established, doctors will access the damage and give their patients a range of treatment options. They may also discuss a patient’s functional goals and decide whether these are feasible or not given the extent of the injury.
Conventional Treatments for Carpometacarpal Joint Pain
There are a variety of options for patients suffering from carpometacarpal joint injuries. If the injury is caught soon enough, a patient may only need to rest their joint or splint their thumb so that it heals properly. Options for deeper tissue damage include physical therapy, medication, steroidal injections, and surgery.
Each option should be researched thoroughly to see if it aligns with a patient’s expected goals and whether the side effects and recovery periods of the treatment are worth the effort.
Physical therapy is a popular technique for recovering from soft-tissue-related injuries due to its ease of access. A majority of these treatments may be applied in the comfort of one’s home or at the onset of a flare-up.
As the name implies, physical therapies are treatments by physical means. Massage and guided stretches can help alleviate painful swelling and increase blood flow. Hot and cold therapy can both numb the nerves and open up the arteries within the thumb. Splints and other supportive devices reduce the strain of the carpometacarpal joint and can help the injury set properly.
If pain is minimal, over-the-counter treatments such as naproxen, acetaminophen, and ibuprofen may be enough to provide an adequate level of relief. In some cases, doctors may prescribe higher doses of these medications or resort to options that inhibit the brain’s response to pain stimuli.
It should be noted that medication’s effects wane over time and that they may come with dangerous side effects of their own. Additionally, medication is only a treatment for the symptoms of a patient’s issues and in no way helps to alleviate the root causes.
Popularized by sports medicine, steroidal injections have brought a great amount of relief to those suffering from pain created due to swelling and compression of the nerves found within our joints.
Studies have concluded that while these treatments provide relief from these pains, they have been shown to break down tissues over time and may cause further complications with prolonged use.
Surgery is typically a last resort for patients suffering from carpometacarpal joint pain. Long recovery periods, as well as sustained medication use and required regimens of physical therapy, push patients away from surgical intervention.
If patients feel that surgery is their only option, these treatments can be simple, minimally invasive procedures such as arthroscopy, or can be more involved, requiring doctors to open the hand and perform sculpt portions of the tissues which make up the carpometacarpal joint.
While conventional treatments are routinely the only options a patient is given, there exist many alternative treatments for soft-tissue-related injuries such as carpometacarpal joint pain. One of these treatments, regenerative therapy, not only helps alleviate the pain caused by a carpometacarpal injury but may also help treat the root causes.
Regenerative Therapy for Carpometacarpal Joint Pain
Regenerative therapies are not a new science and have been routinely applied since the early 1970s. A recent discovery in the field of stem cell sciences has led to a breakthrough discovery of a pseudo-stem cell which has changed the nature of these types of treatments.
At CELLAXYS, we offer two common types of orthobiologic treatments, Platelet-rich plasma (PRP) therapy and cell-based therapies.
Platelet-rich plasma or PRP therapy has been a known solution to soft-tissue-related injuries for more than 20 years. The procedure extracts blood from a patient, isolates the platelets within it, and then reinjects these platelets into the patient. Platelets are the healing elements of our body.
They release 10 Growth Factors, send chemical signals to attract healing cells in the blood, and produce fibrin. Fibrin is a sticky web that supports the development of healthy tissues and cells in your joints.
PRP therapy is beneficial for multiple spine, sports, and orthopedic injuries. The procedure completes in 45 minutes.
Also known as Stem cell therapy, cell-based therapies work on your body’s autologous tissues, which are your own cells or tissues. The healthcare professional harvests stem cells from different parts of your body and inject them into the injury site to promote healing.
There are two types of cell-based therapies:
- Minimally Manipulated Adipose Tissue Transplant (MMAT). This procedure transplants your injured tissues with healthy cells from the adipose tissues. One benefit of MMAT is that it can be performed in multiple parts of your body in the same procedure.
- Bone Marrow Concentrate (BMAC). This method harvests healthy cells from your bone marrow and injects them in the affected areas.
You will barely feel any pain from these cell-based therapies since you’ll be under anesthesia. Both of these procedures take about 1.5-2 hours to complete. The doctor uses X-rays and ultrasound to identify the exact transplant location.
If conventional treatment options seem like a burden, patients may want to consider these alternative treatment options. In addition to treating the root cause of a patient’s carpometacarpal pain, these treatments are simple outpatient procedures with minimal downtimes.
Patients can also expect to feel results within a few weeks of the injections, and some patients report relief that lasts upwards of a year.