Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with chronic, progressive pain at the base of the thumb, exacerbated by pinch and grasp activities. Reports morning stiffness, weakness in grip strength, and difficulty with tasks such as opening jars or turning keys. No history of acute trauma. Pain is localized to the CMC joint, occasionally radiating to the thenar eminence.
Clinical Examination Findings
Inspection reveals prominence at the thumb CMC joint with possible adduction contracture. Palpation elicits tenderness over the trapeziometacarpal joint. Grind test is positive, reproducing pain and crepitus. Positive shoulder sign. Range of motion shows restricted abduction and extension. Neurovascular status is intact distally.
Treatment Protocol
Conservative management initiated: activity modification, thumb spica splinting for stabilization, and non-steroidal anti-inflammatory drugs (NSAIDs). Referral for hand occupational therapy for strengthening and joint protection techniques. Consider intra-articular corticosteroid injection if symptoms persist. Surgical consultation for trapeziectomy or arthroplasty if refractory to conservative measures.