First Carpometacarpal Joint, or CMC Joint.

ANATOMY

The movements of the thumb in this area are dictated by the saddle-shaped articular surface of the base of the first metacarpal, which articulates with the trapezium. It glides multiple ways, perhaps this is why it’s often the first point of arthritis.

I found it started when I was plugging in my phone charger, or casually doing up a zip. Others it’s turning a key or grabbing a cup.

INDICATIONS AND DIAGNOSIS

Pain and weakness that are associated with arthritis or overuse of the joint, is the most common indication for injection here. Diagnosis is determined by limitation of motion and palpation of crepitus and tenderness over the joint. Diagnosis may also be confirmed by xrays, or symptom checklist.

Usually first point of call a GP will listen to symptoms and say it’s arthritis,then send you off for xrays to confirm.

TIMING AND OTHER CONSIDERATIONS

Injection is usually performed after other more conservative therapies, including use of NSAIDs, wheat bags, or icing, compression gloves and a brief period of immobilization, have been tried. As with any arthritic joint, relief after injection may only be temporary, and surgical intervention may need to be considered.

I’m still on the injections stage, and using splints almost daily. As I have Ehlers Danlos Syndrome the success rate of surgery is lower,at least while my joints are so loose.

TECHNIQUE

Palpate the joint space between the trapezium and the first metacarpal. Using ultrasound for a guided approach. It’s crazy to see the needle enter and how tiny the joint space now is.

PERSONAL

Well for me it was injection day on the 24th March.

For my left hand it’s my 3rd injection, however the last one did not work well, and I was in a flare for months. But it’s a different product so I’m hoping it will work. It’s Depomedrone this time instead of Kenalog.

For my right hand it’s the 4th one, which thankfully has always responded well, the difference between these hands is my right is intermittently sore and weak, whereas the left is ALWAYS painful and nearly always splinted and gloved.

It’s been 2 days now, and this is how I am

Day 1 of injection (wednesday)

Had the lesser evil thumb (right one) done first, bit sharp but it quickly passes and is finished. Injection done through the thumb pad.

Left hand is done from back of hand position, space narrower so I feel it a lot more, but less volume of liquid with Depomedrone, compared to Kenalog so no exploding thumb feeling at least.

Super stiff a few hours later, so icing them and wearing splints and compression gloves. Pain mainly in the left thumb, dull nagging pressure feeling, like it’s being squeezed in a vice. Glad right thumb is feeling a bit nicer so I can type and use hand in most things, while being careful of course.

Having easy to eat food tonight so I don’t need to use my hands too much.

Slept ok ish, they woke me up twice for paracetamol, and to try and not knock in my sleep. Wore the splints off the Occupational therapist,as they use the wrist for support too.

Day 2 thursday

Not too bad today, eased off that vice squeeze pressure at least. Now they are just stiffer and achy overall.

Still wearing splints for support and strength. And taking pain relief. Some swelling but ice and ibuprofen gel is planned all day.

Evening they started to nag a bit more, still having help with cutting up some foods. Holding cups is a 2 handed job.

Skin tender and puffy, so splints for all night too. MCP joints hurt on the thumbs too, hopefully I will sleep better tonight. Had to have tramadol and paracetamol, and etoricoxib throughout the day.

It’s been 1 year since Lockdown started.

And what a year it’s been… Mentally it’s took it’s toll being away from my children, and grandchildren and of course parents.

Delayed treatments haven’t helped as it’s caused high anxiety and tremendous stress all round.

But what I can take from this past year, is walking, as much as I can, when I can, whether it’s a snail’s pace (and it really is) aided by sticks, and copious amounts of freeze gel and pain medications, it’s been worth all the pain.

Let’s hope this year of waiting, I will be able to keep going for as long as the hip is holding out.