Abstract
Purpose
Osteoarthritis of the trapezio-metacarpal joint (TMJ or basal thumb joint) is a common condition causing significant disability. A range of non-operative and operative management options can be used for its treatment. One of the most common conservative treatments is a steroid injection into the joint. To confirm correct placement of the steroid it is preferable to use X-ray image intensification. Few previous studies have audited effectiveness, particularly with the use of radiological guidance.
Methods
This clinical observational study prospectively reviewed the longevity of benefit of steroid injections into the TMJ. They were followed up until the analgesic effects ceased with a questionnaire including visual analogue scores. The clinical improvement was compared with the degree of radiological osteoarthritis (Eaton grade). Seventy-seven patients were recruited with a median age of 62 years and injected with steroid and local anaesthetic under radioscopic guidance.
Results
Nearly half of the patients had a 3-month improvement. Two-thirds benefited for at least 2 months. One in six patients had a 6-month benefit, with some patients still improved 2 years after injection. Previously injected patients had a reduced duration of benefit compared to their previous injection. Effectiveness was not affected by Eaton grade. We had no complications except pain during injection.
Conclusion
This study demonstrates that there are potentially significant benefits to be gained from steroid injections into the TMJ. We believe the outcome is improved by using radiological guidance and by adding local anaesthetic. Based on this study we recommend steroid injections in all degrees of TMJ osteoarthritis.
