The trapeziometacarpal joint (TMJ) is the most commonly involved arthritic joint in the hand and is often injected in the outpatient setting. This study assesses the accuracy of TMJ injections. Six pairs of thawed, fresh-frozen cadaveric upper limbs were placed in the anatomic position. The limbs were randomized to be injected by one of two clinicians (a senior and a junior orthopaedic trainee). The TMJ of these specimens was palpated and injected with 0.5mls aqueous jelly dyed with methylene blue. An independent investigator dissected the specimens and the location of the dye was recorded. A Posterior-Anterior radiograph was then taken to assess the bony anatomy of the joint and graded according to Eaton's classification. Dye was found inside the joint capsule in 10 (83%) of the 12 specimens. Using Fishers Exact test no significant difference was found between the 2 injectors (p=0.46). The 2 joints where the dye was extra-articular had grade III and IV arthritis, whereas all other joints were graded I. This study shows that good accuracy of TMJ injection can be achieved using palpation in the earlier stages of TMJ arthritis, when surface anatomy is accurate enough for an intra-articular injection. This is also when synovitis is more prevalent and injections are more relevant. However the failure rate of injections increases as the disease advances

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

Background. The trapeziometacorpal joint (TMJ) of the thumb is a common site of primary osteoarthritis. Pain, crepitis and instability secondary to subluxation are common symptoms associated with TMJ arthritis. Conservative therapy help to control symptoms however with time, many patients progress with pain, deformity and functional limitation. The goals of operative intervention are to restore stability and strength, decrease pain and to provide a functional range of motion. Francobal-prosthesis may fulfil these criterions. Technique. We implanted the prosthesis through a dorso-radial straight longitudinal or slightly curved skin incision. A dorsal capsulotomy is performed and at this step adduction deformity should be addressed. An osteotomy of the proximal surface of the first metacarpal is made perpendicular to the long axis of the medullary cavity followed by reaming of the medullary cavity and then a trial fit. This is followed by preparation of the trapezium including removing any osteophytes, drilling of a cavity. Dental burs may be used at this step to deepen the cavity. The process of cementation started by cementation of the cup with its opening neutral to the joint surface, and if there is any muscle tension, bone is removed from the metacarpal before the metacarpal component is cemented. Reduction is achieved by snapping. The capsule and wound are closed and the thumb is immobilised in an adduction splint for ten days. Results. Results showed marked improvement of pain in many patients with high rate of satisfaction. No restriction of movement or instability was observed. In some cases, loosening of the shaft was noticed. However, this does not affect the overall function. Discussion. De La Caffini`re-prosthesis presents one of the operative options in the management of trapeziometacorpal joint (TMJ). Arthritis, however, this operation is recommended only in selective cases where skaphoid-trapezium-trapezoid (STT) joints are not involved