Intra-Articular Corticosteroid Injections to Manage Trapeziometacarpal Osteoarthritis

Abstract

Background

Osteoarthritis of the trapeziometacarpal joint (TMJ) is a common condition causing significant disability. The aim of this study is to ascertain whether an intra-articular corticosteroid injection leads to pain relief and increased function and what is the duration and magnitude of this effect. Methods A systematic review with a critical appraisal of identified studies that met the inclusion criteria was performed. Two authors performed the literature review by independently searching the Cochrane, PubMed and Google Scholar databases.

Results

A total of 118 relevant articles were found, but only nine studies met the inclusion criteria which included 4 double-blinded randomised control trials (RCTs) and 5 prospective case series. There is some evidence in the literature to support the efficacy of steroid injections into the TMJ. Most studies do suggest a good short-term benefit. However, one identifies no benefit over placebo but two studies found a benefit lasting at least 6 months.

Conclusions

This study demonstrates that there are potentially significant although short-term benefits to be gained from steroid injections into the TMJ. They can lead to pain relief and improved function, certainly in the first 1 to 3 months post-injection. Steroid injections are a low-risk procedure and are helpful in delaying or avoiding the need for surgery.

Keywords

Intra-articular injection Trapeziometacarpal joint Corticosteroid

Get full access to this article

View all access options for this article.

References

Armstrong

Hunter

Davis

. The prevalence of degenerative arthritis of the base of the thumb in post-menopausal women. J Hand Surg (Br). 1994;19(3):340–1.

Bahadir

Onal

Dayan

Gürer

. Comparison of therapeutic effects of sodium hyaluronate and corticosteroid injections on trapeziometacarpal joint osteoarthritis. Clin Rheumatol. 2009;28(5):529–33.

Caldwell

. Intra-articular corticosteroids. Guide to selection and indications for use. Drugs. 1996;52(4):507–14.

Cochrane review: conservative therapy for thumb (trapeziometacarpal joint) osteoarthritis. Stage: registered title; date of creation: 10. 2009; last updated: 2. March 2010; Entity: musculoskeletal group.

Day

Gelberman

Patel

Vogt

Ditsios

Boyer

. Basal joint osteoarthritis of the thumb: a prospective trial of steroid injection and splinting. J Hand Surg [Am]. 2004;29(2):247–51.

Dell

Brushart

Smith

. Treatment of trapeziometacarpal arthritis: results of resection arthroplasty. J Hand Surg [Am]. 1978;3(3):243–9.

De Smet

. Responsiveness of the DASH score in surgically treated basal joint arthritis of the thumb: preliminary results. Clin Rheumatol. 2004;23:223–4.

Eaton

Lane

Littler

Keyser

. Ligament reconstruction for the painful thumb carpometacarpal joint: a long-term assessment. J Hand Surg [Am]. 1984;9(5):692–9.

Harrison

Fahmy

. (ii) Management of peri-trapezial osteoarthritis. Curr Orthop. 2005;19(3):190–5.

10.

Helm

Higgins

Rajkumar

Redfern

. Accuracy of intra-articular injections for osteoarthritis of the trapeziometacarpal joint. Int J Clin Pract. 2003;57(4):265–6.

11.

Heyworth

Lee

Kim

Lipton

Strauch

Rosenwasser

. Hylan versus corticosteroid versus placebo for treatment of basal joint arthritis: a prospective, randomized, double-blinded clinical trial. J Hand Surg [Am]. 2008;33(1):40–8.

12.

Hudak

Amadio

Bombardier

. Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand). The Upper Extremity Collaborative Group (UECG). Am J Ind Med. 1996;29(6):602–8.

13.

Joshi

. Intraarticular corticosteroid injection for first carpometacarpal osteoarthritis. J Rheumatol. 2005;32(7):1305–6.

14.

Kenniston

Bozentka

. Treatment of advanced carpometacarpal joint disease: arthrodesis. Hand Clin. 2008;24(3):285–94.

15.

Khan

Waseem

Raza

Derham

. Quantitative assessment of improvement with single corticosteroid injection in thumb CMC joint osteoarthritis? Open Orthop J. 2009;19(3):48–51.

16.

Kumar

Newman

. Complications of intra- and peri-articular steroid injections. Br J Gen Pract. 1999;49(443):465–6.

17.

Maarse

Watts

Bain

. Medium-term outcome following intra-articular corticosteroid injection in first cmc joint arthritis using fluoroscopy. Hand Surg. 2009;14(2–3):99–104.

18.

Mandl

Hotchkiss

Adler

Ariola

Katz

. Can the carpometacarpal joint be injected accurately in the office setting? Implications for therapy. J Rheumatol. 2006;33(6):1137–9.

19.

Mayer

. Carpometacarpal osteoarthritis of the thumb. Lancet. 1970;2(7666):270.

20.

Meenagh

Patton

Kynes

Wright

. A randomised controlled trial of intra-articular corticosteroid injection of the carpometacarpal joint of the thumb in osteoarthritis. Ann Rheum Dis. 2004;63(10):1260–3.

21.

Moher

Hopewell

Schulz

Montori

Gøtzsche

Devereaux

. CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomised trial. BMJ. 2010;340:c869.

22.

Newman

. Local skin depigmentation due to corticosteroid injection. Br Med J (Clin Red Ed). 1984;288(6432):1725–6.

23.

Oxford Centre for Evidence Based Medicine—Levels of Evidence (2009). Produced by Bob Phillips, Chris Ball, Dave Sackett, Doug Badenoch, Sharon Straus, Brian Haynes, Martin Dawes since November 1998. Updated by Jeremy Howick.

24.

Pendse

Nisar

Shah

Bhosale

Freeman

Chakrabarti

. Surface replacement trapeziometacarpal joint arthroplasty—early results. J Hand Surg Eur. 2009;34(6):748–57.

25.

Pollard

Cermak

Buck

Williams

. Accuracy of injection into the basal joint of the thumb. Am J Orthop (Belle Mead NJ). 2007;36(4):204–6.

26.

Public Health Resource Unit, Institute of Health Science, Oxford. Critical Appraisal Skills Programme (CASP), www.phru.nhs.uk/Pages/PHD/resources.htm. Accessed 20/07/2010.

27.

Rogojan

Hetland

. Depigmentation—a rare side effect to intra-articular glucocorticoid treatment. Clin Rheumatol. 2004;23(4):373–5.

28.

Schulz

Altman

, Moher D, for the CONSORT Group. CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. BMJ. 2010;340:c332.

29.

Sodha

Ring

Zurakowski

Jupiter

. Prevalence of osteoarthrosis of the trapeziometacarpal joint. J Bone Joint Surg Am. 2005;87(12):2614–8.

30.

Stahl

Karsh-Zafrir

Ratzon

Rosenberg

. Comparison of intraarticular injection of depot corticosteroid and hyaluronic acid for treatment of degenerative trapeziometacarpal joints. J Clin Rheumatol. 2005;11(6):299–302.

31.

Stefanich

. Intraarticular corticosteroids in treatment of osteoarthritis. Orthop Rev. 1986;15(2):65–71.

32.

Swindells

Logan

Armstrong

Chan

Burke

Lindau

. The benefit of radiologically-guided steroid injections for trapeziometacarpal osteoarthritis. Ann R Coll Surg Engl. 2010;92(8):680–4.

33.

Umphrey

Brault

Hurdle

Smith

. Ultrasound-guided intra-articular injection of the trapeziometacarpal joint: description of technique. Arch Phys Med Rehabil. 2008;89:153–6.

34.

Wajon

Carr

Edmunds

Ada

. Surgery for thumb (trapeziometacarpal joint) osteoarthritis. Cochrane Database Syst Rev. 2009;4:CD004631.

35.

Yao

Park

. Early treatment of degenerative arthritis of the thumb carpometacarpal joint. Hand Clin. 2008;24(3):251–61.

Intra-Articular Corticosteroid Injections to Manage Trapeziometacarpal Osteoarthritis—a Systematic Review