Presentation
Pain in the base of the right thumb.
Patient Data
There is seen reduced joint space, marginal lipping, anterior osteophytes formation, subchondral cystic changes and thinning of articular cartilage involving first carpometacarpal joint suggest degenerative osteoarthritic changes.
Mild-to-moderate joint effusion with synovial thickening is noted involving first carpometacarpal joint suggest chronic degenerative synovitis.
Coronal GRE image shows thinning and distal retraction of the anterior oblique ligament (AOL) (larger pink arrow) and coronal STIR image shows the development of volar synovial recess (green arrow) due to stripping off of AOL.
There is seen dorso-radial subluxation of the base of the first metacarpal with thickening of dorsal ligament complex (smaller pink arrow).
Case Discussion
Osteoarthritis of the first CMC joint is a common disorder (significantly more in female possibly due to the increased concavity of articular surface of trapezium and laxity of the anterior oblique ligament [AOL] 1).
Degeneration and laxity of the AOL are thought to play a significant role in the development of degenerative changes in first carpometacarpal joint 2. Progressive degeneration of AOL will lead to its periosteal stripping from the base of first metacarpal and development of volar synovial recess.
Eventually, there will be proximal migration of AOL and dorsal subluxation of the first metacarpal (as seen in this case).
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