MENGENAI EPISOD INI
Today’s fifty-year-old deadlifts, plays pickleball, and does yoga. When pain starts at the base of her thumb and the X-ray looks normal, it is easy to call it tendinitis and miss early arthritis. On this episode of BackTable Bone & Sports, Dr. Larry Balle welcomes Dr. Jamie Alexander and Dr. Daniel Torres, orthopedic hand surgeons at Houston Methodist, to discuss how they diagnose and manage thumb carpometacarpal (CMC) osteoarthritis in active and younger patients. They explore why early disease often gets missed, which metabolic and inflammatory workups matter, and how a multidisciplinary team helps patients get the right care.
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Timestamps
00:00 - Introduction
07:02 - Prevalence and Underdiagnosis of Thumb CMC Arthritis
13:56 - Instability in Younger Active Patients
15:34 - Metabolic and Inflammatory Workup
21:27 - Multidisciplinary Care
27:22 - Limits of Trapeziectomy and the Move to Implant Arthroplasty
36:43 - Conservative Management
45:54 - Injections and Bracing
50:21 - Candidate Selection and Bone Health
55:18 - Surgical Pearls and Revision Options
57:58 - Closing Remarks
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More about this episode
The conversation moves from conservative management, such as splints, hand therapy, grip changes, and injections, to surgical options. Dr. Torres and Dr. Alexander explain when to consider dual mobility thumb CMC arthroplasty for patients with good bone stock, how trapeziectomy compares, and why setting realistic expectations about function and recovery is so important. They share pearls for picking candidates, protecting bone health, and keeping surgical options open for future revisions, closing with advice for sports medicine physicians and therapists about recognizing instability and early arthritis before it progresses.
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Resources
American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis Care Res. 2020
https://doi.org/10.1002/acr.24131
Own the Bone, the American Orthopaedic Association bone health and fragility fracture prevention program
https://www.ownthebone.org/
Dr. Daniel Torres, Houston Methodist physician profile
https://www.houstonmethodist.org/doctor/daniel-torres/
Dr. Jamie Alexander, Houston Methodist physician profile
https://www.houstonmethodist.org/doctor/jamie-j-alexander/
Houston Methodist Orthopedics & Sports Medicine at Clear Lake
https://www.houstonmethodist.org/orthopedics/locations/clearlake/
Dr. Larry Balle, BackTable contributor page
https://www.backtable.com/shows/msk/contributors/dr-larry-balle
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