Rhode Island Hospital
The purpose of this clinical trial is to gather information on the safety and effectiveness of botulinum toxin injection (or Botox) in the treatment of thumb joint pain/arthritis. People with thumb joint pain or arthritis usually receive steroid injections to help with the pain. However, this medicine does not always work well and also carries known important side effects. There is currently no alternative to this injection medicine. This clinical trial seeks to investigate botulinum toxin as a possible alternative to steroid injection. The difference between Botox and steroid injections is that they are different medicines and work in different ways. Botox, as it is being used in this study, is not FDA-approved. It is therefore considered an investigational medicine.
Thumb carpometacarpal (CMC) osteoarthritis (OA) is one of the most common conditions treated by hand surgeons in the US. The treatment algorithm includes a stepwise strategy starting with conservative management and escalating to operative interventions when nonoperative measures fail to control pain or there is progression to a painful joint. Intra-articular injection of steroids represents a mainstay in the treatment approach for patients with thumb CMC OA, but despite its ubiquity, the American College of Rheumatology only conditionally recommends steroid injections due to a lack of evidenc…
Inclusion Criteria: * Adult patients (\> 18 years old) with a diagnosis of thumb CMC OA * Diagnosis of thumb CMC OA * History, clinical exam, and radiographic findings, as done in prior studies on this topic. * Subjective: thumb or wrist pain at rest or with activity, joint stiffness * Exam: basal joint tenderness, decreased mobility, deformity, instability * Radiograph: joint space narrowing, subchondral sclerosis, osteophytes, subchondral cysts, Eaton-Littler stage. * Failed conservative management with oral pain medication and splinting for at least 3 months. Exclusion Criteria: * Severe…
Patients in this group will receive an injection of Botulinum toxin.
Patients in this group will receive an injection of corticosteroid injections, which are considered standard of care.
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