Long-term results using a treatment algorithm for chronic sesamoiditis of the thumb metacarpophalangeal joint

We report a series of 18 patients with chronic sesamoiditis of the metacarpophalangeal joint of the thumb treated in the period from 1997 to 2002. We describe a diagnostic clinical test (sesamoid provocation test [SPT]) and present the long-term results of the senior author's treatment algorithm.

The study included 20 thumbs in 18 patients (8 men and 10 women) with an average age of 36 years. The mean duration of symptoms at initial presentation was 6 months. The dominant thumb was symptomatic in 80% of patients, and 30% of patients gave history of prior trauma. The diagnosis was made clinically and aided by the SPT. Radiographs were normal in 65% of thumbs. The treatment algorithm consisted of steroid injection(s) into the subsesamoid joint. Sesamoidectomy was reserved for patients who were symptomatic (visual analog pain score ≥ 3) after 2 steroid injections. The patients were contacted by telephone in 2010 for an assessment of long-term results.

Eight thumbs improved with a single steroid injection whereas 5 thumbs required a second steroid injection. Of the 6 thumbs that underwent sesamoidectomy, 1 required secondary surgery for recurrent symptoms. At long-term follow-up (average, 9 y), 1 patient, who had declined sesamoidectomy, continued to have persistent pain affecting thumb function.

Previous reports have suggested that nonoperative treatment is not effective in the management of chronic sesamoiditis. We found that steroid injections were an acceptable treatment modality with long-lasting results. Failures can be successfully treated with sesamoidectomy.

Therapeutic IV.