A 2014 CORR translation of M. Robert's landmark 1936 French paper on thumb carpometacarpal (TMC) joint imaging. Robert describes why standard AP wrist radiographs fail to capture this joint and establishes forced pronation as the correct technique. He also characterizes the radiographic stages of TMC degenerative arthritis, from asymmetric joint space narrowing to advanced trapezial erosion.
Every resident learns to order a 'hand series' for thumb pain, but Robert's 1936 paper explains why a standard AP wrist film will miss TMC arthritis entirely.
When a patient presents with vague thumb pain and a 'normal wrist film,' that film almost certainly did not capture the TMC joint. Order a dedicated TMC view in forced pronation — beam centered on the joint, identified by palpating the first metacarpal.
On that dedicated view, look first at the lateral joint space: asymmetric lateral narrowing is the earliest finding. Osteophytes arise on the trapezial side, not the metacarpal side.
The inflammatory vs. Degenerative distinction is board-testable: inflammatory arthritis hits the small carpal joints early and the TMC joint late. If you see early TMC involvement with sparing of smaller carpal joints, think OA, not RA.
A 2014 CORR translation of M. Robert's landmark 1936 French paper on thumb carpometacarpal (TMC) joint imaging. Robert describes why standard AP wrist radiographs fail to capture this joint and establishes forced pronation as the correct technique. He also characterizes the radiographic stages of TMC degenerative arthritis, from asymmetric joint space narrowing to advanced trapezial erosion.
Every resident learns to order a 'hand series' for thumb pain, but Robert's 1936 paper explains why a standard AP wrist film will miss TMC arthritis entirely.
When a patient presents with vague thumb pain and a 'normal wrist film,' that film almost certainly did not capture the TMC joint. Order a dedicated TMC view in forced pronation — beam centered on the joint, identified by palpating the first metacarpal.
On that dedicated view, look first at the lateral joint space: asymmetric lateral narrowing is the earliest finding. Osteophytes arise on the trapezial side, not the metacarpal side.
The inflammatory vs. Degenerative distinction is board-testable: inflammatory arthritis hits the small carpal joints early and the TMC joint late. If you see early TMC involvement with sparing of smaller carpal joints, think OA, not RA.