Menstrual hormone-induced cyclic thumb CMC instability and degeneration in women: a systematic review

Abstract

Highlights It is widely recognized among hand surgeons that female patients present at a younger age for basal thumb osteoarthritis, with more severe degeneration. The little-known menstrual hormone relaxin, which peaks every ovulatory cycle, may be responsible for the female predominance of this pathology. The soft tissue support structures for the thumb are known to express relaxin receptors which, when activated, trigger lysis of collagen and other extracellular matrix components. Laxity in soft tissues supporting the thumb, such as the deep anterior oblique ligament, would result in joint instability and microtrauma. If women cyclically experience thumb instability and cumulative cartilage microtrauma from menarche through menopause, the female propensity to develop TMC arthritis is aptly justified.

Keywords

• Musculoskeletal sex differences
• Thumb osteoarthritis
• Trapeziometacarpal degeneration
• Trapeziometacarpal instability
• Thumb CMC arthroplasty