Annabelle (75 years old)

Annabelle is a 75-year-old woman who plays piano as an amateur.

In her medical record, the following is noted:

• BMI: 25
• Osteoporosis, treated with calcium and vitamin D
• Diagnosis of trapezio-metacarpal OA to the right hand 2 years ago, managed by wearing night splint orthosis and performing warm-up exercises prior to playing piano

She comes to your clinic reporting increasing pain in her right hand, despite self-administration of paracetamol (2-3 g/day) or ibuprofen.

Upon clinical examination you find stiffness, swelling and deformation of the joint. In addition, an X-ray confirms subluxation of the base of the first metacarpal joint, excluding associated scapho-trapezio-trapezoid OA.