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Thumb Arthritis

Definition:
Thumb arthritis, also called basal joint arthritis, occurs when the joint at your wrist and the base of your thumb — the basal, or carpometacarpal (CMC), joint — develops osteoarthritis.

Having thumb arthritis can cause debilitating hand pain, swelling and decreased strength and range of motion, making it difficult to do simple household tasks, such as turn doorknobs and open jars.

Thumb arthritis usually occurs after age 40, and is more common in women than in men. A history of fractures or other injuries to the basal joint may increase the likelihood of developing thumb arthritis.

Treatment for thumb arthritis may include self-care measures, splints, medication or corticosteroid injections. In severe cases, you may need surgery.

Causes:
The exact cause of thumb arthritis, as with osteoarthritis in general, isn't known. Researchers suspect that it's a combination of factors, including being overweight, the aging process, joint injury or stress, heredity, muscle weakness and "cumulative load" to the joint. This is when you use your joint repetitively, such as in assembly line work. There's some recent evidence that the female hormones estrogen
and relaxin in the joint ligaments may play a part in thumb arthritis.

Made up of the small bone at the base of your thumb (trapezium), the first bone of your thumb (first metacarpal), and the wrist's scaphotrapezio-trapezoidal (STT) joint, the basal joint allows your thumb its wide range of motion and allows your hand to pinch, grip and grasp objects.

In a normal basal joint, cartilage covers the ends of the bones — acting as a cushion and allowing bones to glide smoothly against each other. With thumb arthritis, the cartilage that covers the ends of the bones deteriorates and its smooth surface roughens. The bones then rub against each other, resulting in friction and joint damage.

Your body goes to work repairing the damage, but the repairs may be inadequate, resulting instead in growth of new bone along the sides of the existing bone (bone spurs), which can produce noticeable lumps on your thumb joint. Each of the steps in this repair process produces pain — causing the discomfort associated with thumb arthritis.

Risk Factor:
The exact cause of thumb arthritis is unclear, but these factors increase your risk:
  • Being female
  • Being 40 years or older
  • Having certain hereditary conditions, including joint ligament laxity, defective cartilage and malformed joints
  • Past injuries to your basal joint, such as fractures and sprains
  • Having diseases that change the normal structure and function of cartilage, such as rheumatoid arthritis
  • Certain activities and jobs that put high stress on this joint
When to seek medical advice:
If you have swelling, stiffness or pain at the base of your thumb for more than two weeks, seek medical advice. If your doctor determines that you have thumb arthritis, he or she can work with you to develop a pain management and treatment plan.

Also seek medical advice if you experience side effects — such as nausea, abdominal discomfort, black or tarry stools, constipation or drowsiness — from arthritis medications.

Symptoms:
The first and most common symptom of thumb arthritis is pain. Pain occurs at the base of your thumb when gripping (which applies the most force to this joint), grasping, pinching an object between your thumb and forefinger, or applying force — such as when turning a key, zipping a zipper or opening a jar.

Other signs and symptoms may include:
  • Swelling, stiffness and tenderness at the base of the thumb
  • Decreased strength when pinching or grasping objects
  • Decreased range of motion
  • Enlarged, bony or out-of-joint appearance of the joint at the base of the thumb
  • General discomfort or achiness after continued use
  • A sense of instability
The pain, stiffness and decreased movement may be minimal or significant, depending on the severity of the condition and how you use your hands in work and recreation.

Dignosis:
Your doctor may use a variety of methods to diagnose thumb arthritis, including a physical examination and certain X-ray imaging techniques.

During a physical exam, your doctor will ask about your symptoms and look for noticeable swelling or lumps on your joints.

Your doctor may conduct a test in which he or she holds your joint while moving your thumb against your wrist bone. If this movement produces a grinding sound, or causes pain or a gritty feeling, it means the cartilage has worn down and the bones are rubbing against each other.

Imaging techniques can reveal bony projections that grow along the edges of bones (bone spurs), worn-down cartilage and loss of joint space — each indicating the presence of thumb arthritis. Your doctor may recommend the following techniques:
  • X-rays
  • Bone scans
  • Computerized tomography (CT) scans
  • Magnetic resonance imaging (MRI) scans
  • Arthrography, an image taken after dye has been injected into your joint
Treatment:
Treatment focuses on helping to reduce pain, maintain or improve joint movement, and minimize disability. Your doctor may recommend a combination of treatments, including self-care measures, activity modification, splints, medications and physical therapy. In early stages, nonsurgical treatments are usually effective. In severe cases, surgery may be necessary.

Splints
Your doctor may recommend the use of a splint to support your joint and limit the movement of your thumb and wrist. Splints help decrease pain, encourage proper positioning and give your joint some much-needed rest. Depending on your needs, you may wear a splint overnight or throughout the day.

Several types of splints are available. Some are prefabricated, and you can find them in medical supply stores or drugstores. Others can be custom-made to fit your hand. They may be soft and cloth-like or made of plastic. Your doctor or an occupational or physical therapist with special training in the hand (hand therapist) can help you decide which kind of splint is right for you.

Medications
Your doctor may recommend nonsteroidal anti-inflammatory drugs (NSAIDs) to decrease the inflammation and relieve the pain in your thumb and wrists. NSAIDs include such over-the-counter (OTC) medications as ibuprofen (Advil, Motrin, others) and naproxen (Aleve, others). Prescription-strength NSAIDs include diclofenac (Cataflam, Voltaren), nabumetone (Relafen) and ketoprofen (Oruvail, others).

NSAIDs have risks of side effects that increase when used at high dosages for long-term treatment. Side effects may include ringing in your ears, gastric ulcers, cardiovascular problems, gastrointestinal bleeding, and liver and kidney damage.

Acetaminophen (Tylenol, others) also will relieve your joint pain, but will not reduce inflammation.

Injections
If a combination of NSAIDs and splint use isn't effective, your doctor may recommend injecting a long-acting corticosteroid into your basal joint. Corticosteroid injections can offer some pain relief and reduce inflammation. Corticosteroid injections are only a temporary solution. This is because frequent use of corticosteroid injections can result in side effects such as nerve damage and decreased resistance to infection.

When surgery is necessary
In some cases, your doctor may recommend a surgical procedure called arthroscopy. During arthroscopy, your surgeon makes a tiny incision in the area around your joint and inserts a tubular instrument called an arthroscope. The arthroscope contains a light and a small camera, which projects an enlarged image of the interior of your joint onto a video monitor so that your surgeon can view it. If your joint needs repairing, the surgeon can insert surgical instruments into the joint through the arthroscope or through additional small incisions.

Arthroscopy is most often performed during the early or middle stages of thumb arthritis. In advanced stages, it may be difficult for your doctor to perform arthroscopy because nearly all of the joint cartilage is gone and the space to view the joint is diminished.

Based on what your doctor discovers during arthroscopy, or based on your history, physical exam and imaging studies, he or she may recommend the following treatments:
  • Joint fusion (arthrodesis). In arthrodesis, surgeons permanently fuse bones in a joint to increase stability and reduce pain. The fused joint can then bear weight without pain, but has no flexibility.
  • Osteotomy. In this procedure, sometimes called bone cutting, surgeons reposition your bones to help correct deformities.
  • Trapeziectomy. In this procedure, the surgeon removes the trapezium bone that sits adjacent to the joint.
  • Joint replacement (arthroplasty). In this procedure, surgeons remove part or all of the joint and replace it with a graft from one of your tendons. New plastic or metal devices called prostheses are also being developed to replace the joint. Currently, however, doctors prefer soft-tissue (tendon) arthroplasty.
You undergo each of these surgical procedures on an outpatient basis. After surgery, your thumb and wrist is placed in a cast or splint for up to six weeks. Once the cast is removed, you may work with a physical therapist to help regain hand strength and movement. Although recovery is slow, you should be able to resume your normal activities within six months of surgery.
 
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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