Arthritis of the Thumb

Arthritis is a condition that irritates or destroys a joint. Although there are several types of arthritis, the one that most often affects the joint at the base of the thumb is osteoarthritis (degenerative or "wear-and-tear" arthritis).

Cause

Smooth cartilage covers the ends of the bones. It enables the bones to glide easily in the joint. Without it, bones rub against each other, causing friction and damage to the bones and the joint. Osteoarthritis occurs when the cartilage begins to wear away.

The CMC (carpo-metacarpal) joint at the base of the thumb enables the thumb to swivel, pivot, and pinch so that you can grip things in your hand.

Arthritis of the base of the thumb is more common in women than in men, and usually occurs after 40 years of age. Prior fractures or other injuries to the joint may increase the likelihood of developing this condition.

Symptoms

• Pain with activities that involve gripping or pinching, such as turning a key or opening a door.
• Swelling and tenderness at the base of the thumb.
• An aching discomfort after prolonged use.
• Loss of strength in gripping or pinching activities.
• An enlarged, "out-of-joint" appearance.
• Development of a bony prominence or bump over the joint.
• Limited motion.

Diagnosis

Your physician will ask you about your symptoms, any prior injury, pain patterns, or activities that aggravate the condition. The physical examination may show tenderness or swelling at the base of the thumb.

One of the tests used during the examination involves holding the joint firmly while moving the thumb. If pain or a gritty feeling results, or if a grinding sound (crepitus) can be heard, the bones are rubbing directly against each other.

An X-ray may show deterioration of the joint as well as any bone spurs or calcium deposits that have developed.

Many people with arthritis at the base of the thumb also have symptoms of carpal tunnel syndrome, so your physician may check for that as well.

Treatment

Nonsurgical Treatment
In its early stages, arthritis at the base of the thumb will respond to nonsurgical treatment such as:

Ice: Applying ice to the joint for five to fifteen minutes several times a day may help reduce pain and swelling

Medication: Anti-inflammatory medication such as aspirin or ibuprofen to help reduce inflammation and swelling is very effective, especially in the earlier stages of arthritis.

Bracing: A supportive splint to limit the movement of the thumb, and allow the joint to rest and heal may also be effective. The splint may protect both the wrist and the thumb. It may be worn overnight or intermittently during the day.

Steroid Injection: This will usually provide relief for several months. However, these injections cannot be repeated indefinitely.

Surgical Treatment

Because arthritis is a progressive, degenerative disease, the condition may worsen over time. When nonsurgical treatment is no longer effective, surgery is recommended. The operation is usually performed on an outpatient basis.

Surgery typically involves removing part of the diseased joint and reconstructing it using either a tendon graft or an artificial substance.

Rehabilitation

After surgery, you will have to wear a cast for several weeks. A rehabilitation program, often involving a physical therapist, helps you regain movement and strength in the hand. You may feel some discomfort during the initial stages of the rehabilitation program, but this will diminish over time. Full recovery from thumb arthritis surgery takes several months. Most patients are able to resume normal activities and are quite satisfied with the results.