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 (the basal joint) is osteoarthritis (degenerative or “wear-and-tear” arthritis).

Osteoarthritis occurs when the smooth cartilage that covers the ends of the bones begins to wear away. Cartilage 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.

The joint at the base of the thumb, near the wrist and at the fleshy part 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 age 40.

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, opening a door, or snapping your fingers.
  • 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
In its early stages, arthritis at the base of the thumb will respond to nonsurgical treatment.

  • Ice the joint for five to fifteen minutes several times a day.
  • Take an anti-inflammatory medication such as aspirin or ibuprofen to help reduce inflammation and swelling
  • Wear a supportive splint to limit the movement of the thumb, and allow the joint to rest and heal. The splint may protect both the wrist and the thumb.
  • It may be worn overnight or intermittently during the day.

Because arthritis is a progressive, degenerative disease, the condition may worsen over time. The next phase in treatment involves a steroid solution injection into the joint. This will usually provide relief for several months. However, these injections cannot be repeated indefinitely.

Surgical Options
When conservative treatment is no longer effective, surgery is an option. The operation can be performed on an outpatient basis, and several different procedures can be used. One option involves fusing the bones of the joint together.

This, however, will limit movement. Another option is to remove part of the joint and reconstruct it using either a tendon graft or an artificial substance. You and your physician will discuss the options and select the one that is best for you.

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 surgery takes several months. Most patients are able to resume normal activities and are quite satisfied with the results.

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Dr. Jonathan Franklin Publications

1. Aitken, M.L., Schoene, R.B., Franklin, J.L., and Pierson, D.J.: Pulmonary Function in Individuals at the Extremes of Stature. Am. Resp. Dis., 131:166-168, 1985.

2. Aitken, M.L., Franklin, J.L., Pierson, D.J., and Schoene, R.B.: Influence of Body Size and Gender on the Control of Ventilation. J. of Applied Physiology, 60(6):1894-1899, 1986.

3. Barrett, W.P., Franklin, J.L., Jackins, S.E., Wyss, C.R., and Matsen, F.A., III: Total Shoulder Arthroplasty. J. Bone and Joint Surgery, 69(A):865-872, 1987.

4. Franklin, J.L., Jackins, S.E., Matsen, F.A., III: Glenoid Loosening in Total Shoulder Arthroplasty: An Association with Rotator Cuff Deficiency. J. of Arthroplasty, Vol. 3(1):39-46, 1988.

5. Franklin, J.L., Johnson, K.D., and Hansen, S.T., Jr.: Immediate Internal Fixation of Open Ankle Fractures. J. Bone and Joint Surgery, 66(A):1349-1356, 1984.

6. Franklin, J.L., Parker, J.C., and King, H.A.: Non-traumatic Clavicle Lesions in Children. J. of Pediatric Orthopaedics, Vol. 7(5):575-578, 1987.

7. Franklin, J.L., Rosenberg, T.D., Paulos, L.E., and France, E.P.: Radiographic Assessment of Instability of the Knee Due to Rupture of the Anterior Cruciate Ligament – A Quadriceps-Contraction Technique. J. Bone and Joint Surgery, 73(A):365-372, 1991.

8. Franklin, J.L., Winquist, R.A., Benirschke, S.K., and Hansen, S.T., Jr.: Broken Intramedullary Nails. J. Bone and Joint Surgery, 70(A):1463-1471, 1988.

9. Matsen, F.A., III, Bonica, J.J., and Franklin, J.L.: Pain in the Shoulder, Arm and Elbow. In The Management of Pain, ed. J.J. Bonica, 1990.

10. Paulos, L.E. and Franklin, J.L.: Arthroscopic Shoulder Decompression Development and Application, A Five Year Experience. Am. J. of Sports Medicine, 18(3):235-244, 1990.

11. Paulos, L.E., Franklin, J.L., and Beck, C.L.: Arthroscopic Management of Rotator Cuff Tears. In Operative Arthroscopy, ed. J.B. McGinty, pp. 529-541, 1991.

12. Paulos, L.E., Franklin, J.L., and Beck, C.L.: Arthroscopic Management of Rotator Cuff Tears. In Operative Arthroscopy, Second Edition, ed. J.B. McGinty, pp. 725-739, 1996.

13. Paulos, L.E., Franklin, J.L., and Harner, C.D.: Arthroscopic Subacromial Decompression for Impingement Syndrome of the Shoulder, A Five Year Experience. In Operative Techniques in Shoulder Surgery, ed. L.E. Paulos and J.E. Tibone, pp. 31-38, 1991.

14. Rosenberg, T.D., Franklin, J.L., Baldwin, G.N., Nelson, K.: Extensor Mechanism Function After Patellar Tendon Graft Harvest for Anterior Cruciate Ligament Reconstruction. Am. J. of Sports Medicine 20(5):519-526, 1992.

15. Rosenberg, T.D., Franklin, J.L., and Paulos, L.E.: Skiing. In Sports Medicine: The School-Age Athlete, ed. B. Reider, pp. 673-688, 1991.

16. Rosenberg, T.D., Franklin, J.L., and Paulos, L.E.: Skiing. In Sports Medicine: The School-Age Athlete, 2nd Edition, ed. B. Reider, pp. 741-756, 1996.

PRESENTATIONS

1. “Glenoid Loosening in Total Shoulder Arthroplasty”, presented at closed meeting of American Shoulder and Elbow Surgeons, November, 1986. Open meeting of the American Shoulder and Elbow Surgeons, January 1987, San Francisco, California. Annual Meeting of the American Academy of Orthopedic Surgeons, January 1987, San Francisco, California. Annual Meeting, Puget Sound Chapter Western Orthopaedic Association, July 1987.

2. “Broken Intramedullary Nails”, presented at Annual Meeting American Academy of Orthopaedic Surgeons, Atlanta, Ga., 1988.

3. “Development and Application of Arthroscopic Shoulder Decompression for Impingement Syndrome”. Eighth Annual Meeting of the Arthroscopy Association of North America, Seattle, WA, April 1989. Biennial Meeting of the International Arthroscopy Association. Rome, Italy, May 1989.

4. “Immediate Internal Fixation of Open Ankle Fractures”. Annual Meeting American Academy of Orthopaedic Surgeons. Anaheim, California, 1983 by co-author K.D. Johnson.

5. “Total Shoulder Arthroplasty”. Annual Meeting of American Academy of Orthopaedic Surgeons. Atlanta, Georgia, 1986, by co-author W. P. Barrett.

6. “Non-Traumatic Clavicle Lesions in Children”. Children’s Day. Childrens Hospital, Seattle, Washington, 1987.

7. “Technique and Results of a New Arthroscopic Method for Measuring ACL Isometry”. Biennial Meeting of the International Arthroscopy Association. Rome, Italy, May 1989 by co-author T. D. Rosenberg.

8. “Extensor Mechanism Morbidity Associated with Patellar Tendon Harvest for ACL Deficiency”. Thirteenth Annual Skeletal Symposium. Sun Valley, Idaho, March 1990.

9. “Quadriceps-Active X-ray Evaluation for Anterior Cruciate Ligament Deficiency”. American Orthopaedic Society for Sports Medicine Meeting. New Orleans, Louisiana, February 1990.

10. “Preliminary Report of the Use of Allograft for Ligament Reconstruction in Multiple Ligament Injuries”. Western Orthopedic Association, Puget Sound Chapter Meeting. Blaine, Washington, May 1992.

11.“Multiple Ligament Reconstruction Using Allograft with Associated Posterior Cruciate Ligament Injuries.” Arthroscopy Association of North America, Annual Meeting, Seattle, Washington, April, 2001.

INSTRUCTIONAL COURSES – FACULTY

1. Lecturer and Lab Instructor for “Proficiency in Treating the ACL” Course. Salt Lake City, Utah, July 1989 and June 1990.

2. Lecturer for Spectrum of Orthopaedic Symposia. University of Washington Goodwill Games Course. Seattle, WA, July 1990.

3. Volunteer Medical Staff at 1990 Goodwill Games. Seattle, WA, July 1990.

4. Lab Instructor for “Posterior Cruciate Ligament Reconstruction and Repair” Course. Salt Lake City, Utah, January 1992.

5. Lab Instructor for “Arthroscopic Enhanced Surgery of the Shoulder” Course. Salt Lake City, Utah, December 1992.

6. Lecturer for Madigan Army Medical Center “Spring Symposium on Orthopaedic Trauma”. Tacoma, WA, June 1993.

7. Lecturer for “Current Trends in Knee and Shoulder Surgery”. Tacoma, WA, October 1993.

8. Lab Instructor for “Mitek Bioskills Course for the Knee and Shoulder.” Salt Lake City, Utah, March 1996.

9. Lab Instructor for “Endoscopic Reconstruction of the ACL and Meniscal Repair.” Salt Lake City, Utah, Sept 1996.

10. Moderator for Sports Medicine Section and Lecturer for Orthopedics for the Primary Care Physician, CME Course, Seattle, WA, Nov 1996.

FACULTY POSITIONS:
Clinical Assistant Professor, Department of Orthopaedics, University of Washington School of Medicine

Collateral Ligament Injuries

Anatomy
collateral-300x208The medial collateral ligament (MCL) runs from the inner side (medial side) of the femur (thigh bone) to the inner (medial side) of the tibia (lower leg bone). It prevents the knee from opening on the inside when struck from the outside of the knee joint. The MCL lies on the outside of the joint capsule and has a good blood supply that contributes to its good healing potential.

The lateral collateral ligament (LCL) runs from the outer side (lateral side) of the femur (thigh bone) to the top of the fibula (the smaller of the two lower leg bones). It prevents the knee from opening on the outer side when struck from the inner side of the knee joint. The LCL is thinner and when completely disrupted often requires surgical repair.

Injury Mechanism
The MCL is often injured in sports when one is struck from the outer or lateral side of the knee, such as having an opponent fall against the outside of one’s knee in football. Another common mechanism of injury to the MCL is when the foot is forced out to the side away from the body, such as with a simultaneous kick of a soccer ball with the inside of the foot. LCL injuries are much more rare and usually occur when the knee is struck from the inside while the foot is planted, forcing a distraction force to the outside of the knee.

Symptoms
When patients sustain an injury to the collateral ligaments they often experience pain, localized swelling and bruising on the involved side of the knee. With partial tears, there is stiffness and pain when fully bending the knee, but no sense of instability. With a complete tear, the knee will feel unstable and will give way to the side with any lateral movements.

Diagnosis
The physician’s work-up will start with a careful history and exam. Often the description of a direct blow to either side of the knee can lead the physician to the suspected injury to the MCL or ACL. On examination, the physician can feel the instability when pulling the foot to one side or the other while stabilizing the knee. X-rays are often obtained to see that no fractures have occurred. Occasionally, a small avulsion fracture might hint that a collateral ligament injury has occurred. An MRI scan is often obtained to confirm the diagnosis and to evaluate any associated injuries to the menisci, other ligaments, and damage to the joint surfaces.

Treatment
Your physician will discuss treatment options with you. Treatment decisions are based on degree of instability. Minor tears (sprains) can be treated with rest, ice, elevation and compression. More significant tears in which many of the fibers of the ligament have been torn may require bracing for 6 weeks to keep the fibers from healing in a stretched out position. Occasionally physical therapy is needed to help regain full range of motion and strengthen the surrounding muscles after the period of bracing. Rarely is surgery recommended for an isolated MCL tear, but occasionally LCL injuries can benefit from surgical repair or reconstruction.

Knee Anatomy

The knee joint is one of the largest joints in the body. It is a complex joint with four bones: the femur (thigh bone), the tibia (main lower leg bone), the fibula (smaller lower leg bone), and the patella (kneecap). The bones are connected with four main ligaments: ACL (anterior cruciate ligament), PCL (posterior cruciate ligament), MCL (medial collateral ligament), and the LCL (lateral collateral ligament).

The ACL and PCL control the forward/backwards movement of the knee joint and prevent pivoting of the knee. The MCL and LCL prevent giving away on either side of the knee. The quadriceps is a group of 4 muscles that converge on the front of the thigh and together allow one to straighten their knee by pulling through the kneecap and patellar tendon, which attaches to the front of the lower leg bone (tibia).

The hamstrings are the muscles on the back of the thigh that help bending the knee by crossing the joint in the back of the knee and attaching to the lower leg bones. Between the femur and tibia, sitting centrally in the knee joint, are two C-shaped pads (the medial and lateral menisci) that act as cushions or shock absorbers between the two bones. The meniscal pads are made of cartilage.

There is also about a quarter of an inch of cartilage on the distal end of the thighbone and on the proximal end of the lower leg bone. Arthritis occurs when that joint cartilage becomes damaged or thin.