We have three joints in our thumb. If activities of daily living such, such as rotating doorknobs, unscrewing jar tops, zipping a jacket, buttoning buttons, etc. cause pain, and are difficult to perform, consider seeing your healthcare provider right away. You may be suffering from a condition called basal joint thumb arthritis, says Dr. Wayne Weil, a board-certified orthopedic surgeon known for his expertise in hand surgery.
Thumb arthritis is usually caused by inflammation of the basal joint at the base of your thumb due to degeneration of the cartilage which is the smooth gliding surface of the joint. Hence, orthopedic surgeons also refer to it as basal joint arthritis. The condition is painful and can make everyday activities extremely challenging. That said, Dr. Weil recommends a variety of non surgical treatments to try and prevent further cartilage damage and prevent it from deteriorating your hand function.
Symptoms of Thumb Arthritis
Pain at the base of the thumb is often the first symptom of basal joint arthritis. This pain can take various forms. Some people may feel a constant, dull ache, whereas, for others, it might be a sharp, piercing type of pain, typically exacerbated by twisting, straining, and gripping motions of their thumb, lasting only momentarily, says Dr. Wayne Weil.
Another subset of patients may feel a burning, stabbing, creaking, or grinding sensation when they try to make just about any thumb movement.
How an Orthopedic Surgeon will Treat Thumb Arthritis?
History and Examination
When you present with pain and swelling of your thumb, Dr. Wayne Weil takes a thorough history, asks about the patterns of your pain and type of activities that tend to worsen your condition.
Then he performs some tests on the affected thumb. “One of these tests is known as the grind test, in which I grip the patient’s base of the thumb and move it in a circle while loading it with a gentle axial force,” Dr. Weil mentions.
If a patient has thumb arthritis, the bones would be rubbing against each other, causing a grinding sound (crepitus) that I can hear and feel, he adds. Findings on a clinical exam and the patient’s history can usually confirm a diagnosis of thumb arthritis. An X-ray that is usually done for staging the disease and for patient education, would show a narrowing of the joint space, bone spurs or calcium deposits.
Treatment of Thumb Arthritis
Medical Treatment
Dr. Weil recommends the following conservative treatments for early-stage thumb arthritis:
- Anti-inflammatory medications to help ease inflammation and pain.
- Splinting, which will rest and restrict the movement of the arthritic joint, allowing it to heal.
- Activity modification, such as refraining from forceful pinching, using the alternate hand, and switching to larger diameter writing instruments.
- Cortisone injections: A powerful anti-inflammatory steroid medication can be directly injected into the arthritic joint. This injection usually provides effective pain relief, but the symptoms may recur after repeated use.
Surgery for Thumb Arthritis
If conservative treatments fail, or the patient has advanced stage arthritis, surgery can be performed in order to alleviate pain and restore hand function. While there are various surgical options, Dr. Weil recommends removing a small wrist bone at the base of your thumb known as trapezium via a procedure called trapeziectomy. Because this bone is involved in the disease process of thumb arthritis, removing it will slow down disease progression. The removed bone and ligament can then be reconstructed using a procedure called ligament reconstruction and tendon interposition (LRTI). The LRTI surgery involves replacing the resected bone and ligament with your wrist flexor tendon that serves as a cushion for the arthritic thumb joint and restores your thumb function with the rest of the hand.
