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.
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
- Rest your joint
Depending on your needs, you may wear a splint just at night or throughout the day and night.
To relieve your pain, your doctor may recommend oral and topical medications, including:
- Acetaminophen (Tylenol, others). Acetaminophen may have fewer side effects than do other pain relievers.
- Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs, which decrease inflammation and relieve pain, include over-the-counter (OTC) medications such as ibuprofen (Advil, Motrin, others) and naproxen (Aleve, others).
- Prescription pain relievers. These include COX-2 inhibitors (Celebrex), meloxicam (Mobic) or tramadol (Conzip, Ultram, others).
NSAIDs have risks of side effects that increase when used at high doses for long-term treatment. Side effects may include ringing in your ears, gastric ulcers, cardiovascular problems, gastrointestinal bleeding, and liver and kidney damage.
If a combination of analgesics and splint use isn't effective, your doctor may recommend injecting a long-acting corticosteroid into your basal joint. Corticosteroid injections can offer temporary pain relief and reduce inflammation.
If you don't respond to other treatments or if you're barely able to bend and twist your thumb, your doctor may recommend surgery.
You and your doctor can discuss surgical options and select the one best suited to you. Options include:
- Joint fusion (arthrodesis). In arthrodesis, your surgeon permanently fuses the bones in the affected 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, your surgeon repositions the bones in the affected joint to help correct deformities.
- Trapeziectomy. In this procedure, your surgeon removes the trapezium, one of the bones in your thumb joint.
- Joint replacement (arthroplasty). In this procedure, your surgeon removes part or all of the affected joint and replaces it with a graft from one of your tendons. New plastic or metal devices called prostheses also are being developed to replace the joint. Currently, however, doctors prefer to use a tendon arthroplasty.
Each of these surgical procedures can be done on an outpatient basis. After surgery, you can expect to wear a cast or splint over your thumb and wrist 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.
June 19, 2012
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- Imbodin JB, et al. Current Rheumatology Diagnosis & Treatment. 2nd ed. New York, N.Y.: The McGraw-Hill Companies; 2007. http://www.accessmedicine.com/content.aspx?aid=2729561. Accessed March 29, 2012.
- Self-help arthritis devices. Arthritis Foundation. http://www.arthritistoday.org/treatments/self-treatments/arthritis-devices-print.php. Accessed March 29, 2012.
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