Thumb arthritis is the most common form of osteoarthritis affecting the hand. Also called basal joint arthritis, thumb arthritis occurs when the cushioning cartilage wears away from the adjoining ends of the bones that form your thumb joint (carpometacarpal joint).
Thumb arthritis can cause severe hand pain, swelling, and decreased strength and range of motion, making it difficult to do simple household tasks, such as turning doorknobs and opening jars.
Treatment for thumb arthritis may include self-care measures, splints, medication or corticosteroid injections. If you have severe thumb arthritis, you may need surgery.
The first and most common symptom of thumb arthritis is pain. Pain occurs at the base of your thumb when you grip, grasp or pinch an object between your thumb and forefinger or use your thumb to apply force — such as when turning a key, pulling a zipper or opening a jar. Eventually, you may even experience pain when not using your thumb.
Other signs and symptoms may include:
- Swelling, stiffness and tenderness at the base of your 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 your thumb
When to see a doctor
If you have persistent swelling, stiffness or pain at the base of your thumb, 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.
Thumb arthritis usually occurs as a result of trauma or injury to the joint. Some people also develop thumb arthritis in association with osteoarthritis in larger joints.
The basal joint gives the thumb a wide range of motion, allowing you to pinch, grip and grasp objects. The bones in the thumb's basal joint are the first metacarpal bone, which runs through the heel of your hand, and the trapezium (truh-PEE-zee-um), a small bone at the base of your thumb.
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.
The damage to the joint may result in growth of new bone along the sides of the existing bone (bone spurs), which can produce noticeable lumps on your thumb joint.
These factors may increase your risk of thumb arthritis:
- Being female
- Being age 40 or older
- Having certain hereditary conditions, including joint ligament laxity and malformed joints
- Experiencing 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
- Performing certain activities and jobs that put high stress on this joint
You're likely to start by seeing your family doctor or a general practitioner. In some cases, you may be referred to a doctor who specializes in the treatment of arthritis and other inflammatory conditions (rheumatologist).
Here's some information to help you prepare for your appointment.
What you can do
- Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
- Write down key personal information, including any major stresses or recent life changes.
- Make a list of all medications, vitamins or supplements you're taking.
- Write down questions to ask your doctor.
Preparing a list of questions for your doctor will help you make the most of your time together. For thumb arthritis, some basic questions to ask your doctor include:
- What is likely causing my symptoms or condition?
- Other than the most likely cause, what are other possible causes for my symptoms or condition?
- What tests do I need?
- Is my condition likely temporary or chronic?
- What are the alternatives to the approach you're suggesting?
- Are there any restrictions that I need to follow?
- Should I see a specialist?
- Are there any brochures or other printed material that I can have? What websites do you recommend visiting?
Don't hesitate to ask any other appropriate questions.
What to expect from your doctor
During the physical exam, your doctor will check joints in your hand for swelling, redness and warmth. He or she may also ask you some questions, including:
- When did your pain begin?
- Have you ever injured that hand?
- Does your work or any other activity aggravate your symptoms?
- Have your symptoms been continuous or occasional?
- How severe are your symptoms?
- What, if anything, seems to improve your symptoms?
- What, if anything, appears to worsen your symptoms?
What you can do in the meantime
Until your appointment, you can try easing your pain by:
- Adapting activities or using your other hand to rest your affected thumb
- Applying heat or cold to your thumb
- Taking over-the-counter pain relieves, such as acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others) or naproxen (Aleve, others)
During a physical exam, your doctor will ask about your symptoms and look for noticeable swelling or lumps on your joints.
Your doctor may adjust the positions of the bones in your wrist joint, pressing on the base of the thumb while rotating the joint slightly. 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, usually X-rays, 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 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.
Self-care measures can help relieve pain, improve mobility and ultimately increase your independence. Here's what may help:
- Perform range-of-motion exercises. Exercises that move your thumb through its full range of motion can help improve your joint's mobility. Your doctor or a hand therapist can demonstrate the specific techniques.
- Modify hand tools. Consider purchasing jar openers, key turners and large zipper pulls designed for people with limited hand strength. Enlarge the handles on garden tools, kitchen utensils and writing devices — or buy items with large handles. Replace traditional door handles, which you must grasp with your thumb, with levers. Adaptive equipment is often available by catalog. Ask your doctor or hand therapist for recommendations.
- Apply heat or cold. Your doctor may recommend using heat or cold — or alternating between them to help relieve swelling and pain and to soothe your joints.
- Avoid hand clenching when you carry things. Choose a purse with a sturdy elbow or shoulder strap instead of a short handle. Instead of using grocery bags with handles, use boxy paper bags you can balance on your hip and arm.
Talk to your doctor about other equipment and ideas that may be helpful for you.
June 19, 2012
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