January 25, 2013
Dear Mayo Clinic:
Are there any effective treatments for thumb arthritis that do not require surgery?
Surgery for arthritis of the thumb is usually a treatment of last resort. A variety of less-invasive treatment options are available. Although they may not always provide long-term relief, for most people with thumb arthritis, these therapies can effectively lessen symptoms, and surgery may not be necessary.
The thumb is designed to give you a wide range of motion, allowing you to pinch, grip and grasp objects. In a normal thumb joint, the cartilage that covers the ends of the bones acts as a cushion and allows the 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 more joint damage.
The most common symptom of thumb arthritis is pain at the base of your thumb during activities of daily living such as opening a jar, turning a key or pulling a zipper. You may notice other symptoms, too, such as stiffness, tenderness or swelling at the base of your thumb. You may not have as much range of motion or strength in your thumb as usual.
Arthritis of the thumb joint is quite common, affecting about eight to 12 percent of the population. It is the second-most common part of the hand to have arthritis. The joints at the end of the fingers are the most common spot for hand arthritis. Thumb arthritis affects more than 50 percent of women age 70 and older.
For some people, simple at-home treatments may be all that are needed to successfully reduce symptoms of thumb arthritis. Anti-inflammatory medication, such as ibuprofen, is often effective. A gel form of a similar anti-inflammatory medication (diclofenac) is available for those whose stomachs do not tolerate anti-inflammatories well.Other medications, including acetaminophen and prescription pain relievers, also may help.
In addition to medications, try using tools that make it easier for you to grip with your thumb. For example, jar openers, key turners and large zipper pulls designed for people with limited hand strength are all available. Many people who have thumb arthritis also find it useful to replace traditional round door handles that must be grasped with the thumb with lever handles instead. Your doctor may have other suggestions about techniques and equipment that can make it easier to use your thumb.
If those steps aren't enough, talk to your doctor about getting a splint. A splint can support your joint and limit your thumb and wrist movement. That helps rest the thumb joint and lessens pain. Some people only need to wear a splint at night. But, depending on your situation, your doctor may recommend prolonged use of a splint, especially when you do activities that cause thumb pain.
Finally, an injection of medication into the thumb joint, such as a corticosteroid injection, may reduce inflammation and relieve pain temporarily.
If none of these approaches work, then surgery may be a reasonable option, especially if symptoms are making it hard for you to do your day-to-day activities. There are a variety of treatments including arthroscopy (key hole surgery), removal of the arthritic bone at the base of the thumb possibly with a tendon graft, and even joint replacement (in select cases). It is important to thoroughly try all the non-operative treatments before surgery. In most people, they can successfully relieve symptoms of thumb arthritis.
— Sanjeev Kakar, M.D., Orthopedic Surgery, Mayo Clinic, Rochester, Minn.