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Thumb Arthritis

Arthritis of the Thumb

Arrow denote three different joints affecting three different bones at the base of the thumb

Arrow denote three different joints affecting three different bones at the base of the thumb

The thumb, specifically the base of the thumb, is a commonly affected area. Frequently, the neighboring joint is more mobile than normal. The joint at the base of the thumb, near the wrist, enables the thumb to turn in more directions than any other joint in the hand. This makes it less stable and thus more susceptible to arthritis.

  • An X-ray shows how much damage has occurred and how many joints are involved.

Many people with arthritis at the base of the thumb also have symptoms or are show early signs of carpal tunnel syndrome.

Treatment In its early stages, arthritis at the base of the thumb can be successfully treated without surgery. Icing,  anti-inflammatory medications are useful. A supportive splint allows the joint to rest and is usually highly effective. There are different types of splints, and thumb arthritis splint are the least known. A good thumb splint should reach up towards the tip of the thumb. Most patients who tried splints before they were seen in my office had used a wrist splint, not a thumb splint. A wrist splint is not effective for thumb pain. There are different designs for a thumb splint, but they all share the concept of supporting and limiting the motion at the base of the thumb. I often combine splinting with a steroid injection. This may provide relief for several months or longer.

When non-surgical treatment is no longer effective, the next step may be surgery. There are three general types of surgery for arthritis of the base of the thumb.

wpid-CMC%20fusion_20130328225550202.jpgOne option involves fusing the bones together. This is effective if only one joint is affected. It also sacrificed motion. You will still be able to bend your thumb but you won’t be able to put your palm flat on a surface, may have difficulty reaching into a pocket or a purse. It is however a very durable surgery and I recommend it for younger patients who need a supportive thumb for their jobs. Of course, any time we fuse a joint, it has to heal like a fracture, and it may not (non-union).

LRTI cmc oaAnother option is to remove the damaged part replace it. There are implants designed for that, but I think it is best to suspend it to the rest of the hand using your own tendon as there has been too many failures using artificial implants. The price is that, although it is does not sacrifice motion, it may not be as supportive as the thumb is cushioned and suspended with soft tissues, not bone. For this, I think it is best reserved for patients with less demand for grip and heavy support and more emphasis on mobility.

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