• Diagnosis
  • Treatment
  • Rehabilitation

Thumb Base Arthritis

This is also known as trapeziometacarpal arthritis or first carpometacarpal arthritis.

Thumb base arthritis occurs when the joint between the base of the thumb and the wrist is worn away.

The joints are normally lined by smooth cartilage. Osteoarthritis occurs when this smooth surface starts becomes worn and roughens.

This pattern of osteoarthritis is common in women over 45 years of age and less common in men.

X-rays show it is present in about 25% of women over the age of 55, but many people with arthritis of this joint have no significant pain. Occasionally it occurs after a fracture involving this joint.

Symptoms

The most frequent symptom is pain at the base of the thumb, aggravated by thumb use.

Tasks such as opening jars or turning a key in the lock may become difficult. Eventually the thumb may become stiff with a bump at its base.

Investigation

A simple x-ray is usually all that is required to confirm the diagnosis.

For further information go to www.sussexhandsurgery.co.uk

Thumb Base Arthritis

Treatment is individual to each patient, sometimes alarming x-rays give rise to few symptoms and vice versa.

Most treatments start with non-surgical options. These include activity modification, painkillers (rubbed in or taken orally) and supportive splints.

Another option is an injection into the joint of steroid (cortisone injections). This can dramatically reduce the symptoms, and can be repeated, but is not always effective and its effect will wear off over time.

Various gadgets are available to help out with household tasks (opening taps etc) and a review by an experienced hand therapist is sometimes recommended to discuss specific requirements in more detail.

Symptoms from this condition often stabilise over time and can be accommodated, but if this is not the case surgery can be considered. Many options have been tried for this pattern of arthritis but none are perfect.

The most common operation is to remove the small bone at the base of the thumb (trapezium) and allow the space to fill in with a soft pad of scar tissue. 90% of patients have no complications from this procedure. This is sometimes supplemented by using part of a tendon to control the position of the base of the thumb (ligament reconstruction).

Alternatives include osteotomy (cutting and realigning the base of the thumb) or fusion (joining the two bones at the base of the thumb which are worn out together so they don’t grate on each other). Various artificial replacements for the joint are also available.

Thumb Base Arthritis

Recovery after any operation on the base of the thumb takes several weeks and many patients won’t feel the benefit until about 3 months after surgery.

Immediately after the operation there will be a small adhesive dressing on the wound and a padded bandage with a plaster incorporated in it around the thumb base and wrist. Finger exercises to keep the digits moving are encouraged immediately after surgery, as is movement of the tip of the thumb. Patients will need to keep the hand and arm elevated for a week or so after the surgery to avoid swelling.

Between one and two weeks after the operation the wound is checked in clinic and further rehabilitation is dictated by the type operation which was performed. Usually dissolving stitches are used which do not need to be removed.

Rehabilitation is guided by a hand therapy team who will work to regain the mobility of the thumb, the function of the hand and soften the scar tissue. Patients will need to undergo an exercise regime at home.