Thumb-Base Arthritis

Thumb-Base Arthritis
Get a Grip on This Common Condition
by Jan Revella, R.N.

If you're experiencing pain while turning a key, holding a coffee cup, opening the car door, golfing, crocheting, holding a hand of cards, pinching, grasping and performing other fine motor activities using the thumb, you may have what is called "thumb-base arthritis."

Arthritis at the base of the thumb is extremely common, with women affected four times as often as men. For the most part, the causes are unknown. We do know that this condition is not always related to generalized arthritis of the hip, knee or even finger joints.

Symptoms of Thumb-Base Arthritis

Frequently, thumb-base arthritis is an isolated case and affects only the unique "saddle" joint of the thumb. The saddle joint is the joint that allows humans to turn and oppose their thumbs in cooperation with the fingers. Arthritis of this joint results in painful pinching, gripping and grasping actions between the thumb and hand. Thumb-base arthritis is painful to varying degrees and can be progressive. The pain is usually located directly over the base of the thumb where it meets the wrist.

Thumb-base arthritis, particularly in women, frequently begins with a loose joint. Such a person may be "double jointed" at the thumb and is able to pull his or her thumb down to the wrist.

This x-ray shows degenerative arthritis at the base of the thumb, a common problem that causes pain and dysfunction. Both conservative measures, such as therapy and joint protection, and corrective surgery can provide relief.

This looseness or instability (it's actually a partial dislocation) of the joint can progress to the point where cartilage wears away (arthritis) and pain worsens. Pain will occur from both the partial dislocation and the arthritis.

Treatment of Thumb-Base Arthritis

   Treatment usually begins with a cortisone injection and splint immobilization of the thumb and wrist. This may be followed by hand therapy. For cortisone to be effective in this case, it must be injected accurately into the joint, not just somewhere near it. Cortisone can help the painful symptoms of thumb-base arthritis; however, it will not correct the problem or change the ongoing deterioration.

  Immobilization of the thumb in a "thumb spica" splint is also an effective treatment for thumb-base arthritis. The splint immobilizes both the thumb and the thumb side of the wrist. In addition, a rubber-like neoprene splint often can be temporarily used and is quite helpful during stressful activities. Learning about joint protection techniques is also a very important part of conservative management for this condition.

  Since the thumb is used every time you perform pinching or grasping activities, it gets plenty of exercise. Specific exercise for the thumb is not necessary. In fact, joint protection and learning how to use the thumb less can help relieve pain and protect the joint at the same time. For example, you should use two hands instead of one when picking up an object, such as a coffee cup, dinner plate or magazine; this prevents one hand from bearing all of the stress between the thumb and fingers. Or, lighten the load when you can, such as when lifting wet clothes from the washer to place into the dryer.

  If conservative treatment fails to relieve pain, and correct use of the thumb and hand continues to be a problem, surgery can be an appropriate next step. Early in the condition's course, surgical tightening of the ligament in this area can be the best treatment to prevent further deterioration of the joint.

  The newest method of surgery is arthroscopic evaluation and cleaning out the joint. Fusion--making the joint stiff so it cannot move, and therefore there is no pain--can be performed through either a traditional open incision or less invasively through arthroscopy. Fusion can be an excellent way to limit the pain and provide more function, but you will experience some loss of motion in the joint. Fusion can be the treatment of choice in men and women who perform repetitive hand tasks, for example on a production line or at a checkout counter at the grocery store.

  For people who would not place a high demand on their thumb base, reconstruction with ligament rebuilding and tendon transfer, both with or without artificial joints, can be used with good results. This type of reconstruction is excellent for pain relief and will increase mobility and function of the thumb for relatively normal use. After this surgery, most people can once again enjoy golf, tennis, needlepoint and other hobbies.

  Postoperative recovery includes splinting for six weeks, with six to eight weeks of hand therapy. All surgeries can be done in about one hour as an outpatient. You'll be able to use the splinted hand within 48 hours of surgery.

  If you have thumb pain, there are many options for help to relieve the pain and dysfunction. You don't have to live with the pain of thumb-base arthritis. Also, it's important to remember that not all pain is arthritis. Some thumb pain can be tendinitis, which is easily treated with a proper program of cortisone and therapy.

About the author:
Jan Revella, R.N., arthritis nurse specialist, is founder and director of Arthritis Education by Professionals, Inc., based in Phoenix, Arizona. She is among the most prominent speakers and educators on the subject of arthritis in the United States. Her mission is to empower people with arthritis to use knowledge as power when making decisions about their personal healthcare. Arthritis Education by Professionals, Inc. provides educational programs and services to people with arthritis.