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Senior Citizen's Guide to Southwest Ohio

Arthritis Relief
Enjoy the Things You Love Again

The most common type of arthritis is osteoarthritis, and the most frequent body part to be affected by osteoarthritis is the hand . The thumb is commonly involved by osteoarthritis. The thumb has three joints: the joint at the tip called the interphalangeal joint; the middle joint or metacarpalphalangeal joint; and the base (basal or carpalmetacarpal) joint, where the thumb arises from the wrist.

The basal joint of the thumb is a frequent site of arthritis. A long, slender, metacarpal bone is balanced on a smaller bone of the wrist that acts as a pedestal. This pedestal bone, called the trapezium, has sloped facets that allow for the motion we call opposition, whereby the thumb turns to face the fingers and produce pinch. This is the famous “opposable thumb” that is specific to humans within the animal kingdom. The thumb basal joint is stabilized by bands called ligaments.

Degeneration of the tethering ligaments to the thumb basal joint can occur, resulting in joint wear and tear over time. Genetic and hormonal factors may contribute to the ligament degeneration and to the development of painful thumb arthritis. There is no conclusive evidence that any type of work predisposes to thumb arthritis, although once arthritic, the thumb base joint may be more painful with pinching motions.

Nonsurgical treatment options for thumb basal joint arthritis often includes modifications of pinch. The thicker pens on the market are more ergonomic than thinner writing utensils. Golf clubs, gardening tools, and kitchen instruments (e.g. potato peelers) all have “adaptive” varieties to make them easier to handle. For activities where little adaptation can be made, a thumb spica splint that supports or immobilizes the thumb may help symptoms. The fabric thumb spica splints can be purchased at drug or medical equipment stores and the harder splints are made by hand therapists. Hand therapy can also help strengthen and stretch the thumb, and ease pain.

Medical management of thumb basal joint arthritis may include oral or topical non-steroidal anti-inflammatory drugs. Many people today try joint supplement or herbal drugs. Often the best doctor to direct medical management is the family physician. It is very important that your family doctor is informed of any of arthritis medications you start taking, either non-prescription or prescription, as any medication can have serious side-effects alone or in combination with other medications.

Cortisone is often injected directly into the thumb base joint to help the pain from inflammation. The hylauronic acid preparations used in knee injections are not FDA approved for use in the thumb.

In patients in whom non-operative management has failed to provide satisfactory relief of symptoms, surgery may be considered. Surgical management of thumb basal joint arthritis seeks to decrease pain by removing part or all of the arthritis ravaged trapezium bone. Removing the trapezium eliminates grinding between the trapezium and the metacarpal bones. While pain is often decreased, it is a significant step to remove a bone, and the postoperative rehabilitation takes time. The operated thumb will not be exactly like a normal thumb and it is important to have reasonable goals for the surgery.
The best approach to the patient with thumb basal joint arthritis is often a stepwise one, with the patient and physician working together toward informed decisions about the best options for each patient.

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