Base of thumb arthritis: Expert insight on symptoms, diagnosis and treatment

In this informative article, revered consultant hand and wrist surgeon Miss Sally-Anne Phillips sheds light on the most common symptoms of base of thumb arthritis and how the condition is diagnosed. The leading specialist also discusses the various treatment options and reveals when surgery is indicated.

What is base of thumb arthritis?

It is a common ageing process where there is the loss of cartilage at the thumb carpometacarpal joint (CMCJ) which is thought to occur due to attenuation of a ligament in the thumb leading to instability. Previous trauma or accident to the thumb can also lead to abnormal forces through the joint causing loss of cartilage.

What are the typical symptoms?

Base of thumb arthritis can result in symptoms of thumb swelling, pain on movement and difficulties with tasks that load the thumb, such as opening jars, wringing out clothes, turning a key in a door or writing.

What are the risk factors for developing base of thumb arthritis?

There is a greater incidence in Caucasian women and in those with prior trauma, a history of osteoarthritis, hypermobility syndromes or an increased body mass index (BMI).

How is base of thumb arthritis diagnosed?

It is diagnosed with symptoms of pain in the thumb or wrist or difficulty using the thumb for grasping and loading tasks. In examination of the thumb, there are signs of pain over the carpometacarpal joint (CMCJ) and reduced range of movement of the thumb joint. The bones at the bottom of the thumb may become prominent in advanced disease. X-rays can confirm the presence of arthritis but they have been shown not to correlate with the severity of patient’s symptoms.

What are the available treatment options for base of thumb arthritis?

Simple painkillers or anti-inflammatory medication and a thumb wrap support can improve symptoms initially. Avoiding activities that aggravate the pain is also recommended. If pain persists then a joint injection of local anaesthetic and steroid can improve things. This is a temporary measure which has a shorter duration of action the more frequently it is given.

Depending on the severity of the arthritis, patient comorbidites and lifestyle, surgery can vary from:

• Insertion of a joint spacer to act as a buffer between the joint surfaces of the base of the metacarpal and trapezium
• An osteotomy (a bone cut) to the metacarpal bone to realign it
• Trapeziectomy, a removal of the trapezium bone which makes up the CMCJ, with or without a ligament suspension
• Joint replacement of the CMCJ
• Fusion of the bones that make up the CMCJ joint
• Denervation of nerves to the CMCJ, where the nerves to the thumb are divided to allow pain free movement even though the arthritis continues to progress.

What is the prognosis and long-term management for base of thumb arthritis?

Overall the osteoarthritis will burn itself out with time. The pain is a temporary feature although this may take years rather than months to improve. Surgery is often viewed as the last option if pain and restriction remain after conservative treatment fails.

If you are suffering with symptoms of base of thumb arthritis and wish to schedule a consultation with Miss Phillips, you can do so by visiting her Top Doctors profile.