What is thumb arthritis?

Thumb arthritis is when the cartilage in the carpometacarpal (CMC) joint wears away and creates pain. The pain felt most often occurs at the base of the thumb and can be triggered after periods of increased joint use, where gripping, pinching or grasping takes place. Other symptoms may include swelling, stiffness and tenderness in the joint at the base of the thumb. 

Thumb arthritis surgery and treatment

Symptoms from arthritis at the base of the thumb usually come on slowly, although some patients experience it rather abruptly.

They may be doing an activity that causes some impact in the thumb, they may fall onto their thumb, and all of a sudden their thumb is sore, only to see their doctor and be given a diagnosis of arthritis.

It’s probably been there for years and was probably asymptomatic. But usually it’s a slow onset that gets worse over time. Patients experience this as described merely with pinching activities, and eventually it becomes intolerable.

This is a point where you may get referred to either a therapist to make an appropriate brace for you, because bracing does help.

You can treat this with anti-inflammatories, and some doctors like to administer injections into the joint. Ultimately, if it because unmanageable with these vitalities, surgery is recommended.

The most common operation for arthritis at the base of the thumb involves removing a bone. The bone is a trapezium. This is a bone that’s at the bottom of the thumb metacarpal.

If you excise this bone, there’s no longer a bone for the metacarpal to rub against. The problem is you need to do something else to suspend that bone so it doesn’t collapse against the next bone in the wrist.

So usually a ligament reconstruction is added to that, and a classic operation is called an LRTI, which stands for ligament reconstruction and tendon into position, because some doctors will use a piece of tendon to put into the space created by the excised trapezium.

By and large, the operation’s a day care procedure that takes up to an hour, but most patients usually need either splinting or casting of their thumb for approximately six weeks after surgery to allow these ligaments to heal.

Once the cast is removed after your surgery for arthritis at the base of the thumb, the thumb is usually very stiff for many months. Some patients prefer to go to physiotherapy to get adequate help to regain their motion. Local Orthopedic Surgeon

The overwhelming majority of patients, however, obtain complete pain relief from their surgery. Some patients may notice a bit of stiffness, and some may notice a bit of pinch weakness ultimately, but it’s rarely a functional problem.

If you think you may have arthritis at the base of the thumb, you should seek attention from your family physician, who may refer you to a specialist with expertise in hand surgery. Most of these surgeons are either plastic or orthopedic surgeons.

Presenter: Dr. Bertrand Perey, Orthopaedic Surgeon, New Westminster, BC

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Arthritis at the base of the thumb is premature wear of the cartilage between the thumb metacarpal and the trapezium bones in the wrist. Patients usually experience pain at the base of the thumb in the area called the thenar eminence, or in the back area of the thumb.

Causes & Symptoms of Thumb Arthritis

Thumb arthritis can be aggravated with pinching activities, such as opening a jar or squeezing a towel. The cause of arthritis at the base of the thumb is somewhat unknown. It usually starts off with instability, when the joints shear against each other in an abnormal way during their lifespan, causing the cartilage to wear prematurely. Most patients who get thumb arthritis are in their 50s and 60s, although it can happen at any age. The majority of patients who get it are women; women generally have more instability in their joints than men do.

Symptoms from arthritis at the base of the thumb usually come on slowly, although some patients experience pain and stiffness rather abruptly. They may be doing an activity that causes an impact on the thumb or fall onto the thumb, only to see their doctor and be given a diagnosis of arthritis.

Thumb Arthritis Treatment

Treatment of thumb arthritis includes anti-inflammatories, cortisone injections, physiotherapy and bracing. If you require surgery for thumb arthritis, your orthopedic surgeon may remove the trapezium bone. If the surgeon excises this bone, there’s no longer a bone for the metacarpal to rub against. Usually, a ligament reconstruction is added to that procedure. The classic operation is called an LRTI (ligament reconstruction and tendon interposition), because some doctors will use a piece of tendon to put into the space created by the excised trapezium.

arthritis-of-the-thumbGenerally, the operation is a day procedure that takes about an hour. Most patients usually need either splinting or casting of their thumb for approximately six weeks after surgery to allow ligaments to heal. Once the cast is removed, the thumb is usually very stiff for many months. Some patients benefit from physiotherapy to help to regain their motion. The overwhelming majority of patients obtain complete pain relief from their surgery. Some patients may notice a bit of stiffness or pinch weakness, but it’s rarely a functional problem.

Talk to your healthcare provider including a physiotherapist, massage therapist, orthopedic surgeon  if you’d like more information on thumb arthritis.

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Print this Action Plan and check off items that you want to discuss with your healthcare provider

  • Thumb arthritis can be aggravated with pinching activities, such as opening a jar or squeezing a towel.
  • Most patients who get thumb arthritis are in their 50s and 60s, although it can happen at any age. The majority of patients who get it are women; women generally have more instability in their joints than men do.
  • Symptoms from arthritis at the base of the thumb usually come on slowly, although some patients experience pain and stiffness rather abruptly. They may be doing an activity that causes an impact on the thumb or fall onto the thumb, only to see their doctor and be given a diagnosis of arthritis.
  • Treatment of thumb arthritis includes anti-inflammatories, cortisone injections, physiotherapy and bracing.
  • If you require surgery for thumb arthritis, your orthopedic surgeon may remove the trapezium bone. If the surgeon excises this bone, there’s no longer a bone for the metacarpal to rub against. Usually, a ligament reconstruction is added to that procedure.

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