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. 

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 athletic  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. A local chiropractor may work with your local massage therapist and your local physiotherapist to create the best health or rehabilitation plan for your situation.

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. 

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.  Often seeing a local family physician or a physiotherapist in conjunction with a registered dietitian and athletic therapist is a great option to take control of this condition. Smart Food Now and exercise is also optominal for overall health.    

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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