Many patients present to our surgeons at Proliance Hand, Wrist and Elbow with ongoing thumb joint pain. While there are many diagnoses in that small area at the base of the thumb, one of the most common is arthritis of the first (thumb) carpometacarpal joint. This form of arthritis has been described for so many years that there are even different names for it including basal joint arthritis, thumb base arthritis, and thumb carpometacarpal (CMC) osteoarthritis (OA). It is so common that one Swedish study found that physicians diagnosed this problem in 1.4% of the entire population, with 78.5% of those affected being women. Once thumb CMC OA is diagnosed there are a number of different conservative and surgical treatment management options available.
How do I know if my thumb joint pain is due to osteoarthritis?
(A slight disclaimer here as if you are having pain and loss of function in your thumb then you should be evaluated at Proliance Hand, Wrist and Elbow physicians to know the exact reason for your symptoms)
Patients that present with thumb CMC OA often describe thumb joint pain at the base of the thumb. The pain can be dull in nature, occasionally sharp and stabbing, and almost never burning in nature. This can be particularly aggravated by any activities that use a heavy grip or pinch activity, for example trying to open a jar. The pain can range from a dull night time ache all the way to severe depending on the patient and depending on the day. It is very common to have stretches of time where the thumb does not seem to have any problems at all followed by debilitating days where the thumb and hand are incapable of any activity. Many patients are surprised by the activity or motion that caused the thumb to start hurting as they have “done it a thousand times before.”
So now my thumb joint pain sounds like arthritis but what can I do about it?
Once an appropriate diagnosis has been made for thumb carpometacarpal osteoarthritis, treatment largely starts with non-surgical options. The goal of conservative management is to manage the symptoms that result from painful inflammation as the joint wears out. Many patients have found positive results with avoiding certain activities involving heavy grip and key pinching type motions. Other patients swear by warm water soaks in the morning and assistive devices like jar openers.
Nonsteroidal anti-inflammatory medications include a large family of medications and many studies have proven their reliability in the treatment of hand arthritis. Classic medications include ibuprofen or naproxen and there are even over-the-counter gel versions, diclofenac, for those patients that have stomach issues that preclude taking pills.
Various splinting regimens have shown reliable improvements of pain especially in patients with early forms of the disease. One study found 76% of patients with Eaton stage 1 or 2 reported improvements in symptoms with regular use of thumb splints. Which splint a patient uses seems to be less important as the worst splint is one that the patient wears home and places on the bedside table in a form of splint purgatory, lost between functional usefulness and the trash. Our clinic alone has soft neoprene versions, hard sized plastic ones to stabilize the specific joint and custom versions that are the most immobilizing. Our patients benefit from our unique clinical setup with in-office hand therapists who can help you find the perfect splint for you.
Occupational therapist can also teach a series of joint stabilization exercises that can help manage some of the normal instability that occurs that thumb joint osteoarthritis. This exercise program can be carefully tailored to your hand and one group of researchers showed that specific exercises can help reduce the joint objectively using radiographs.
How Can Proliance Hand, Wrist and Elbow Physicians Help?
The most important step to tackling any problem is having the correct diagnosis and our surgeons at Proliance Hand, Wrist and Elbow Physicians can help Our highly trained occupational therapists are onsite at our Kirkland and Bellevue offices for your convenience to see your hand surgeon and therapist quickly and conveniently. Thumb joint pain and particularly osteoarthritis can seem a daunting prospect for many patients and our surgeons can help find the best treatment for you. Contact us to make an appointment at any of our five convenient Eastside locations.
Bonus Content:
Thumb carpometacarpal osteoarthritis can be an overwhelming diagnosis and researchers in Boston, Texas and the Netherlands have designed a tool to help patients make the right decision. Check it out at: https://www.decisionaid.info/pp/thumboa/intro/
