Thumb Arthritis / Basal Joint Arthritis


 

The joint at the base of the thumb (carpometacarpal joint) is like a saddle, and allows a lot of motion of the thumb at that joint. If the cartilage coating the ends of the bones wears out, bone starts to rub against bone, and arthritis results.

 

Common Causes

Generally a ‘wear and tear’ phenomenon, with a genetic or family predisposition. More common in women. May be a late result of earlier trauma.

 

Symptoms

Pain deep in the base of the thumb, relieved with rest, and worsened with pinching, squeezing, and gripping activities. Opening jars, door handles, and turning keys are problematic.

 

Physical Findings

Tenderness at the carpometacarpal joint of the thumb. There may be deformity present, and loss of motion.

 

Workup

History, physical examination, and x-rays are usually diagnostic.

 

Non-operative Treatment

Splinting, anti-inflammatory medication, and rest may reduce symptoms. A corticosteroid injection can provide relief for a while, but will not repair the joint. Thumb splints are effective, but poorly tolerated due to restriction of thumb motion. Physical therapy is contraindicated, as it tends to irritate things.

 

Surgical Treatment

A joint replacement, or thumb basal joint arthroplasty.

 

Injury Comment

Most patients can be managed non-operatively, but surgical reconstruction is very effective for pain relief, strength, and motion. About four weeks of casting are required after surgery, and up to several months of hand therapy.