Joseph J. Schreiber, MD

thumb arthritis

Thumb arthritis, sometimes called basal joint arthritis, is a common cause of pain at the base of the thumb. Normal and healthy joints are lined by smooth cartilage, which allows the bones to easily glide pain-free during use. When this cartilage wears thin, or bone spurs develop, normal motion of the joint can become painful.  Cartilage can wear out more quickly due to genetics, over-use, or prior injuries.

Symptoms

Patients with basal joint arthritis experience pain at the base of the thumb that tends to be worse during activities, such as when pinching objects, opening jars, turning doorknobs, getting dressed or writing. 

Diagnosis

Thumb arthritis can be diagnosed by talking with your doctor and having them examine your hand.  X-rays can be useful to see the severity of the cartilage loss, and oftentimes will show development of bone spurs, also known as “osteophytes”. 

Non-Surgical Treatment

• Splints - can be worn during activities to support of the base of the thumb and can decrease arthritis pain.

• Ice & heat - ice, warm water, paraffin baths, heating pads and others can help with pain.

• Anti-inflammatories - oral NSAIDS (e.g. ibuprofen, naproxen) or topical anti-inflammatory gels (e.g. Pennsaid, Voltaren).

• Steroid injection - a cortisone injection into the arthritic joint can be very helpful for relieving pain.

• Therapy - strengthening the muscles around the thumb helps stabilize the joint, can increase strength, and decrease pain (see 3 videos below, courtesy of Stanford University Hand Therapy Rehabilitation).

Surgery

• Many surgical treatment options are available for thumb arthritis. The vast majority involve removing the arthritic trapezium bone to create a space at the base of the thumb. This eliminates the “bone on bone” arthritis sensation.

• My preference is to remove the trapezium and its bone spurs, and support the thumb on a bed of local tendon and suture (like a hammock). This is an outpatient procedure that takes less than an hour. It is done through a single 1-2 inch incision at the base of the thumb (see illustration below). The arm is numbed by an anesthesiologist, and some sedation is given through an IV. No intubation or general anesthetic is required.

• Therapy is often used after surgery to restore strength and motion to the thumb.

Post-Surgery Rehabilitation

• Weeks 0-2 (rest) - A splint is applied around the thumb in the OR, and is worn at all times.

• Weeks 3-4 (more rest) - At the first post-op visit, x-rays are obtained, the incision is assessed, and a removable splint is applied. This splint is worn at all times other than for showering.

• Weeks 4-6 (motion) - At this point, the thumb has started to cure in position, and patients start working with a therapist to restore motion of the thumb and wrist. The splint is worn for sleeping and activities, but is removed throughout the day for motion.

• Weeks 6+ (strengthening) - After 6 weeks, patients wean from the splint. Strengthening exercises begin, and patients gradually return to activities as tolerated.

  
  

STT Arthritis

Arthritis of the STT (scapho-trapezio-trapezoidal) joint is similar to basal joint arthritis. The adjacent joint is affected, but symptoms and treatment are very similar. Surgery involved removing the trapezium bone and a portion of the trapezoid joint.

Dr. Schreiber is a board certified orthopedic surgeon specializing in hand, wrist, and elbow conditions. Dr. Schreiber practices at the Raleigh Orthopaedic Clinic in Raleigh, North Carolina.