What is arthritis at the base of the thumb?
The word arthritis means joint (arth-) inflammation (-itis). The most common form of arthritis is osteoarthritis, or OA. Another name for it is degenerative joint disease, or DJD. The ends of bones normally move smoothly against each other. Smooth cartilage inside the joint makes this possible. The disease process of arthritis causes this cartilage to wear out and the joint no longer works as it was designed to.
In the worst, most advanced cases, bone literally grinds on bone inside the arthritic joint!
The base of the thumb is where the thumb joins up with the wrist. The main joint involved in arthritis at the base of the thumb is the trapeziometacarpal joint (also known as the carpometacarpal joint – CMC joint of the thumb).
This joint is formed by a long bone in the thumb called the metacarpal and a bone in the wrist called the trapezium. This joint provides the majority of the useful motion in your hand – gripping, pinching, twisting, opening jars, and writing all require this joint to have pain-free function. Arthritis may cause pain with all these activities.
This type of arthritis is more common in women than men, and usually doesn’t happen before age 40. Fractures and other trauma to the thumb joint may put you at risk for developing arthritis in the future.
What are the Signs and Symptoms of basilar thumb arthritis?
Some patients with arthritis at the base of the thumb never have symptoms. Others have crippling and severe pain at an early age.
The earliest symptom of thumb arthritis is pain at the base of the thumb (the heel of the palm) with pinching, opening jars, or after long periods of writing. Turning keys or opening door knobs may also be painful.
Weather changes (such as before it rains) may create pain in the thumb. Heavy repetitive use may also cause deep aching in the thumb. As the arthritis gets worse, the strength of pinching gets weaker and heavy activity is no longer required to make the thumb painful.
Patients with advanced arthritis may feel a grinding/crunching sensation with even small movements of the thumb, and the thumb joint may start to look enlarged, swollen, or “out of place”. The joint at the base of the thumb becomes very stiff at this point.
Other joints further out towards the tip of the thumb may become looser and more deformed to compensate for the stiffness at the thumb base.
How is thumb arthritis diagnosed?
Arthritis at the base of the thumb is diagnosed by history (the story of how symptoms develop) and physical examination.
The base joint (CMC joint) is tender to touch and you can often feel crunching or grinding as the joint is moved in a circular pattern. Swelling is usually present around the joint.
Other conditions in the same area may cause a similar appearance, such as tendonitis and arthritis in other joints of the wrist and thumb.
X-rays are useful for confirming the specific joint involved with arthritis, though the appearance of the joint on x-ray may not match how the patient feels.
There are several x-ray views ordered by your hand surgeon that show the arthritis more clearly than those ordered by your family doctor. These additional views are especially helpful in mild cases, where the diagnosis isn’t obvious on regular x-rays of the hand or wrist.
The swelling, tenderness, or abnormal motion of other joints nearby may also reinforce the diagnosis of arthritis at the base of the thumb.
Can thumb arthritis pain be treated?
Arthritis at the base of the thumb is treated like arthritis elsewhere in the body:
- limited motion or use
- splinting (click here to see the best splint for thumb arthritis)
- anti-inflammatory medicine (pills or creams)
- heat therapy (warm/hot water soaks)
Cortisone (steroid) injections in the joint may give some significant relief for several months. This can be done along with the above methods or after they have failed to provide pain relief.
After non-surgical treatments fail to provide adequate pain relief, surgery should be considered.
Surgery for CMC arthritis involves removing the arthritic portion of the joint (some or all of the trapezium bone) and replacing it with tendon to serve as a cushion between the bones. Joint replacement with artificial joints is also an option for worn-out CMC joints in the thumb – we can talk about this option in greater detail in the office.
Click here for even more detailed information about what happens in thumb arthritis surgery, called suture suspension arthroplasty surgery.
Many patients read about or watch YouTube videos on a surgery called an LRTI (ligament replacement tendon interposition), which is a close cousin of the surgery I do.
This surgery is done as an outpatient procedure (have the surgery and go home the same day) under a general anesthetic or arm nerve block. The thumb is placed in a splint or cast for six weeks and therapy (stretching and strengthening at home) is started during the second six weeks. The fingers are left free during recovery.
Total recovery time ranges from two to three months. Most patients return to unlimited use of the thumb three months after surgery.
Advice from a real patient for after thumb arthritis surgery
One of my patients created a list of super-helpful tips and tricks for anyone going through this surgery. Click here to download and/or read the list.
What Dr. Henley’s Thumb Arthritis Patients Are Saying
by Chuck Rice
I saw Dr. Henley for problems with my left thumb. After an x-ray he said it was the worst arthritis he had seen, he said we could try “limping” through treatments or fix the problem with surgery. Surgery required removal of a bone in my thumb and replacing it with tendons. Not being interested in limping, I agreed to surgery. The thumb had to be completely immobile for about six weeks after surgery, not an ideal situation. It has been about four months after surgery and I am almost back to full strength.
I would not hesitate to see Dr. Henley again and will recommend him to anyone.
by Delnita Foust
Dr. Henley was concise and informative during my initial visit but more importantly,relieved a ten year pain from a debilitating arthritic thumb.The clinical staff is professional and polite. I appreciated never waiting more than 20 minutes to see Dr. Henley.The surgical team made a worrisome day pain free (honestly!) on the hour and a half trip home. The Physical Therapy Dept. was exceptionally helpful and forthcoming with patient education. I really felt I had great partners in my efforts returning to optimal range of motion.
My osteoarthritic thumb had bothered me for over 2 years, getting worse and worse. I had tried topical analgesics, cortisone shots and was wearing a brace most of the time. I was at the point where I could not unscrew any lids, hold vegetables in my hand to chop them or hold dishes to wash them.
I had already visited a doctor that does surgery for this, and then found out that Dr. Henley only does hand surgery and had a different procedure for this problem. I made an appointment with Dr. Henley. My husband, also a physician, went with me for the appointment and we both knew he was the right doctor for my surgery. As Dr. Henley told me what to expect after surgery, he didn’t sugar coat anything about it, but I was tired of not being able to do things for myself any longer and booked my surgery.
The first 2 weeks I was not able to get my hand wet at all or do anything with it, not that I would have wanted to! The next 2 weeks were a little better, but I still could not do much, except wiggle my fingers on that hand. Physical therapy started after that and it was a relief to finally start moving my fingers and thumb a little.
After 3 ½ from surgery, I have an ache once-in-awhile in my hand or wrist. It is nothing like the pain I had before surgery! I have full movement of my thumb, I can open jars!!! And chop veggies and wash dishes again. I am working on gaining more strength in my hand / wrist.
Dr. Henley was up-front in telling me that the recovery would take 3 months plus. I am glad that I had the surgery, as I was not able to do much before surgery and I had a lot of pain most of the time. My husband and I recommend Dr. Henley, who is so nice, to anyone looking for a hand surgeon. Dr. Henley has an office in Fayetteville and in Bentonville, Arkansas, so it is easy to make it to get in to see him.