Thumb base pain is one of the most common complaints we see on a daily basis. X-rays often prove that the pain comes from arthritis in the first (thumb) carpometacarpal joint. Let’s focus now on thumb joint pain relief injections: what types and what evidence we have as to why we use what we do.
My surgeon is telling me the next step is an injection, but what does that mean?
Of the numerous patients presenting to my office with thumb base pain, many have already started treatment with splints and medications. When these treatments do not give the needed pain relief, the next step to try is injection. In my practice, the mainstay of injection therapy is a corticosteroid injection. Intra-articular injections of steroids have been around for many decades and are very standard within the field of orthopedic surgery, rheumatology, and primary care. Let’s explore what options are available for patients considering intra-articular injections.
The comprehensive list of thumb joint pain relief injections…
A recent review article out of Siena, Italy comprehensively discussed all of the possibilities for thumb carpometacarpal osteoarthritis.
- Intra-articular injections of steroids
- Hyaluronic acid
- Platelet-rich plasma
- Stem cells
(There is even a smaller study that mentioned trialing Botox but the results are still pending so this may be more of a flash in the pan rather than a clinical reality.)
A number of studies have shown that corticosteroid injections of many different forms (e.g. betamethasone, methylprednisolone, and triamcinolone) are effective and safe with generally better and longer-lasting results in earlier forms of the disease.
Hyaluronic acid also comes in different formulations and has generally positive results on patient-reported pain scores within the first year. Unfortunately, only small studies with a limited number of patients have been performed on platelet-rich plasma and stem cells. So, it is difficult to make literature-based recommendations at this time. There are two larger ongoing trials further exploring these modalities. And once those results are published, we will update this post.
How do I choose the right injection for my thumb base pain?
At this time the decision depends on the surgeon’s clinical experience, medication cost/availability, and patient factors. Our practice has been using betamethasone, a corticosteroid, injection for many years to treat thumb joint pain with proven results time and time again to be effective, safe, and readily available.
We have very few studies that provide comparative guidance between the injection options targeting the thumb carpometacarpal joint. One noteworthy study from Columbia University focused on direct comparisons between a steroid injection, a hyaluronan injection, and a placebo injection. This blinded study was unable to find lasting significant differences between the three options. Two other studies from Israel and Germany reported similar benefits of steroids and hyaluronic acid injections. Some results even favored hyaluronic acid in a limited way.
How Can Proliance Hand, Wrist and Elbow Physicians Help?
Once you have been diagnosed with thumb basal joint arthritis, our surgeons can help find the best treatment for you We offer same-day corticosteroid injections along with highly trained occupational therapists that are onsite at our Kirkland and Bellevue offices. This allows patients to see both their hand surgeon and skilled therapist conveniently. Thumb joint pain relief and particularly osteoarthritis can seem daunting for many patients. Our surgeons are ready to help guide you through the process. Contact us to make an appointment at any of our five convenient Eastside locations.
Stay tuned as we continue the conversation about thumb carpometacarpal osteoarthritis. It doesn’t have to be an overwhelming diagnosis. Researchers in Boston, Texas and the Netherlands have designed a tool to help patients make the correct decision for their thumb, check it out by clicking here. »
Samuel E. Galle, M.D. is a board-certified orthopedic surgeon with subspecialty fellowship training in conditions of the hand and upper extremity. He has published numerous peer-reviewed articles and surgical technique videos. He lives in Kirkland, WA with his wife, two kids and one especially spoiled Cavalier King Charles Spaniel.