Thumb base pain is one of the most common complaints we see on a daily basis.
X-rays often prove the pain comes from arthritis in the first (thumb) carpometacarpal joint. This form of arthritis is so widespread there are a variety of 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. Last time we discussed thumb joint pain relief we focused on simple, non-invasive treatments. Now we will deep dive into injections: what types, what evidence we have and why we use what we use.
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. For more information about that, check out our last article. This thumb base pain can be particularly disabling. Many patients avoid activities requiring a heavy grip such as opening a jar and may avoid using the hand entirely. 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. But what options are even out there for patients considering intra-articular injections to achieve thumb joint pain relief?
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. The list includes intra-articular injections of steroids, hyaluronic acid, platelet-rich plasma, and 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?
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 in treating thumb osteoarthritis. Some results even favored hyaluronic acid in a limited way.
At this time the decision depends on surgeon experience, medication cost/availability, and patient experience factors. Our practice has been using betamethasone, a corticosteroid, injections for many years to treat thumb joint pain. It has proven time and time again to be effective, safe, and readily available.
How Can Proliance Hand, Wrist and Elbow Physicians Help?
Once you have been diagnosed with thumb basal joint arthritis, our surgeons at Proliance Hand, Wrist and Elbow Physicians can help find the best treatment for you We offer same-day corticosteroid injections for the patients that need it. Our highly trained occupational therapists are onsite at our Kirkland and Bellevue offices so patients can see both their hand surgeon and therapist conveniently. Thumb joint pain relief and particularly osteoarthritis can seem a daunting prospect 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 in the next few weeks as we continue the conversation about thumb carpometacarpal osteoarthritis. Next, we will provide an in-depth review of the various surgical options that patients can consider to tackle their thumb pain!
Thumb carpometacarpal osteoarthritis 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. »
About the Author:
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.
