Many patients present to our surgeons at Proliance Hand, Wrist and Elbow with ongoing pain in the joint of the thumb. One of the most common diagnoses in that small area is arthritis of 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. Fortunately, there are many treatment options available to patients.
How do I know if the pain in the joint of my thumb is due to osteoarthritis?
(Disclaimer: this blog is not meant to provide a diagnosis. You should be evaluated by a board-certified hand surgeon if you are experiencing pain and loss of function in your thumb.)
Patients that present with thumb CMC OA often describe pain about the base of the thumb. The pain can be dull in nature, occasionally sharp and stabbing, and may occur regularly or intermittently. Activities that use a heavy grip or pinch activity, like opening a jar or opening a lock while holding a key, are often the trigger. The pain can range from a dull night time ache all the way to severe depending on a variety of factors. Patients also commonly have periods of normal use followed by days of debilitating discomfort. Most patients are surprised when an activity or motion they have “done it a thousand times before” becomes painful.
So now the pain in the joint of my thumb sounds like arthritis but what can I do about it?
Initial treatment for thumb carpometacarpal osteoarthritis largely starts with non-surgical options. The goal of conservative management is to help alleviate the symptoms that result from painful inflammation as the joint wears out. Many patients have found positive results with avoiding certain activities involving heavy grip and key pinching type motions. Other patients swear by warm water soaks in the morning and assistive devices like jar openers.
A large family of nonsteroidal anti-inflammatory medications exist, and many studies have proven their reliability in the treatment of hand arthritis. Common medications include ibuprofen and naproxen, and there are even over-the-counter gels, like diclofenac, for patients who are unable to take pills.
Various splinting regimens have shown reliable improvements of pain especially in patients with early forms of the disease. One study found 76% of patients with Eaton stage 1 or 2 reported improved symptoms with regular use of thumb splints any kind. (The Eaton classification is used to classify thumb CMC OA from radiographs with stage one describing the most early changes and level four noted the most severe.) The type of splint didn’t affect the patient outcomes, proving yet again that the worst splint is universally one that the patient wears home and then places on a bedside table. Our clinic alone has soft neoprene versions, generic plastic ones to stabilize the specific joint and custom versions that are the most immobilizing. Our patients benefit from our unique clinical setup with in-office hand therapists who can help you find the perfect splint for you.
Occupational therapist can also teach exercises which help manage some of the instability that occurs with thumb joint osteoarthritis. These exercises are most effective when carefully tailored based on your specific hand recovery. One group of researchers showed that specific exercises can help reduce the joint objectively using radiographs.
How Can Proliance Hand, Wrist and Elbow Physicians Help?
The most important step to tackling any problem is having the correct diagnosis. Surgeons at Proliance Hand, Wrist and Elbow Physicians can help; as can our highly trained occupational therapists who are onsite at our Kirkland and Bellevue offices. Our goal is that patients see both their hand surgeon and therapist quickly and conveniently. Pain in the joint of the thumb and particularly osteoarthritis can seem a daunting prospect for many patients and our surgeons can help find the best treatment for you. 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 injections 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 at: https://www.decisionaid.info/pp/thumboa/intro.
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.