Imagine how frustrating it would be to try to open a jar or button a shirt without your thumb. This feeling is all too common for those with one of the most common types of hand osteoarthritis.
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Hand osteoarthritis is second in prevalence only to knee arthritis in the United States. Osteoarthritis in the thumb joint nearest the palm — the carpometacarpal (CMC) or basal joint — is the type that most commonly causes patients to seek the care of a hand or orthopaedic surgeon. The CMC joint, which is between the thumb metacarpal and a small bone called the trapezium, allows the swiveling, pivoting and pinching needed to grip things in your hand.
“While men and women can get basal joint arthritis, women seem to have more joint laxity, which leads to malalignment of the joint, cartilage wear, arthritis and pain, “ Dr. Shapiro says.
Losing your grip from arthritis
While your gender may predispose you to hand osteoarthritis, and in particular thumb arthritis, fractures or other injuries to the joint also may increase the likelihood of developing this condition. When osteoarthritis causes the cartilage to wear away, the shock and impact absorbing function of the cartilage is lost and the bones can rub against each other, causing stiffness and pain.
Symptoms that signal thumb arthritis include pain with activities that involve gripping or pinching, swelling and tenderness at the base of the thumb, and an aching discomfort after prolonged use. The joint also may appear enlarged or develop a bony prominence or bump over the joint, with limited motion.
An X-ray may show the severity of the osteoarthritis, but the x-ray findings do not necessarily correlate to the severity of symptoms, Dr. Shapiro says.
Although thumb arthritis can be debilitating, several non-surgical treatments can ease pain and help restore function. You may benefit from icing the joint for five to 15 minutes a few times a day, other treatments you can try at home include acetaminophen or a nonsteroidal anti-inflammatory medication, heat packs, paraffin baths, and/or topical arthritis creams.
Splints also can provide some pain relief, Dr. Shapiro says. You wear a soft splint, similar to a biking glove with a strap that stabilizes your thumb, as needed during the day. Hard plastic splints, either custom-made or off the shelf, also may help increase function and decrease pain.
Treatment beyond splints
If splinting doesn’t bring pain relief after a few months, the next phase of treatment usually involves steroid (cortisone) injections directly into the joint. While different physicians will manage this differently, one or two injections are usually worth a try, and in many cases will provide lasting relief, Dr. Shapiro says.
When nonsurgical treatment is no longer effective and the pain is overwhelming, surgery is an option.
A generally successful and rewarding procedure is ligament reconstruction and tendon interposition (LRTI) surgery. This procedure has been refined over the last 50 years, but still remains the gold standard for surgical treatment of basal joint arthritis, Dr. Shapiro says.
LRTI involves removal of the trapezium and the use of a “spare” tendon from the forearm to stabilize the thumb. The procedure is performed on an outpatient basis. Patients usually wear a splint or cast for up to six weeks, typically followed by a course of occupational therapy.
“After removing the bone, we maintain the space with soft tissue, either with a patient’s tendon or by some other method,” Dr. Shapiro says. “LRTI provides 95 percent pain relief and about 70 percent to 80 percent return of grip strength. While complete recovery can take a while, most patients end up much more functional, and much happier after the operation than before. “