What is Thumb Arthritis?
Thumb arthritis, specifically basal joint arthritis, occurs when the cartilage wears away from the ends of the bones that form the joint at the base of your thumb (the carpometacarpal or CMC joint).
Because this joint allows you to pivot, pinch, and grip, arthritis here can cause severe pain, swelling, and decreased strength, making it difficult to perform simple tasks like turning doorknobs or opening jars.
How is Thumb Arthritis Diagnosed?
To diagnose thumb arthritis, your doctor will perform a thorough evaluation:
- Physical Exam: Your doctor will look for swelling or bumps at the base of the thumb and perform the “grind test” by applying pressure and rotating the thumb joint to see if it produces pain or a gritty sensation.
- X-rays: Imaging can confirm the diagnosis by showing bone spurs, narrowing of the joint space, or bone-on-bone contact.
Management and Treatment
Nonoperative Management
In the early stages, symptoms can often be managed without surgery:
- Activity Modification: Changing how you use your hands to avoid painful pinching motions.
- Bracing/Splinting: A thumb spica splint can support the joint and limit movement to reduce pain.
- Medication: Topical or oral anti-inflammatories (NSAIDs) to manage pain and swelling.
- Injections: Corticosteroid or viscosupplementation injections can provide temporary relief from inflammation.
Operative Management
When nonsurgical treatment is no longer effective, several surgical options are available:
- Ligament Reconstruction and Tendon Interposition (LRTI): The most common surgery, where the damaged joint bone is removed and replaced with a piece of your own tendon to act as a cushion.
- Joint Fusion: The bones in the joint are permanently fused together to eliminate pain, though this limits mobility.
- Recovery: Recovery usually involves a period of casting or splinting followed by physical therapy to regain strength and motion.