Base of Thumb Arthritis

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What is Base of thumb arthritis?

Osteoarthritis of the base of the thumb is a very common condition affecting mostly post-menopausal women. Men are less affected and develop this condition as a result of previous thumb fracture.

   

Causes

Wear of the articular cartilage is the main reason behind any arthritis. As the articular cartilage is lost across the joint and therefore the two ends of the bone rub over each other and lead to pain. This can be due to;

  • Previous thumb fracture dislocation
  • Ligament injury
  • Old age

Symptoms

  • Pain and burning sensation at the base of the thumb
  • Stiff ness and pain in the morning
  • Inability or weakness to unscrew or open jars due to pain
  • Restricted range of motion
  • Deformity and bony bump at the thumb
  • Inability to grasp

Diagnosis

Clinical assessment is often painful as the thumb is pushed for relocation test. Xrays of the thumb is the preferred investigation.

Treatments available

Non-operative treatment

  • Rest, pain killers (analgesia)
  • Avoiding aggravating activities
  • Resting night splint

                                       

Operative treatment

  • Injection under x-ray control. This is carried out under clean environment in a minor procedure unit. Up to 70% of patients notice an improvement in their symptoms after an injection and hand therapy. Risks of steroid injection includes infection, fat necrosis leading to thinning of the skin and skin depigmentation (both are permanent changes), poor diabetic control up to 2 weeks and failure to resolve symptoms up to 30%.
  • Surgery: the type of surgery depends on the nature of the arthritis, age and physical demand of the patient.
    • Fusion of the thumb CMC joint in young and active patient, where trapezium is fused to the thumb metacarpal.
    • Trapeziectomy and ligament interposition in older patients. This procedure is performed under general anaesthetic or regional anaesthesia (wide awake surgery when only the arm is made numb). The surgery takes about 1 hour. The trapezium is excised. Half of a thumb tendon is then used to create a suspension sling or hammock to stabilize the thumb and fill up the space that was created by removing the trapezium. A half plaster slab is applied after the wound is closed.

                                     

Aftercare and follow up

Pain relief is provided after surgery. Hand should be kept dry and clean until the stitches are removed. One week after the procedure the dressing are reduced by the practice nurse and a new light weight plaster is applied for further 5 weeks. This is to allow for pain relief and soft tissue healing. Normal daily activities and use of the hand is encouraged to avoid tendon and nerve adhesions immediately after surgery.

Hand therapy will start following removal of the plaster at 6 weeks.

Recovery from surgery can take 9-12 months and perseverance with physiotherapy is very important.

Driving

You should allow a period of approximately 8 weeks before driving and slightly longer if the procedure has been carried out on the left hand side as changing the gear and using the hand break may be difficult to perform.

Time off work

Your return to work will depend on your job. Light manual workers can return to duty in 6-8 weeks. Heavy manual workers should not exert maximal grip for 8-10 weeks.

Risk of surgery

  • Infection
  • Injury to superficial nerve, blood vessels and tendons
  • Scar sensitivity (Scar desensitisation exercises after removal of plaster will help to improve scar sensitivity however this can last up to 6 months after surgery)
  • Failure to resolve all symptoms (If there is arthritis in the adjacent joints)
  • Further surgery (in event of further injury or other complications)
  • Reduced grip strength
  • CRPS (chronic pain syndrome: A small percentage of patients will develop a severe reaction after hand surgery, with lifelong permanent pain and stiffness which requires extensive physiotherapy and pain medication)

 Scar desensitisation exercises

  • Circular motion massages to the scar, from the palm moving towards the wrist using a simple moisturising cream. This must be carried out for 10 minutes, at least 3 times a day.
  • Rubbing the scar on different textured materials to improve skin sensitivity.
  • Submerging the hand under the cold and warm water to improve the temperature sensitivity.