Arthritis At The Base Of The Thumb

General
  • A common problem
  • Often no cause is found
  • Middle-aged women
  • Previous thumb fractures
  • Family history of arthritis
Symptoms

1. Pain in the base of the thumb:

  • simple activities that involve the thumb
  • removing the lid from a jar
  • turning a key in a lock or opening a door

2. Clumsiness or pain when handling small objects.

3. Stiffness – making it difficult to grasp larger objects

4. Weakness of grasp.

5. Deformity – the MCP joint of the thumb stretches to make up for the loss of CMC joint movement and this can cause secondary arthritis at the MCP joint.

Treatment
  • Rest
  • Activity restriction
  • Anti-inflammatories
    • Tablets – beware of stomach upset
    • Always take with food
    • Creams – e.g. Voltaren Gel
Splints

1. Thermoplastic

  • Removable splint made by a Hand Therapist.
  • Rigid and therefore somewhat restrictive but provides support for the thumb when doing heavy activities.

2. Thermoskin

  • Obtain from Hand Therapist or Chemist.
  • Wet suit material (Neoprene).
  • Less supportive but will keep the thumb warm.
  • Less cumbersome.

Often having both types of splints can be of benefit. Splints only work when they are being worn and so some people find them a nuisance after a while.

Cortisone Injections
  • Often provide good relief of pain for a variable period of time.
  • If one obtains 6 months relief the injection can be repeated over and over.
  • If injection only lasts for 1 month then other treatments may be required.
  • Occasionally it is difficult to enter the joint due to spurs from the arthritis. Under these circumstances the injection can be inserted under x-ray control.
  • Once the anaesthetic wears off, it is common for the thumb to ache for 1-2 days after the injection due to stretching of the joint capsule. Take some Panadeine after the injection.
  • At times one may experience pain from both the Basal Thumb joint and also the nearby STT joint. An injection of cortisone can be used as a test to try and determine how much of the pain is coming from each joint.
Surgery
F.C.R. Interposition Arthroplasty involves...
  • Excision of all or part of the trapezium.
  • Replacement of this bone with a tendon in the forearm.
  • Only one half of the tendon is used.
  • This removes the area of arthritis and the tendon acts as a cushion between the remaining bones.
  • Avoids use of artificial materials eg Silicone which can cause long-term problems in the body.
  • Hospital stay overnight.
  • General anaesthetic.
Incisions...
Problems
  • Rare – 90% patients very satisfied with the pain relief & restored use of the thumb.
  • Nerve irritation in the scar.
  • Infection
  • Prolonged recovery of pinch strength.

Other thumb joints may also require corrective surgery, which can be done at the same time without prolonging the recovery time.

Recovery Period
  • Plaster 6 weeks – the thumb is rested in a fibreglass cast for 6 weeks.
  • Removable splint for a further 4 – 6 weeks.
  • Strenuous activity is avoided for 3 months following the surgery.
  • Total recovery may take from 6 – 12 months following surgery, with a steady increase in strength, motion and comfort.
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