Arthritis At The
Base Of The Thumb
- A common problem
- Often no cause is found
- Middle-aged women
- Previous thumb fractures
- Family history of arthritis
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.
- Activity restriction
- Tablets - beware of stomach upset
- Always take with food
- Creams - e.g. Voltaren Gel
- Removable splint made by a Hand Therapist.
- Rigid and therefore somewhat restrictive but provides support for the thumb when doing heavy activities.
- 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.
- 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.
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.
- Rare - 90% patients very satisfied with the pain relief & restored use of the thumb.
- Nerve irritation in the scar.
- 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.
- 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.