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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

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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

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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

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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

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  • 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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