Osteoarthritis

What is Osteoarthritis?

If you have pain around the bottom of your thumb, you may have osteoarthritis. The thumb is one of the most common places to develop arthritis in the arm and hand. Arthritis happens when a joint loses its cartilage coating and starts rubbing bone on bone. This causes irritation, inflammation and subsequent pain.

Who Gets Thumb Arthritis?

Arthritis of the thumb and hand are most common in women and the elderly. Symptoms can start in forty-year-olds, but is more common in people over fifty. Women develop thumb arthritis twice as often as men. Sometimes, trauma can lead to arthritis starting at an earlier age.

What are Symptoms of Thumb Arthritis?

Symptoms can occur gradually over time or can start quickly after trauma or overuse. Patients will complain of pain in and around the base of their thumb. Frequently there is swelling and the appearance of an enlarged thumb joint. The pain is often a constant ache, but can have episodes of quick sudden pain. Activities that cause repetitive use or grasping can increase pain, such as weeding your garden, writing, knitting, and/or opening jars or doors. Cold weather can also increase symptoms.

What Can You Expect at Your Doctor’s Visit?

The doctor will take a history in order to determine several things; where and how long the pain has been there, what makes it worse, and what you’ve done for treatment. They will look for swelling or deformity. They will feel around the hand and wrist trying to pinpoint the exact area of pain. Often the doctor will compress the joint to try and reproduce what the thumb does when grasping. If pain is produced, it helps zero in on the diagnosis. Often times, x-rays are ordered to confirm the diagnosis and gauge the severity. Other tests like MRI’s, CT’s, or ultrasound are rarely needed. Other issues such as tendinitis, wrist arthritis, or ganglion cysts can mimic thumb arthritis.

Non-Operative Treatment

1. Anti-inflammatories (Advil or Aleve) can help relieve some of the pain and irritation resulting from the bones rubbing on each other.
2. Topical anti-inflammatory creams can lessen symptoms and might be useful for people who can’t take oral anti-inflammatories.
3. Modifying activities can lessen symptoms. Try to changing how you use the thumb: using a different mouse on the computer or switching it to the other side, using thicker pens when writing, or using the other hand more often when doing grasping activities like weeding the garden.
4. Braces help modify activities to help support or immobilize the thumb, which can lessen pain.
   Cortisone shots directly into the joint can deliver a more direct anti-inflammatory effect.

Operative Treatment

Surgery is reserved for people that have failed conservative treatment and believe the pain is significant enough to undergo an operation. Non-operative treatment does not cure arthritis, but is an attempt to lessen the symptoms. Surgery should be considered when the pain is so severe that it is not bearable nor lessened enough with conservative treatments. Surgery is designed to eliminate the rubbing of the bones that is caused by arthritis.

1. The most common surgery has many variations. However, the main idea is to remove a small bone at the base of the thumb. In doing so the rubbing is eliminated and the pain improves. Once the bone is removed, there are various ways to fill the gap left by the missing bone, often using a tendon. This surgery has been the gold standard for years; it is reliable, and has positive long term outcomes. This is an outpatient surgery performed under general anesthesia. After surgery, the patient is immobilized in a cast then transitioned to a brace. Therapy is often prescribed to work on range of motion and strength. It is approximately 3-4 months before returning to unrestricted activities.
2. Another surgical approach is to fuse the two bones that are rubbing together into one bone (arthrodesis). This surgery gives a very stable base to pinch from, but some motion is lost. This surgery is usually reserved for younger patients that have traumatic arthritis, and is also an outpatient surgery. The thumb is immobilized until the bones are fused (typically 6-8 weeks).
3. There are some additional options for younger people that show significant symptoms, but still have reasonable cartilage. One surgery changes the position of one of the bones (extension osteotomy) so the joint is more stable. Another surgery uses soft tissue to help stabilize the joint, making the thumb more stable during pinching activities.
4. For years, many companies have been trying to make artificial thumb joints. There have been many failures of these implants. The jury is still out whether an implant will ever become the standard of care, but to date no implant has been shown to be superior to the first option above. Often when these implants fail, the patient needs a revision surgery that is the same as option one.

The decision between operative and non-operative treatment is entirely up to the patient. The patient has to decide if their pain is to the point that it is worth undergoing surgery. If surgery is chosen, your surgeon will discuss the best surgical treatment option.