Arthritis in the thumb
Have you ever had sore, achy thumbs after a morning of gardening or tennis? Have you ever felt that your grip and ability to pinch was becoming weaker? Do you ever have pain around the base of your thumbs, even when you’re not using your hands (possibly while trying to fall asleep)? If you answered yes to any of these questions, you might suffer from arthritis at the base of the thumb.
Arthritis at the base of the thumb is the second most common type of arthritis in the hands. It can affect anyone, whether you’ve had other types of arthritis or not.
In a normal healthy joint, bones are covered by cartilage. This allows the bones to move smoothly and comfortably with one another, with very little friction. In an arthritic joint, however, this process breaks down, and cartilage can become irregular and worn out. Often, this results in an inflamed, stiff and painful joint. In the most advanced cases, the cartilage can be completely destroyed, and bones grind together painfully. You may have heard this condition referred to as "bone-on-bone arthritis."
Arthritis at the base of the thumb most often occurs in the carpometacarpal (CMC) joint. This is where the bones of the thumb meet the bones of the wrist. The shape of this joint allows the wide range of motion that is essential for a well-functioning thumb and hand.
An arthritic CMC joint can cause pain and difficulty with any type of gripping or pinching tasks, from turning a key to wringing out a washcloth or trying to open a jar. The earliest and most common symptom of this type of arthritis is pain at the base of the thumb with these types of activity. As the joint becomes more arthritic, a person may notice a decreasing range of motion with the thumb and increasing swelling and weakness. Often, the arthritic joint will become more painful with activity, but also painful at rest. Sometimes, the joint will catch or grind painfully, as bony surfaces with worn-out cartilage rub against one another.
In addition to a patient’s history, there are two essential components to diagnosing CMC arthritis: the physical exam and X-rays. Usually, swelling, tenderness and some deformity can be found on physical exam. There are also certain maneuvers a physician may perform to help determine if a patient’s pain is coming from the CMC joint, rather than one of the other nearby structures in the hand.
Typically, X-rays will reveal a narrowed space between the bones of the joint where the cartilage has worn out, allowing the bones to creep closer together. There also may be some misalignment of the joint and bone spurs apparent on the X-rays. It is very important to understand that the joint’s appearance on X-ray does not always match the patient’s pain or impairment. Thus, the patient’s symptoms are the most important factor in determining appropriate treatment.
There are numerous options for patients whose CMC joint pain and dysfunction require treatment. As a first step, activity modification, or changing the way certain jobs are performed, may decrease the forces on the arthritic joint and make it less painful. Many times a supportive brace will allow a person to perform normal routine tasks in relative comfort. When bracing and or activity modification are not enough, an injection of cortisone into the arthritic joint often will give excellent pain relief for many months.
When non-surgical treatments are unable to provide adequate pain relief, it may be time to discuss surgical options. CMC joint surgery very dependably results in pain relief without significantly altering the function of the thumb.
The bad news is that CMC arthritis is a relatively common condition and often can result in significant pain with everyday tasks. The good news is that there are many treatments available, and the vast majority of patients can return to pain-free use of their hands and thumbs. If you have noticed pain, swelling or stiffness in your hands, or struggle with tasks that used to be routine, contact your physician for an appointment and start on the road to recovery.
About the Author
Dr. Stephen Hoover is an orthopedic surgeon specializing in the hand and wrist with Sentara Martha Jefferson Orthopedic Services.