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Thumb Arthritis

Definition


Disease: Thumb Arthritis Thumb Arthritis
Category: Bones, joints, muscles diseases
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Disease Definition:

When osteoarthritis develops in the joint at the wrist and the base of the thumb (the basal, or carpometacarpal (CMC), joint), it is a condition called thumb arthritis or basal joint arthritis.

This condition may lead to difficulties in performing daily tasks such are turning door knobs, decreased strength and range of motion, pain and swelling.

While severe cases need surgery, less intense cases are treated by splints, medications or corticosteroid injections.

Work Group:


Prepared by: Scientific Section

Symptoms, Causes

Symptoms:

People with thumb arthritis initially experience pain at the base of the thumb when their hand is in use. In later stages, pain is felt even if the thumb is not in use. Activities that may be painful include applying force such as when turning a key, pulling a zipper or opening a jar; grasping; gripping, which applies the most force to this joint; and pinching an object between the thumb and forefinger.

Some of the other signs and symptoms of thumb arthritis may be:

 

  • Pain at the base of the thumb along with tenderness, swelling and stiffness
  • Failing to apply the required force when grasping or pinching
  • Decreased range of motion
  • Disfigurement at the base of the thumb


Symptoms are proportional to the severity of the case and the working habits of the patient.

Causes:

While the exact cause of thumb arthritis as with all cases of osteoarthritis is yet unknown, some factors may increase the risk of its occurrence; these include aging, obesity, family history, joint injury or stress, muscle weakness and recursive stress injury to the joint.

The basal joint is the one granting the thumb its wide range of movement and it consists of a small bone at the base of the thumb called trapezium, the first bone of the thumb called the first metacarpal, and the scaphotrapezio-trapezoidal joint in the wrist.

In the case of thumb arthritis, the cartilage that cushions and covers the joints and grants their smooth relative glide deteriorates and its smooth surface roughens, causing joint damage due to friction. As a reaction, the body starts a repair process, but when the repair is inadequate, the condition deteriorates, leading to bone growth beside the existing ones (bone spurs), forming lumps at the joint.

Factors that increase the risk of thumb arthritis include:

 

  • Being older than 40 years
  • Being a woman
  • Having a family history of joint ligament laxity and malformed joints
  • Prior injury to the basal joint, such as fractures and sprains
  • Diseases that alter the normal function and structure of cartilage, such as rheumatoid arthritis
  • Certain activities and jobs that put high stress on this joint

Complications

Complications:

None

Treatments:

Treatment is carried out for:

 

  • Pain relieve
  • Motion range improvement
  • Disability reduction


When diagnosed in its early stages, treatment may be sufficient with activity modification, splints, self-care measures,  medications and physical therapy. In severe case, surgery may not be avoided.

SPLINTS:
These are worn during the day or night according to the needs of the patient. Splints are used to support the joint, reduce pain and movement, and hold the joint in a comfortable position.

A physician or a specialized hand therapist can decide the type of the splint needed for each case, since there is a large variety of them, according to material (fabric or plastic), and form. Splints are available in some drugstores or medical supply stores, or can be custom made to fit the needs of each patient.

MEDICATIONS:
Joint pain is treated with acetaminophen, which has more tolerable side effects than other painkillers. Nonsteroidal anti-inflammatory drugs (NSAIDs), which can be found in some over-the-counter medications like naproxen and ibuprofen, relieve pain and reduce the inflammation. Diclofenac, nabumetone and ketoprofen are other prescription-strength NSAIDs.

NSAIDs may cause side effects especially when used for a long period of time. These side effects may include gastrointestinal bleeding, liver and kidney damage, gastric ulcers, ringing in the ears and cardiovascular problems.

INJECTIONS:
If all previously mentioned treatments fail, a physician may opt for long-acting corticosteroid injections in the basal joint to reduce inflammation and relieve pain for a relatively short period of time, since further joint damage may result from longer usage.

SURGERY:
Arthroscopy is recommended when all other means have failed to treat thumb arthritis. It involves making a small incision on the joint area to insert an arthroscope, which contains a camera and a light source to transmit the images of the joint interior to a monitor. Upon the physician's decision about the procedure, surgical tools are inserted through the arthroscope or through another small incision.

After the information retrieval phase by arthroscopy, the patient’s history and exams, a surgeon may opt for one of the listed procedures:

Joint fusion (arthrodesis):
In arthrodesis, surgeons permanently fuse bones in a joint to increase stability and reduce pain. The fused joint can then bear weight without pain, but has no flexibility.

Osteotomy:
In the case of disfigurement, a surgeon tends to re-shape the deformed bones, correcting their position. This procedure is also called bone cutting.

Trapeziectomy:
This procedure involves the removal of the trapezium bone that is located adjacent to the joint.

Joint replacement (arthroplasty):
In arthroplasty, partial or complete removal of the joint is carried out, replacing it with a graft from one of the tendons. Plastic or metallic prostheses are being developed as replacement of damaged joints, but until now soft tissue replacement is prevalent.

In these procedures, the patient returns home the same day of the operation, after putting the joint in a cast or a splint for up to six weeks. After that, the patient is aided to regain normal function of the joint through a slowly progressing physical therapy, which may restore joint function within six months.

Prognosis:

Not Available

Expert's opinion

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