What is thumb arthritis?

Thumb arthritis, also known as basal joint arthritis, is the degeneration of the thumb joint at the base of the thumb metacarpal. Thumb arthritis is usually found in the trapezium/metacarpal joint (TMC), but it can be present in the joint below the TMC as well. It is the second most common form of arthritis in the hand, surpassed only by arthritis in the last joint of each finger.

Who gets thumb arthritis?

Basal joint arthritis of the thumb is extremely common. It usually occurs in women over the age of 45, or men over the age of 60. It can be isolated to the thumb alone or be present alongside other hand and/or wrist arthritis. Often, patients will present with a family history of arthritis. While the condition itself is not work-related, doing any job will be hard with thumb arthritis. While osteoarthritis is the biggest culprit, there are other conditions such as inflammatory arthritis that can affect the base of the thumb and cause the deterioration of that joint. In rare cases, an old fracture can lead to thumb arthritis.

What are the symptoms of thumb arthritis?

The most common symptom of thumb arthritis is pain at the junction of the thumb and the wrist, which is exacerbated by pinching, or flexing, those bones together. Many times there is deformity of the wrist, including loss of the web space between the thumb and index finger. Swelling and stiffness of the joint are also common symptoms of basal joint arthritis.

How do we treat thumb arthritis?

The name of the game in treating thumb arthritis is controlling pain and maximizing quality of life. Generally, thumb arthritis will progress for years before patients seek treatment. Furthermore, there is no prevention or preventative treatments one can undergo for arthritis. Additionally, there is no benefit to early surgical intervention. Once you have been diagnosed with basal joint arthritis, your initial treatment plan will likely consist of bracing and periodic steroid injections. There are no exercises that would help thumb arthritis, so physical therapy can do little to improve the condition.

When patients get to a point where bracing and steroid injections no longer help, surgical treatment can be very successful. The decision to operate is made by the patient. During the procedure for thumb arthritis, the trapezium bone is removed and a tendon is usually placed in the space that once held the trapezium. Any anatomical deformity is usually corrected at the time of surgery.  While it is an uncommon requirement, if a patient has a significant “Z” deformity it may necessitate a fusion of the joint above the site of surgery.

Following surgery, patients are seen every two weeks. They will usually go through a progression of smaller splints and increasing range of motion. At six weeks post-surgery, normal activities are allowed, but full grip strength can take longer to return to normal. At this point, supervised hand therapy may be required for optimal function.  Decisions on hand therapy are made post-operatively based on how well the hand and wrist are moving.

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