You might not realize how much you rely on your thumb until it hurts. A disabled thumb can translate into a 50 percent reduction in function for the entire arm. Imagine that—one digit hurts and it affects the whole limb.
One of the most common sources of thumb pain is thumb arthritis. Most people think about the hips and knees as areas most affected by arthritis, and they’re half right. While the knee joint is the most common site for arthritis, the hands are also a top site of arthritis. An analysis of a long-running study suggests that nearly half of women and more than a third of men will develop osteoarthritis of the hand.
Hand arthritis takes the form of thumb osteoarthritis in many people. Osteoarthritis is the most common type of arthritis. It’s often called wear-and-tear arthritis and happens when the cartilage that wraps the ends of bones starts to break down and wear away. In the thumb, this often happens to the two bones of the carpometacarpal (CMC) joint, where the thumb meets the hand. Other forms of arthritis that can affect the thumb include rheumatoid arthritis—an autoimmune disease that causes inflammation in joints—and post-traumatic arthritis, which happens after an injury.
Thumb Arthritis Symptoms and Causes
Thumb arthritis affects more women than men, and the risk of developing an arthritis condition in the thumb increases with age. It is generally an overuse injury—the more you use your thumb, the greater your likelihood to develop arthritis in the thumb. Thumb arthritis can also occur after an injury to the thumb.
Pain is the main symptom of thumb arthritis. It’s usually felt at the base of the thumb and gets worse when grasping something with your hand or trying to use your thumb and fingers to pinch an object. Other symptoms can include:
- Crepitus, a grinding sound when the thumb moves
- Decreased range of motion
- Redness or heat at the base of the thumb, especially in rheumatoid arthritis
- Swelling at the base of the thumb
- Weak grip
Any job or activity that requires heavy use of the thumb can put someone at risk for developing thumb arthritis. People over age 40 and those who are obese also have a greater likelihood of developing thumb arthritis.
Diagnosing Thumb Arthritis
The first step in treating thumb arthritis is figuring out what kind of arthritis it is. Arthritis is an umbrella term for more than 100 conditions, some of which are treated very differently than others.
I like to start with a medical history and a physical exam. I want to hear about any family history of arthritis, especially arthritis of the hand or thumb, as well as any hand or thumb injuries the patient has sustained recently. I’ll manipulate the thumb in various directions, looking for any signs or symptoms of arthritis. I’ll also be looking for swelling at the base of the thumb, or any bumps.
X-rays are routinely done leading to the diagnosis of thumb arthritis. While they don’t show soft tissue like cartilage, they can help me determine the cause of any thumb pain by showing bone spurs, which are created when bones rub against each other. Bone spurs indicate a lack of cartilage at the end of bones (that cartilage is called articular cartilage), which in turn signals the presence of osteoarthritis.
If osteoarthritis isn’t the culprit, I’ll move on to rheumatoid arthritis. There’s no one test to diagnose rheumatoid arthritis, but a variety of blood tests can tell me if there are elevated levels of inflammation in the body. The vast majority of thumb arthritis cases I see are either osteoarthritis or rheumatoid arthritis.
Thumb Arthritis Treatment
Like most of my colleagues at Summit Medical Group Orthopedics, I follow a conservative approach and philosophy for treatment—I don’t recommend surgery until we’ve exhausted other methods of treatment. Luckily for my patients with thumb arthritis, there are a variety of effective nonsurgical treatments.
To start I usually recommend nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs reduce inflammation, pain and swelling in the joints. Icing the thumb joint for 15 minutes a day can help as well.
A thumb brace for arthritis can be particularly useful. It will keep the patient’s thumb from moving around too much, reducing pain and disability. A thumb brace for arthritis can be either hard or soft. I tell my patients to wear them during the day as needed, and sometimes overnight to keep the thumb from causing pain and waking my patients up as they sleep.
Corticosteroid injections can be effective as well, especially for rheumatoid arthritis. Corticosteroids are powerful anti-inflammatories that can help decrease pain. Physical therapy can also be useful in increasing range of motion and strengthening the muscles of the hand.
If conservative methods of treatment prove ineffective, there are a variety of surgical options available. The type of surgical treatment is determined based on the severity of the arthritis.
For more severe cases, the most common surgical procedure is a ligament reconstruction tendon interposition arthroplasty. This is done by removing a small bone from the hand called the trapezium, then using a tendon from the wrist to reconstruct the ligaments that stabilize the CMC joint of the thumb.
For less severe arthritis, I can often clear out some of the worn bone in a process called debridement. This can usually be done arthroscopically, meaning with small tools, comparatively small incisions and a camera called an arthroscope attached to a video monitor.
In very young patients, CMC arthritis can develop after a traumatic injury. When this happens, fusing bones in the CMC joint so that they move less and reduce pain can be a viable treatment option.
Thumb arthritis is painful and can limit your activities, but there are a variety of treatments available. If you have thumb pain, request an appointment with me. Together we’ll determine the cause of your thumb pain and develop a treatment plan that’s right for you.