Mr Andrew Smith, Consultant Orthopaedic Hand & Wrist Surgeon at One Ashford Hospital discusses arthritis at the base of the thumb, symptoms and how it is best treatment.
Arthritis at the base of the thumb is extremely common. The condition is more common in women than men and more common as we get older, it is uncommon in people younger than 50 years of age. Approximately one third of post-menopausal women will have X-ray changes of arthritis at the base of their thumb and approximately one third of these women will experience pain from that joint. The problem also occurs in men but less commonly, for reasons that are unclear.
The pain associated with thumb base arthritis can be a minor inconvenience in some, and significant in others causing difficulty with hand use.
How is thumb base arthritis treated?
This does depend on the severity and functional impairment. Initial non-surgical measures include; pain killers and/or anti-inflammatory medication, activity modification, specialist hand physiotherapy and splinting. The majority of people will find these methods helpful. If these interventions have not settled the discomfort at the base of the thumb, consideration should be given to an intra-articular steroid injection. In some studies up to 2/3 of patients avoided surgery in the following 2 years after implementation of non-surgical treatment. Normally 3-6 months of non-surgical treatment is recommended prior to considering surgery options.
A wide range of surgical options for treating thumb base arthritis are available, from denervation through to total joint replacements. The mainstay of surgical treatment is Trapeziectomy. In this procedure the trapezium is removed, producing a false/scar tissue joint at the base of the thumb metacarpal. This is a widely performed procedure and works well in the vast majority of people, with 80-90% having good results. This surgery is done as a day case procedure under either a short general anaesthetic or a peripheral nerve block anaesthetic [awake]. The thumb is supported in a thermoplastic splint for about six weeks, with input from the Hand Therapy team.
Trapeziectomy isn’t always the best option as joint fusion, resurfacing joint replacement or total joint replacement may be better options which can be discussed.