by Nathan Wei, MD, FACP, FACR
Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.
Click here: Second Opinion Arthritis Treatment Kit
Many types of arthritis affect the thumb.
Inflammatory types of arthritis such as rheumatoid arthritis and psoriatic arthritis cause significant pain, swelling, and stiffness. The swelling involves joints and tendons. This combination can make the thumb look like a sausage and it is often referred to as a "sausage" digit.
Often other fingers or toes are affected as well. Patients will have clinical evidence of a systemic inflammatory process.
Osteoarthritis at the base of the thumb- the carpometacarpophalangeal joint- is a frequent condition, which causes pain and which can impair both strength and function of the hand.
It affects the basal joint at the base of the thumb, formed by the thumb metacarpal bone and the trapezium in the wrist. The bottom of the thumb metacarpal is rounded and interacts with the saddle shaped trapezium. The unique shapes of the surfaces of the two bones that form this joint permit the thumb to have a wide range of motion.
The ends of these bones are covered with a layer of cartilage, which acts as a cushion. Arthritis destroys the cartilage, causing the joint to become inflamed.
Basal joint arthritis results in pain and restricts movement of the thumb across the palm. Far more common among women than men, it typically occurs after the age of forty. Both thumbs may be affected.
The stability of the carpometacarpal joint of the thumb is due to several ligaments, which allow motion but keep the joint surfaces congruent. If the ligaments loosen enough to allow too much sliding of the joint surfaces, arthritis is the end result.
As the disease progresses and more joint cartilage is lost, less stress on the thumb is necessary to produce pain. The patient will often avoid using the thumb for those activities that produce pain and over time this disuse can lead to weakness, muscle loss and a tendency to drop things.
In advanced cases, there may be complete destruction of the joint.
Not all thumb pain is due to arthritis. Tendonitis involving the extensor and abductor tendons of the thumb can cause a condition known as "DeQuervain's disease. This condition must be distinguished from arthritis involving the basal thumb joint.
Another condition is trigger thumb where the thumb will “catch” when bent or straightened. This is a form of tendonitis rather than arthritis.
Examination of the wrist and hand along with the patient's history and x-rays will reveal the diagnosis. Tenderness on pressure by the examiners' finger will be localized over and around the joint.
The physician may also use a diagnostic maneuver known as a "grind test" or "torque test" to determine if arthritis exists at the base joint of the thumb. In this test, the first metacarpal is grasped, pushed downward and rotated. Pain and a crunching or gritty sensation indicate that arthritis is present.
In the early stages, anti-inflammatory medication, cortisone injection into the joint, or splinting of the wrist and thumb may be helpful. Splints will put the thumb at rest and prevent the arthritic joint from moving. This may provide relief from the symptoms.
It is important that the splints used for this condition extend far up on the thumb. Most "drug-store" wrist splints leave the thumb free and don't help the condition.
Arthroscopic debridement of the joint followed by the injection of viscosupplement (lubricant) has been used with success. The advantage of this procedure is that it is minimally invasive compared with other surgical procedures. Injection of platelet-rich plasma (PRP) has been claimed to be useful. Arthroscopic debridement followed by autologous stem cell implantation may be effective.
When these conservative methods of treatment no longer work, surgery may be needed. The procedure is referred to as an arthroplasty.
Most techniques involve the removal of the trapezium. The space created by removing the trapezium will be filled with tendon material from the forearm.
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