Thumb arthritis

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 different types of arthritis affect the thumb.

Inflammatory types of arthritis such as rheumatoid arthritis, psoriatic arthritis, gout, and pseudogout cause significant pain, swelling, and stiffness.

Often other joints are affected as well. Patients will have clinical evidence of a systemic inflammatory process.

The interphalangeal joint – the joint closest to the tip of the thumb- and the metacarpophalangeal joint- the next lower joint down- may be affected by most forms of inflammatory arthritis. In addition, osteoarthritis may also affect these joints. The thumb is rarely affected by itself. Usually other fingers are affected as well.

Arthritis at the joint at the base of the thumb is a frequent condition, which causes symptoms which can impair both strength and function of the hand.

The most common arthritis at the base of the thumb is osteoarthritis, also known as degenerative joint disease. It affects the basal joint at the base of the thumb, formed by the thumb metacarpal bone and a small wrist bone called the trapezium. The ends of these bones are ordinarily covered with cartilage, which acts as a cushion and allows them to move freely. Arthritis destroys the cartilage, causing the joint to become painfully inflamed.

Basal joint arthritis results in pain and restricted 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 first metacarpal connects to a small wrist bone - the trapezium - by forming a mobile joint known as the carpometacarpal or basal joint of the thumb. The joint at the base of the thumb is a very important joint - perhaps the most important joint when it comes to hand function.

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 muscles arranged around the first metacarpal, the joint at the base of the thumb can rotate in a wide arc - in and out of the palm of the hand. It is this movement that allows the thumb to oppose the fingers for pinching and grasping activities.

The stability of the carpometacarpal joint of the thumb relies on several small ligaments, which permit motion but keep the saddle-shaped joint stable. If the ligaments loosen enough to allow too much sliding of the joint surfaces, a wearing down of the joint cartilage may occur leading to arthritis. In time the joint surfaces will be destroyed and bony spurs develop around the joint making it painful.

Basal joint arthritis is caused by wear and tear on the joint at the base of the thumb sometimes occurring as the result of a fracture or injury. Repeated motions such as twisting, turning, or gripping objects with the thumb and fingers can worsen this condition.

In advanced cases, there may be complete destruction of the joint, an inward collapse of the metacarpal and arthritic deterioration of the trapezium.

Another condition is trigger thumb where the thumb will “catch” when bent or straightened. This is a form of tendonitis rather than arthritis.

Patients with arthritis at the base of the thumb usually first notice pain associated with pinching activities such as turning keys or opening car doors. Tenderness in the fleshy thumb muscle over the first metacarpal or on top of the basal joint may also be experienced and there may be an aching discomfort at the base of the thumb following use or with weather changes.

The patient will often avoid using the thumb for activities that induce pain and over time this disuse can lead to weakness, muscle loss and a tendency to drop things.

Swelling at the base of the thumb due to inflammation or fluid in the joint is observed and the joint may be prominent. Tenderness to pressure will be localized at the joint.

The examining physician may also use a diagnostic maneuver known as a "grind 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 during this maneuver indicate that arthritis is present.

X-rays will confirm the presence of and the severity of the condition.

In the early stages of arthritis at the base of the thumb, anti-inflammatory medication, cortisone injections 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 transient relief from the annoying symptoms of this condition.

It is important that the splints used for this condition extend well up on the thumb. Most commercially available, "drug-store" wrist splints leave the thumb free and may actually worsen the discomfort at the base joint. When these conservative methods of treatment are no longer beneficial to the patient, surgery may be warranted.

Arthroscopic debridement of the joint followed by the injection of viscosupplement (lubricant) has been used with success. For more information about this procedure, go to:

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