Osteoarthritis of THE Base of the Thumb

 

What is it?

The joint at the base of thumb, known as the 1st carpometacarpal joint, allows the swivelling motions of the thumb. In a normal joint, cartilage covers the ends of the bones and allows them to move smoothly and painlessly. In an osteoarthritic joint the cartilage wears out and the bone ends rub against each other. This causes pain at the base of the thumb, especially during pinching and gripping movements (such as opening jars or turning keys in a lock).

  
What has caused it?

This joint is particularly at risk of wear and tear during normal hand use. You may have a genetic predisposition to developing osteoarthrosis at this and other joints of your body. Past injuries to this joint may also increase your risk of developing it.     


How is it diagnosed?

Mr Miller will ask you some questions about your symptoms and examine your hands. He will usually organise an x-ray unless one has recently been taken. 


What is the treatment?

Initially, the symptoms can be alleviated by rest but if the symptoms progress, anti-inflammatory medication (tablets, cream or injection), exercises (including patient-performed distraction of the thumb) or a protective splint may help to ease the pain.

There are several operations Mr Miller advocates that are usually helpful in relieving symptoms:

  • Trapeziectomy - the small bone, the trapezium, at the base of the thumb is removed;
  • Denervation - the small nerves surrounding the joint are carefully divided, so that they cannot cause pain.

 

How successful is the treatment?

Non-surgical treatment using splints, tablets or injections can be very helpful for many patients with osteoarthritis of the base of the thumb. If the condition progresses and affects your quality-of-life, surgery may be required. The best operation depends on the particular circumstances of each case. Mr Miller will advise you which options would be best for you and the advantages and disadvantages of each surgical option. 


What are the risks and benefits of surgery?

The operations described are very successful in reducing pain and improving use of the thumb, which is a very important part of the hand. However, it may be up to 6 months before you feel you can use your thumb normally again. A small percentage of patients (1% or less) will develop a severe reaction after hand surgery (called CRPS), with long-standing pain and loss of use in the hand which is something that is difficult to treat. If you are concerned about any of these risks, or have any further queries, please speak to Mr Miller. 

When will I be able to drive after the operation?

 Surgery for osteoarthritis at the base of the thumb means you will be unable to drive for around 3-6 weeks.    

 
How long will I be off work?

Depending on the type of work you do (manual versus office type work), and whether your dominant hand is involved, you may be off work for 6 weeks to 3 months after surgery.