Thumb (Basal Joint) Arthritis

Thumb arthritis, specifically at the basal joint or carpometacarpal (CMC) joint, is a common condition characterized by the wearing away of cartilage in the joint at the base of the thumb where the metacarpal bone connects with the trapezium bone of the wrist.

This joint is crucial for thumb movement and is susceptible to wear and tear due to its frequent use. As the cartilage deteriorates, it can lead to pain, stiffness, and decreased grip strength.

The carpometacarpal (CMC) joint is crucial for thumb movement and dexterity due to its high degree of mobility. This joint allows for flexion/extension, abduction/adduction, and rotation, enabling the thumb to oppose and interact with the other fingers. However, this mobility also makes the joint susceptible to instability and degeneration from overuse, leading to ligament laxity and cartilage wear.

Due to its constant use and complex movements, the CMC joint is susceptible to degenerative changes over time. As the joint ages, the cartilage, which normally provides a smooth gliding surface for the bones, can wear down.

The loss of cartilage leads to increased friction between the bones, causing pain, stiffness, and further damage to the joint surfaces. Since the thumb is crucial for many hand movements, individuals with thumb basal joint arthritis experience significant challenges in performing everyday activities.

Thumb arthritis, specifically at the basal joint, can arise from a combination of factors. Some of the most common ones are the following:

1. Age and Sex:

• Thumb arthritis is more common in women over 45.
• The prevalence increases with age.

2. Metabolic Factors:

• Conditions like menopause and obesity are linked to an increased risk.
• Menopause may affect cartilage health.
• Obesity can put extra stress on joints.

3. Genetic Predisposition:

• Some individuals inherit a predisposition to osteoarthritis.
• This may manifest as joint laxity or poorly formed joints.

4. Injuries and Repetitive Strain:

• Past injuries like fractures or sprains can damage the joint and increase the likelihood of arthritis.
• Repetitive strain from work or activities can wear down the cartilage.

5. Inflammatory Diseases:

• Rheumatoid arthritis, an inflammatory disease, can affect the thumb joint.
• This inflammation can damage the cartilage.

Pain is the first and most common symptom of thumb arthritis. Pain can occur at the base of your thumb when you grip, grasp or pinch an object, or use your thumb to apply force.

Other signs and symptoms might include:

• Swelling, stiffness and tenderness at the base of your thumb.
• Decreased strength when pinching or grasping objects.
• Reducedrange of motion.
• Enlarged or bony appearance of the joint at the base of your thumb.
• Creaking or cracking sensations with thumb or hand movement.
• Deformed thumb joints if the condition progresses to a later stage.
• Potential night pain: Pain may occur at night.
• Worsening with weather changes: Symptoms may be exacerbated by changes in weather conditions.
• Increased pain: Pain becomes more intense and may radiate to the wrist or palm.
• Subluxation (Partial Dislocation): The joint may partially dislocate, causing further instability and pain.

Thumb arthritis treatment varies based on the severity of your symptoms. If you have mild symptoms, a healthcare provider may recommend at-home treatments like:

• Applying ice and/or placing a heating pad on your thumb joint for five to 15 minutes a few times a day (try both options to see what works best for you)
• Taking pain medication like nonsteroidal anti-inflammatory drugs (NSAIDs)
• Wearing a splint to protect your thumb joint and let it rest (you can wear a splint from time to time during the day or overnight)

Your orthopedic surgeon may recommend steroid injections if your symptoms are severe or get worse. He will inject a steroid solution into your thumb joint. This typically provides pain relief for several months. But injections become less effective over time. At that point, he may recommend surgery.

There are various surgical options for managing the condition.

The most common surgical options include:

• Arthroplasty (Joint Replacement): Arthroplasty involves removing all or part of your thumb joint and replacing it with an artificial implant.
• Denervation: This procedure doesn’t directly change the joint. It removes pain signals coming from the nerve ending, which relays back to your brain.
• Fusion (Arthrodesis): Arthrodesis fuses the bones of your thumb joint together. This procedure could reduce pain and increase strength, but it may limit movement.
• Ligament Reconstruction and Tendon Interposition (LRTI): LRTI involves removing all or part of your thumb joint and suspending the rest of your thumb using a tendon from your wrist. This procedure may reduce pain while allowing continued movement.
• Trapeziectomy with Suspensionplasty: This procedure removes part of your thumb joint and suspends your thumb using nearby tendons or sutures. It may reduce pain while allowing motion.

Dr. Panagiotis Pantos is a specialist Orthopedic – Upper Limb surgeon with extensive clinical and research experience in upper limb conditions and sports injuries. He offers personalized treatment plans tailored to the specific needs of each patient, ensuring a careful and responsible approach to care.

He is the Director of the Orthopedic Clinic, Upper Limb Surgery Department, at the Athens Medical Group (AMG) and the Scientific Director and Head of the Upper Limb and Sports Injuries departments at “OSTEON” Orthopedic & Spine Clinic. He holds a PhD from the Medical School of the National and Kapodistrian University of Athens (EKPA).

Please, contact the doctor to schedule an appointment and learn more about how he can give you a safe and effective solution to your problem.