Surgery Treatment for Thumb Arthritis

Arthritis of the thumb is a common form of arthritis affecting adults. The joint most commonly involved is at the base of the thumb metacarpal, the carpo-metacarpal joint (CMC joint). Women are more commonly affected than men. The usual age of onset is 45 to 55 years old.

Paitients with thumb CMC joint arthritis will complain of a stabbing, aching pain at the base of the thumb. It is usually worse with forceful pinch or grasp. The patient will have difficulty turning a key in a door, pulling up his/her pants, or lifting a heavy object such as a large bottle in the refrigerator. The joint may become stiff, which will make it difficult to grasp large objects. The swelling at the CMC joint is sometims mistook for a tumor. Sometimes, the metacarpal bone slips slightly out of joint, which causes more swelling. Some patients are incorrectly told by a physician that they fractured or dislocated the joint, when it just arthritis. Thumb CMC joint arthritis can co-exist with other conditions. Your doctor will evaluate you for conditions such as a trigger thumb, DeQuervain’s tenosynovitis, wrist arthritis, or carpal tunnel syndrome.

The usual first-line treatment involves rest, NSAIDs, splinting, and warm soaks. Occasionally cortisone injections are used. The injections usually provide only short-term relief, usually 2-4 months. There is generally not much use for hand therapy.

The patient is managed non-operatively as long as possible. Surgery is simple and effective, but it requires 3-6 months for complete recovery. The surgery is usually done as an outpatient, either under general or regional anaesthesia. The procedure involves removing one of the arthritic bones (the trapezium) and creating a new joint. I do this by temporarily pinning the thumb metacarpal to an adjacent bone. The space formerly occupied by the trapezium fills in with soft scar tissue. The patient is maintained in a cast for 6 weeks. The pins are removed in the office, and the patient is usually started on hand therapy at that point. Most patients are feeling better by 3 months after surgery, but recovery can take as long as 6 months.

More information is available at Surgery Treatment for Thumb Arthritis.

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