What is Thumb Base Arthritis?
Pain at the base of the thumb is often a sign of arthritis, or degeneration of the cartilage in your thumb joints. Arthritis is a one-way process of wearing away of the cartilage on the ends of your bones. Think of it like a car tire: you start off with lots of tread on your tires, but as you drive more and more, the tread wears away. Similarly, over the course of our lives with all of our activities, the thick cartilage on our bones can wear away. Unfortunately, we don't have a great way of putting cartilage back on bones, so we do our best to manage symptoms or surgically replace joints.
Symptoms of Thumb Arthritis
Pain at the base of your thumb, close to the wrist, is the most common sign of arthritis. As the arthritis progresses, you can develop a bump on the side of your wrist at the bottom of your thumb bones. This happens as the ligaments around your thumb joints become weaker. The other joints of your thumb may also start to become extremely flexible and begin to hyperextend. All of these problems contribute to the loss of pinch and grip strength and worsening pain.
How is Thumb Arthritis Treated?
When we start to get pain in our hands, we naturally tend to avoid the things that make it hurt. This activity modification is helpful to relieve early or mild symptoms, but when you can't do the things you need to do every day, more aggressive treatment is necessary.
Adding over-the-counter anti-inflammatory medications (NSAIDs) like ibuprofen (Motrin) or naproxen (Alleve), can often improve symptoms in people who are able to take these medications. Check with your primary care provider if these medications are safe for you.
Splinting or bracing of the thumb is the next step. Stiff braces can often effectively improve pain, but this comes at the expense of motion. Soft braces made of neoprene can help improve symptoms somewhat while still allowing some thumb motion, but often are not as effective as the stiff braces. Dr. Illing can help determine the best brace for you and your activity level, and get you back to your daily life.
When splinting doesn't help your symptoms enough, Dr. Illing will often recommend a steroid injection into your thumb joint. This quick, in-office procedure can often improve symptoms for 3-6 or more months at a time. These injections can be repeated every 3 months as long as you continue to get benefit from them.
But Isn't This Just Masking The Symptoms?
Unfortunately, as described above, arthritis is a one-way road. NSAIDs, bracing, and steroid injections, improve arthritis symptoms, but unfortunately can't put cartilage back on the ends of your joints. For mild or moderate pain, treatments that control your symptoms but may not directly address the arthritis itself are our first-line recommendations. This is because surgery comes with risks, surgical discomfort, and down time for post-operative rehabilitation.
So What is Thumb Arthritis Surgery?
If non-surgical treatments fail to improve your symptoms, Dr. Illing will talk with you about surgery for your thumb arthritis. Typically, this involves removing the arthritic wrist bone, the trapezium, through a small incision on your wrist. Once the trapezium is removed, a procedure called a "suspensionplasty" or LRTI (Ligament Reconstruction and Tendon Interposition) is performed to reposition your thumb for optimal function.
Surgery is outpatient, meaning you go home after surgery, and typically takes about 60-90 minutes. After surgery, you will be in a splint for two weeks until you are seen in clinic, where your hand will be placed into a cast for another three weeks. Once the cast is removed, a custom removable brace will be made by our in-office hand therapist and you will start regaining your motion and strength in your thumb over the next 4-6 weeks.
While the post-operative rehab process is intensive, this surgery is very successful at improving thumb arthritis pain and improving the function of your hand.
Do You Have Thumb Arthritis Pain?
If you have pain in your thumb, book a consultation with Dr. Illing to come up with a treatment plan that works for you and gets you back to the activities you love!