Basal joint arthritis
Basal joint arthritis of the thumb is a painful form of osteoarthritis that affects hand function, especially the use of the thumb in pinching and gripping. It is a very common cause of thumb pain in our community, particularly in the thumb of the dominant hand in women over 40 years of age.
Symptoms and Diagnosis
The symptoms of basal joint arthritis involve pain with thumb use - especially with pinching, opening jars, turning keys and twisting door handles. The diagnosis of basal joint arthritis is generally confirmed with an x-ray. The x-ray will show signs of osteoarthritis, with narrowing of the joint space, extra bone growths ("osteophytes") and changes in the quality of the bone on either side of the joint ("subchondral sclerosis" and cysts).
Non-surgical treatment including activity modification and splinting are strongly recommended in the first line treatment of basal joint arthritis. Some great joint protection tips to help prevent and minimise the pain of thumb arthritis are available here, and we strongly recommend that you see a hand therapist for further advice and to obtain a splint that you can wear to support your thumb. Regular paracetamol can also help to reduce your pain, as can corticosteroid injections to the joint. You may find that icing the joint helps, or that heat treatment helps. Many people find that their pain worsens during winter.
Surgical treatment options
Non-surgical treatment is not successful in managing the pain in all patients. If your pain is constant and unbearable despite attempts at non-surgical treatment then it is time to explore surgical treatment options.
The surgical treatment options include
- trapeziectomy (removal of the trapezium bone)
- trapeziectomy and suspension arthroplasty (removal of the trapezium bone with use of a tendon to support the remaining bones)
- resurfacing procedures, including joint replacement and the use of prostheses
- joint fusion ("arthrodesis")
- joint realignment
Dr Tomlinson will discuss these options with you at your appointment. Of all of these options, a trapeziectomy and suspension arthroplasty is our most commonly recommended surgical treatment.
Other prostheses that can be used in the treatment of basal joint arthritis include the Ascension PyroHemiSphere, Ascension NuGrip, Ascension PyroDisk, Ascension PyroCarbon Saddle CMC, Ascension PyroSphere, Elektra trapezio-metacarpal prosthesis with cup, Pi2 (Pyrocarbon Interposition Implant), CMI (CarpoMetacarpal Implant) and Pyrocardan (Trapeziometacarpal Interposition Implant).
Trapeziectomy and suspension arthroplasty
This operation provides durable, proven results. This is why we usually recommend it to patients instead of the many other surgical treatment options available. The surgery is performed in hospital under an anaesthetic. During the surgery one of the small wrist bones is removed (the "trapezium") and half of one of the tendons on the front of the wrist is used to create a sling to support the remaining thumb bones in position. Commonly a wire is then placed to stabilise the remaining bones in position for 4-6 weeks while the tissues heal. During this time you must wear a cast or splint. After this time you will begin to strengthen your hand and thumb under the care of a hand therapist. The aim is to allow you to resume most usual activities by 3 months after surgery and all usual activities 6 months after the surgery. The surgery generally provides good pain relief and has permanent results.
In this video Dr Stephen Trigg, an orthopaedic surgeon at the Mayo Clinic in Florida, discusses many of the non-surgical and surgical treatments of basal joint arthritis of the thumb:
To find out what treatment options we recommend for you please contact Melbourne Hand Surgery to arrange a consultation.
Corticosteroid injection for basal thumb arthritis
The video below is an educational video for general practitioners created by NSW Hand Surgeon Dr Stuart Myers showing the technique of injection for basal joint arthritis. There are two main difficulties in injecting this joint as an office procedure. The first is pain, the second is inability to place the needle within the joint space. Often in severe arthritis there is little or no joint space to inject within; in such circumstances it may be helpful for the injection to be performed by a radiologist, or in the operating theatre using x-ray control.