Osteoarthritis of the Hand
Tips to help you prevent and treat thumb pain
When many people think of arthritis, knees or hips come to mind. However, 1 in 4 women will experience osteoarthritis at the base of the thumb.
Osteoarthritis can affect quality of life, but those who experience it do not have to suffer in silence, said Victoria Bruegel, MD, an orthopedic surgeon at Southcoast Physicians Group hand surgery practice.
Dr. Bruegel said osteoarthritis of the basal joint, also called the carpometacarpal joint (CMC) of the thumb is caused when the cartilage covering the ends of the bone wears out. This results in direct contact between the bones at the joint producing pain and deformity. The pain can be aggravated by every-day activities such as opening a water bottle, pinching a clutch handbag or turning a door handle. When it comes to thumbs, “There’s an extraordinary amount of force across a very small joint space,” Dr. Bruegel said.
The exact cause of basal joint arthritis is unknown, however, previous trauma such as fractures or dislocations or genetic predisposition can contribute to early degenerative changes. While men suffer from osteoporosis, it is more common in women, starting at the age of 40 and increasing during the post menopausal years.
Pain and soreness may initially be activity-related. “But as the arthritis progresses, some people will develop pain that is present all the time,” Dr. Bruegel said.
About 75 percent of women over 70 will suffer some pain or limited motion associated with arthritis of the thumb. “It’s quite prevalent,” Dr. Bruegel said. “Many women think it’s just a normal part of aging and nothing can be done for it, but there are a number of treatment options. You don’t have to suffer with it.”
Dr. Bruegel said patients can start with simple things, such as modifying activity. “We try to educate people to avoid using a repetitive pinch, for example,” she said. (See related sidebar for examples
“The second thing we might do is recommend the patient use a simple thumb splint during activities,” she said. “One that provides just enough support to limit the bone on bone contact.”
The diagnosis is made by patient provided history and a physical exam. An X-ray can help the doctor see where any degenerative changes are happening, although severity of symptoms does not always correlate with the changes noted on the imaging.
Also, over-the-counter anti-inflammatory medication may help, although Dr. Bruegel says to always check with your primary care doctor before taking any medications.
“If things progress in terms of pain and functional limitations, a cortisone injection to the joint may be offered,” Dr. Bruegel said. “It’s an anti-inflammatory that’s directed right to the joint, and many times that gives a great deal of relief to people.”
“If they’ve done all of the conservative things and are still having pain, then we talk about performing a surgery to eliminate or reduce the pain,” Dr. Bruegel said.
Surgery can provide immediate relief, but patients will require post operative therapy to regain their strength.