Going from Thumb Pain to Thumbs Up

Practically everything we do involves our thumbs: pulling on pants, holding our coffee mug, gripping the steering wheel, or turning a key. So thumb pain can really make everyday activities more difficult. The most common cause of thumb pain is basal joint arthritis.

Arthritis, especially that in the hands, appears to run in families. Women are more likely to develop osteoarthritis in the hands than men. It is more common among those over age 40 and those who do jobs or activities that require repetitive pinching or gripping activities like factory work and sewing.

Just like other types of osteoarthritis, basal joint arthritis occurs when the cartilage buffer between the joints is worn away. Bone rubs on bone, and it can be painful. It can also be caused by an injury to the thumb. Symptoms include swelling, stiffness, decreased strength, decreased range of motion, and pain. The thumb can appear “out of joint” or subluxated. The pain can be constant or brought on by use. Limiting use can cause a decrease in muscle around the base of the thumb.

There are lots of non-surgical treatments to try, including resting the joint, ice, heat, topical ointments, and anti-inflammatory medications. Patients may find bracing helpful or using products that are designed to be more ergonomic, like fat pens and jar grippers. Some patients find massage, acupuncture, and paraffin wax therapy helpful as well.

If they have tried the other options, patients can consult their primary care physician for a referral to a hand surgeon to evaluate and treat the joint. The surgeon may be able to diagnose with a simple physical exam or may need an x-ray. These steps are important because they help rule out the other potential causes for the pain.

Steroid injections into the thumb basal joint can provide lasting relief for many patients with mild or moderate arthritis.  If all else fails and the pain is still severe, the patient can opt for surgery. The most common surgery for thumb basal joint arthritis is a CMC arthroplasty where one of the bones causing the pain is removed. Traditionally, when the joint is removed it is replaced with a tendon from your forearm. More modern techniques eliminate the need to take the forearm tendon and can stabilize the joint with a strong suture instead. Patients should expect 6 weeks of full-time splinting and 3 months of occupational therapy.

Many patients will find that home treatments will work to reduce the pain at first, but basal joint arthritis will often worsen over time. Surgery may be the only option for pain relief once other options no longer work to control the pain. Fortunately, once the patient has healed and the therapy is complete, most patients have little pain, better strength and much greater function after surgery.

David Veltre, MD, is a fellowship-trained hand surgeon at SVMC Orthopedics in Bennington, VT. He also sees patients at Northern Berkshire Orthopedics in Williamstown, MA.