Osteoarthritis at the base of the thumb
This information provides an overview of osteoarthritis at the base of the thumb, treatment options (including surgery), and what to expect after surgical intervention.
What is Osteoarthritis at the Base of the Thumb?
Osteoarthritis at the base of the thumb is a common condition, typically linked to age-related changes in the joints. The thumb’s base joint (carpometacarpal joint) is particularly susceptible due to the significant strain it endures during everyday activities.
Symptoms
- Early symptoms: Pain during activities such as pinching, opening packets, or peeling vegetables. A weakened grip is also common.
- Advanced symptoms: Swelling at the base of the thumb, persistent pain (even at rest), and the thumb appearing crooked. Symptom severity and progression varies between individuals.
How is it Diagnosed?
A diagnosis is often made based on your symptoms and a physical examination. In some cases, an X-ray may be recommended to confirm the extent of arthritis, though it is not always necessary in the early stages.
Treatment Options
Hand Therapy
Hand therapy focuses on reducing pain and maintaining hand function. This may include:
- Tailored hand exercises to improve movement and strength.
- Splints to provide support and relieve pain.
- Guidance on modifying daily activities to protect the joint.
Steroid Injections
A local steroid injection into the joint may provide significant pain relief. However, the effects are typically temporary (lasting between a few months to a year or two), and repeated injections can increase the risk of complications if surgery is needed later on.
Surgery
If pain is severe and other treatments have not been effective, surgery may be an option. Surgery aims to reduce pain and restore function in the affected joint. Various anaesthetic options are available, and the procedure typically lasts about one hour.
Surgical Options
Trapeziectomy
- This is the most common surgical treatment in the UK for thumb base arthritis.
- The trapezium bone (at the base of the thumb) is completely removed, creating space to prevent painful rubbing between the arthritic bones.
- Recovery time: Approximately 3–4 months.
Arthrodesis (Joint Fusion)
- Suitable for younger patients or those in physically demanding jobs.
- The trapezium and metacarpal bones are fused, eliminating joint movement and pain caused by bone rubbing.
- This option is less common and only offered in specific cases.
Artificial Joint Implant
- An artificial joint (such as the MAIA or TOUCH prosthesis) can replace the damaged joint.
- These implants provide good pain relief, maintain thumb movement and improve pinch strength.
Hospital Stay
The surgery is performed as a day case, meaning you can go home the same day. You should plan to be in the hospital for up to six hours. Arrange for someone to drive you home, as you will not be able to drive after the procedure.
Risks and Potential Complications
While complications are rare, it is important to be aware of the potential risks:
- Infection or delayed wound healing: May require antibiotics or, rarely, a second procedure to clean the wound.
- Tender or sensitive scar: This can often improve with scar massage and therapy.
- Stiffness: Short-term stiffness is common but should resolve within three months. Persistent stiffness may need therapy.
- Pain: Approximately 1 in 10 patients may continue to experience pain after surgery.
- Nerve damage: Can result in numbness or a painful spot near the scar but usually resolves within a few months.
- Thumb joint dislocation (with implants): Rare but may require further surgery.
- Complex Regional Pain Syndrome (CRPS): A rare condition causing severe pain and stiffness, often requiring specialized therapy.
Most patients have a smooth recovery and achieve excellent outcomes.
Preparing for Surgery
Preoperative Assessment
You will be contacted by the preassessment clinic to discuss your surgery. Routine tests, such as blood tests, may be required. Bring a list of any medications you take, including non-prescription or herbal supplements.
Fasting
If fasting is required before surgery, this will be explained during your preoperative appointment.
Rings and Jewellery
Remove all rings from your fingers before coming to the hospital.
Smoking Cessation
Smokers have a higher risk of complications such as poor healing and infections, so consider stopping smoking prior to your procedure
Post-Surgery Care
Hand Elevation
After surgery, it is crucial to keep your hand elevated (above heart level) as much as possible to reduce swelling. A sling will be provided to assist with this.
Movement
Move your shoulder and elbow regularly to prevent stiffness. You should also keep your fingers moving within the limits of your bandages.
Pain Management
Bruising and mild pain are normal after surgery and can be managed with painkillers like paracetamol or ibuprofen. If pain increases or persists, contact your consultant.
Follow-Up Appointments
You will have a follow-up with a hand therapist 10–14 days after surgery. During this appointment:
- Bandages will be removed.
- A protective splint will be provided (to be worn for 4–6 weeks).
- Gentle exercises will begin to restore movement.
Regular follow-ups every two weeks will monitor your progress and assist in returning to daily activities.
Recovery Timeline
Varies significantly depending on procedure.
Typically, joint replacement patients recover full function significantly quicker than either fusion or trapezectomy patients. Please discuss your specifics with your surgeon.
Reminder: Remove all rings from your fingers before arriving for surgery.