The Treatment of thumb base arthritis

Arthritis at the base of the thumb is extremely common. The condition is more common in women than men and more common as we get older. It is uncommon in people younger than 50 years of age but does occur.  Approximately one third of peri/post-menopausal women will have x-ray changes of arthritis at the base of their thumb and approximately one third of these women will experience pain from that joint. The problem also occurs in men but less commonly, for reasons that are unclear.

The pain associated with thumb base arthritis can be a minor inconvenience in some and a significant problem in others, causing difficulty in using hand.

How is thumb base arthritis treated? This does depend on the severity and functional impairment. Initial non-surgical measures include, pain killers and/or anti-inflammatory medication, activity modification, specialist hand physiotherapy and splinting. Many people will find these methods helpful. If these interventions have not allowed the thumb to settle down, consideration can be given to an intra-articular steroid injection

A wide range of surgical options are available for treating thumb base arthritis are available from denervation though to total joint replacements. The mainstay of surgical treatment in the UK is trapezectomy. In this procedure the trapezium bone at the base of the thumb is removed producing a false/scar tissue joint at the base of the thumb metacarpal. This is a very widely performed procedure and works well in the vast majority of people, 80-90% having good results. Recovery typically takes 3-6 months.

Trapezectomy isn’t always the best option, joint fusion, or total joint replacement may be better options. Increasingly, specialist hand surgeons are recommending thumb base total joint replacement.

Thumb base joint replacement is an excellent alternative the trapezectomy in many cases. A formal joint replacement more accurately reconstructs the joint, maintaining the length of the thumb. This procedure has advantages for younger or more active people, it allows faster recovery and better preservation of grip strength. Patients typically recover in four or five weeks, returning to work at this point. In addition, in those patients that have developed a Z type deformity in the thumb, some of this can be corrected using a joint replacement. This surgery is done as a day case under either a short general anaesthetic or a peripheral nerve block anaesthetic [awake]. The hand can resume lighter normal activities immediately.