Basal Joint Osteoarthritis
Arthritis at the base of the thumb is a common diagnosis. It is usually found in patients between the ages of 50 and 70, but it can often manifest earlier due to injury or heredity. Pain is due to the movement of the thumb metacarpal on the trapezium, with inadequate cartilage in the joint. It often affects peoples' lifestyle, and there are many treatment options.
Hundreds of thousands of people will be affected by this during their lifetimes, and it is commonly treated in the hand surgeon's office.
Basal Joint Osteoarthritis Symptoms
Symptoms begin with the pain doing activities that involve pinching, making these actions more difficult. This includes turning keys, opening doors, hooking a bra and pulling up pants or socks. The most commonly mentioned difficulty is opening jars. Certainly other activities can be affected, such as manual activities like hammering, sports including golf and tennis, and recreational activities such as shuffling cards.
Basal Joint Osteoarthritis Diagnosis
Diagnosis begins with taking a history and doing a physical exam. Patient's signs can include mild malalignment dues to subluxation at the carpometacarpal (CMC) joint at the base of the thumb. Tenderness occurs when the proximal metacarpal is pressed into the joint or axially compressed into the trapezium. Pain while pinching or gripping is usually present.
Radiographs confirm the presence of narrowing and possibly malalignment at the CMC-1 joint. Bone-on-bone changes and bone spurs can also be present.An MRI is usually not necessary for diagnosis.
Basal Joint Osteoarthritis Treatment
There are myriad treatment options available. Non-operative measures begin with condition-specific bracing. Non-steroidal anti-inflammatory medications (NSAIDS) at prescription strength can be used in the appropriate patients. Topical anti-inflammatories and compounds that include them have begun to be used with some success as well. Corticosteroid injections can be used intra-articularly at infrequent intervals as well.
Basal Joint Osteoarthritis Surgery
If all the above treatments do not yield acceptable results, surgery can be considered. The philosophy of the surgery involves keeping the metacarpal and trapezium bones from moving against one another. Most of the commonly performed treatments include removal of some or all of the trapezium. Many include reconstruction or replacement of the ligaments to stabilize the thumb and may also include use of the now-absent trapezium. Certainly there are other options, but the above descriptions involves the majority of operations currently performed.
Basal Joint Osteoarthritis After Surgery
Postoperative care includes immobilization for 5 to 6 weeks full time, followed by therapy that may go on another 2 to 3 months. Most patients improve steadily for 6 months and may slowly improve for up to 6 years. In those patients who undergo operations because all other reasonable conservative options have failed, there is about an 85 percent satisfaction rate.
Our office treats hundreds of people with this condition per year and we are always open to trying to assist in the care of these patients.