What does it feel like?
Many patients complain of pain and ache at the base of the thumb, at the region indicated in the photograph. This is often worse at the end of the day, or after excessive use of the hand. The pain can affect strength, with patients describing weakness particularly when attempting to hold a heavy object, such as pots and pans. In advanced cases, patients also notice that the shape and alignment of the thumb changes, with a prominent bony lump at the base, and a hyperextended thumb.
What is it?
It is arthritis or degeneration of the cartilaginous surfaces of the joint around the base of the thumb. There are a few joints that are particularly relevant in basal thumb arthritis, and these are the thumb or 1st carpometacarpal joint, and scaphotrapeziotrapezoidal or triscaphe (or STT) joint.
What causes it?
Most basal thumb arthritis is idiopathic. It is associated with advancing age, but can also arise early if there is a strong family history of early arthritis. Other causes of basal thumb arthritis include inflammatory arthritis conditions, such as rheumatoid arthritis. In some cases, previous fracture in that region can lead to post-traumatic arthritis. Regardless of the cause, the end outcome is a pain that is nearly constant with occasional spikes of exacerbation.
What are my treatment options?
Treatment of basal thumb arthritis depends on the stage or severity of the disease as well as the level of pain or functional loss suffered by the patient. It is important to obtain XRays to assess the radiologic stage of the disease; this also aids later assessment of progression of the disease.
Treatment options range from non-operative management with hand therapy, splints to protect the joints and minimise overuse or excessive movement of the joints, and neoprene sleeves for compression, which can also afford a measure of comfort for some patients. Anti-inflammatory medication can help with pain and flare-ups. Occasionally, patients may require a corticosteroid injection.
Surgical management of basal thumb arthritis will be determined based on your daily demands on your hands, your age, the stage of disease, which joints are involved at the base of the thumb, and your pain profile (how much pain you are in, and how this affects you). A thorough discussion with careful consideration of these factors should be undertaken with your hand surgeon in order to find an appropriate option to meet your needs.