HandArthritis commonly affects the base of the thumb. In fact, approximately 11% of post-menopausal women develop painful arthritis in this area. It’s often worse with pinching and gripping, such as when opening up a jar or turning a key. It may also occur in people who have fractured or dislocated their thumb.
Arthritis of the base of the thumb is diagnosed based on a history and physical examination (talking to you and examining your thumb), as well as by looking at the joint on X-rays.
Treatment always starts with nonoperative management. This includes avoiding pinching and gripping small. When you grasp or pinch a small object, for every 1 pound of force you apply to your thumb tip, your basilar joint experiences 12 pounds of force. You want to pinch and grip big. Big, thick pens with rubber grips on them are much easier on your joint than are small, metal pens. Kitch-aid or simlar devices can slip over jar covers to make them larger and easier to hold. You can buy devices to slip over keys to make turning them easier. Whatever you grab with your arthritic thumb, try to make it bigger.
A splint is also effective. And a steroid injection can provide relief as well. If the symptoms are mild, these may be all that you need. However, they will not provide permanent relief from the pain of significant arthritis.
If nonoperative management is not effective and the pain is significantly botherning you, surgery can be very effective. There are many different types of surgery. I prefer the LRTI (ligament reconstruction tendon interposition). It is the current ‘gold standard’: the most popular and most effective procedure, with a low complication rate. It’s been around since 1986. It uses your body’s natural tissues to provide stability and a new joint. This is one case where newer procedures that use artificial materials to create artificial joints are less effective with a higher complication rate.
During the LRTI, the arthritic bone that your thumb rests on (the trapezium) is removed. I make a small cut in your forearm to release one of your tendons, which is brought to the base of your thumb. So now instead of your thumb resting on a hard piece of arthritic bone (which is painful), it rests on a soft tendon pillow. A small suture anchor is placed into your thumb bone. It’s like a small harpoon with stitches on it to hold everything together. It stays in forever.
You stay in the post-operative splint for two weeks, then a cast for two weeks, then another splint for two weeks while you may undergo some hand therapy to regain thumb motion. While this procedure may cause a fair amount of pain for the first few days after surgery, the pain quickly decreases. It is important to avoid forceful gripping and heavy lifting for 3-4 months after this surgery. Typing and computer use are fine, and may be performed the day after surgery.
The hand needs to be kept clean and dry for the first 4 weeks after surgery. Bathing is safer than showering. Wrap a towel around the splint or cast in case any water gets in, then place a plastic bag over your hand and secure it tightly with rubber bands. Once the cast is removed after 4 weeks, you may get the hand wet.
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