What is Thumb Arthritis & How is it Treated?: Causes, Symptoms, Diagnosis of Thumb Arthritis

What is Thumb Arthritis?

The carpometacarpal or the CMC joint of the thumb is one of the most common areas where arthritis tends to develop. This is because of the use of the thumb which can be said to be as close as endless. The use of thumb is required practically for any and every activity ranging from cooking to writing or giving a presentation. The primary cause for Thumb Arthritis is believed to be damage to the palmar oblique ligament resulting in dorsal subluxation of the metacarpal on the trapezium. This results due to cartilage loss in the thumb which protects the bones of the thumb from rubbing against each other.[1]

Once the cartilage gets damaged the rubbing of the bones causes increased friction resulting in the symptoms experienced by the affected individual. Although there is no definite cure for Thumb Arthritis, there are conservative and surgical treatments available which can relieve the symptoms of pain and inflammation and if deemed ineffective surgical options can be explored. Majority of treatment of Thumb Arthritis involves surgical correction as this is the most effective in restoring the thumb function to a significant degree.[1]

The preferred procedure for this is termed as resection or replacement of the damaged CMC joint and restoring the palmar oblique ligament. The efficacy of this treatment is questionable in the early stages of arthritis but there is evidence of high success rate of these procedures in advanced stages of Thumb Arthritis. However, researchers believe that more work needs to be done to substantiate the successful outcomes of these procedures.[1]

What Causes Thumb Arthritis?

What Causes Thumb Arthritis?

The primary cause of Thumb Arthritis is degeneration of the cartilage around the basal joint of the thumb. This cartilage protects the bones of the joint from rubbing against each other. Cartilage degeneration is an ongoing process that starts to occur after the age of 40 and gradually worsens with time. This process however can be accelerated if an individual sustains an injury to the thumb like a fracture causing arthritis to develop much before than normal.[2]

There are also certain risk factors which increase the likelihood of an individual experiencing Thumb Arthritis. The most common among these is overuse of the hands and the thumbs in particular. Gripping and grasping objects is what thumb is primarily used for aside from writing. If this is done in excess then significant stress is put on the thumb. This stress in turn accelerates the process of degeneration ultimately causing Thumb Arthritis.[2]

People who work on the computer all day are also at an increased risk for developing Thumb Arthritis. Individuals who are obese or have conditions like rheumatoid arthritis also are at an increased risk for developing Thumb Arthritis.[2]

What are the Symptoms of Thumb Arthritis?

The primary presenting feature of Thumb Arthritis is pain at the base of the thumb along with difficulty in gripping and grasping objects. Pushing or pulling even light objects may cause pain and discomfort in an individual with Thumb Arthritis. Some of the other symptoms that can be seen in people with Thumb Arthritis include swelling and inflammation at the base of the thumb along with severe pain with any attempts at using the thumb.[2]

The range of motion of the thumb is also very restricted due to pain and swelling caused by Thumb Arthritis. The basal joint at the thumb also will look enlarged or protruded. There will be literally no strength in the affected thumb. These symptoms are variable and depend on the extent of the damage caused by Thumb Arthritis.[2]

How Is Thumb Arthritis Diagnosed?

For diagnosing Thumb Arthritis, the physician will first take a detailed history of the patient with regard to the symptoms and functioning of the affected thumb. The physician may ask question as to the various movements that make symptoms worse and rating the pain from 0 to 10, with 0 being no pain and 10 being the maximum. The physician will inquire about any previous history of any injuries to the affected thumb. The physician will then examine the thumb and do a range of motion test to check the motion and whether it leads to aggravation of symptoms.[2]

They may also move the thumb to hear for any audible clicking sound which is a sign of the bones rubbing together. The physician will also check for any temperature changes around the affected joint. Once Thumb Arthritis is suspected, the physician will order radiographs in the form of x-ray, CT and MRI scans of the thumb to better explore the area and look for any cartilage loss at the base of the thumb causing the symptoms. Based on the results of the physical examination and radiographs a diagnosis of Thumb Arthritis is made.[2]

How is Thumb Arthritis Treated?

Thumb Arthritis does not have a definite cure. The condition tends to get worse as the individual ages as it is a progressive disease. Depending upon the severity of the symptoms and damage caused to the cartilage, a treatment approach best suited for the patient suffering from thumb arthritis is determined.

As of now, there is no approach either conservative or surgical which can delay the progression of Thumb Arthritis. However, there are options available which can help in relieving the symptoms of arthritic thumb.[2] These include thumb braces which will limit the motion of the thumb and avoid any extra stress on the thumb. The patient will also be given certain exercises to do to strengthen the thumb to negate the effects of arthritis to some extent. NSAIDs in the form of Tylenol and ibuprofen will be prescribed for calming down pain and swelling around the thumb. If the medications are deemed ineffective for thumb arthritis , then the patient will be given corticosteroids for pain relief. Other than this, conservative approaches towards treatment of Thumb Arthritis include ergonomic changes, physical therapy, and heat and ice application. All of these may provide some benefit from the symptoms of Thumb Arthritis.[2]

If all the conservative approaches are found to ineffective in treating the symptoms, then the physician may lean towards a surgical procedure to treat the symptoms of Thumb Arthritis. The surgical options for Thumb Arthritis include removal or excision of the trapezium and suspending the joint and provide cushion to alleviate pain and other symptoms. Another procedure that is commonly used for treatment of Thumb Arthritis includes fusing the thumb joints together. This will relieve the symptoms of arthritis but the mobility of the thumb will be significantly compromised.[2]

A surgery for Thumb Arthritis will involve around one year of recovery time before the individual can return back to normal activities. Postsurgery, the patient will be enrolled in physical therapy to relieve the joint stiffness and weakness after surgery.[2]

In conclusion, Thumb Arthritis is one of the most common forms of arthritis across the United States. The primary cause for it is degeneration of the cartilage that cushions the two bones of the joints at the base of the thumb. Degeneration is an ongoing process which usually starts after the age of 40. The degeneration process however can be accelerated in cases where the thumb gets injured or fractured.[2]

This is because any injury to the thumb results in significant damage to the joint as well as the cartilage cushioning the bones. Thus the degenerative process gets quicker in an already damage cartilage and it gets eroded easily. The primary presenting features of Thumb Arthritis include stiffness and restricted range of motion of the thumb. Any attempts at moving the joints will cause severe pain and discomfort.[2]

There is no definite cure for Thumb Arthritis; however, with treatment, which are both conservative and surgical symptoms can be controlled to a significant degree. However, the efficacy of these treatments, especially the surgical approaches are questionable according to various studies conducted and more research needs to be done in the regard.[2]

Thumb Arthritis is a progressive condition and the disease will gradually progress over time and will make activities of daily living quite challenging. Thus it is necessary to contact a physician promptly if an individual suspects any abnormality with the thumb joint with regard to pain or stiffness. If this is proved to be arthritis then prompt treatment will go a long way in controlling the symptoms and improving the quality of life of the individual.[2]

Reference:

  1. https://www.ncbi.nlm.nih.gov/pubmed/18611999
  2. https://www.medicalnewstoday.com/articles/323104.php

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