Arthritis at the base of the thumb is more common in women and usually
starts after age 40. The cause of this form of arthritis is unknown in
most cases. Past injuries to the joint, such as fractures or severe sprains, and
generalized joint laxity might increase the chances of developing this form of
arthritis at a younger age. Women with the disorder outnumber men by a ratio
of 10: to 15:1.
The most common symptom of thumb basal joint arthritis is a deep, aching
pain at the base of the thumb. The pain often worsens with activities that
involve pinching, such as opening bottles and jars, turning doorknobs or keys,
and writing. As the disease progresses, patients may experience pain at rest and
at night, and patients often note loss of pinch and grip strength. In severe cases,
progressive destruction and malalignment of the joint occurs and a “bump”
develops at the base of the thumb. That is caused by the thumb metacarpal
moving out of position in relation to the trapezium. At this point, thumb
motion becomes limited and the space between the thumb and index finger
narrows, making pinch activities difficult. The next joint up might hyper-
extend to compensate.
The appearance of the thumb and the location of the pain are usually very
helpful in identifying this condition. Although X-rays help confirm the
diagnosis, symptom severity often does not correlate directly with the joint’s
appearance on the X-ray.
Less severe thumb arthritis will usually respond to non-surgical care. Anti-
inflammatory medication, splinting, and steroid injections might help alleviate
pain. In addition to providing splints to support the thumb during activities,
a hand therapist might help by increasing range of motion and decreasing
inflammation and swelling by using various modalities.
The management of symptomatic thumb basal joint arthritis requires an
understanding of normal functional imperatives for the thumb and anatomy
and biomechanics of the hand. There are hundreds of scientific articles that
address treatment options. Dr. Raymond Raven trained where the standard of care was established.
Patients with advanced arthritis or those who do not respond to non surgical
treatment may be candidates for surgery. A variety of surgical techniques are
available that can successfully reduce or eliminate pain and improve thumb
position and function.