My Darn Thumb!! What can I do about osteoarthritis in my thumb?

My Darn Thumb!! What can I do about osteoarthritis in my thumb?

Are you getting excruciating sharp pain at the base of your thumb and losing strength in your grip and pinch? You may have osteoarthritis (OA) in the joint at the base of your thumb, close to your wrist (the carpometacarpal or CMC joint).

Don’t be alarmed… we can help you!

This  joint is the 2nd most common hand joint affected by osteoarthritis (OA), after the joints within the fingers.  This form of OA is, however, the most painful.  It causes your daily activities to become difficult and painful.  Opening bottles and jars are some of our biggest complaints.

Like all OA, it is caused by the overuse of the thumb.  Cartilage breaks down between the bones in the joint. This leads to bone on bone rubbing and inflammation, the reason for your pain. Occasionally you will have swelling and a cracking sensation with thumb movement. In severe cases, the thumb positioning can become deformed.  This further increases pain and decreases strength.

How do I reduce the pain?

  1. Hand Therapy: Your hand therapist will assess your hand movement, strength, function, pain, and the severity of your OA.  We will give you advise on how to manage and treat your arthritis.  This may include splinting, manual therapy with your therapist, joint protection, exercises, compression gloves, heat treatment, and education for your self management.
  2. Splinting: As hand therapists we may fabricate a comfortable lightweight thermoplastic splint to be worn as we recommend, depending on the severity of your pain and arthritis.  The splint provides correct positioning of the joint, rest, and support.  This allows the inflammation and pain to settle. You can still function in this splint as the thumb tip, fingers and wrist are free to move. Also, there are softer fabric brace options for those who are only experiencing mild discomfort, to provide increased support and movement restriction of the thumb in their function and to avoid further deterioration of the joint.  Your hand therapist will discuss these options with you.
  3. Anti-inflammatories:  Medications can relieve pain fast, however we do not recommend this as a long-term solution given the negative impacts that they have on your liver and stomach.  Discuss this option with your GP.

What about corticosteroid injections?

Steroid injections may relieve pain and reduce swelling for a period of time.  Although, this is a temporary fix when it comes to OA.  The injection will not correct the damage and in fact can worsen the symptoms over time.

Why is my thumb weak? 

As the saying goes: use it or lose it. Given that your thumb has been too painful to move and use, you have probably been avoiding using you thumb as usual within most of your daily tasks. This leads to decreased tone of the muscles involved in thumb function.

What can I do to improve my thumb strength? 

Your hand therapist will focus on specific exercises that strengthen the multiple muscles of the hand and forearm.  Your exercises will help stabilise the joint of the thumb.  Strengthening will allow you to perform your daily tasks more easily and will help to avoid future deformity of the thumb.

Do I need surgery?

Maybe.  Seeing a hand therapist for treatment, education, splinting, and self management may be enough.  Therefore, it is always worth trialling a period of therapy prior to considering surgery.

If your daily function and symptoms have become unbearable, the surgery is very often successful. A variety of surgical options are available including joint replacement.  I often warn my patients that the surgery requires a long recovery.  But, most of the time it is worth it.  It can reduce your pain to nothing and increase your function.  As your hand therapist, we will discuss your options with you and if needed we will refer you to a hand surgeon.  The surgeon will give you your options and inform you of whether surgery is the best option.

How do I stop my other thumb from becoming arthritic? 

We would suggest you do the same exercises for your unaffected thumb at the same time. Given that you obviously use your hands a lot, you are at risk of experiencing it in the other thumb.  Compensating with the other hand due to pain causes overuse of the unaffected hand.

Unfortunately the damage caused by arthritis cannot be reversed, however if we get involved early, we can reduce your pain, slow the progression of the condition, increase strength and motion, and improve your function and in turn maximise your quality of life.

 

Amber Knight