Thumb arthritis: causes, management and treatments

How do you know if you have arthritis of the thumb and what treatments are available? Mr Alistair Jepson, consultant orthopaedic surgeon at BMI Three Shires Hospital in Northamptonshire, shares his expertise.

Why does my thumb hurt?

If you have had an injury to your thumb, such as a fracture or sprain, this will naturally lead to pain and limited function for a while.

But, if you are having thumb pain for no reason, or if your pain doesn’t go away after injury, you may have the start of arthritis.

What is arthritis?

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A normal joint is made of two smooth, cartilage-covered bone surfaces that fit perfectly together, with the bones gliding smoothly against each other. When these surfaces are damaged or wear away, this is called arthritis (literally meaning “inflamed joint”).

Arthritis is a condition that can affect any joint, and while the thumb is not the first place people think of, it is actually very common to develop arthritis in the joint at the base of your thumb.

Thumb arthritis is thought to affect around 10% of adults. It is more common in women, affecting up to one third of women over 55. Arthritis is more common as we get older, and most people with the condition are over 40 years of age.

You may be more likely to develop arthritis of the thumb if your job or hobbies put high stress on the joint; if you are obese; or if you have a hereditary condition that affects the joints.

There are various types of arthritis that can affect the thumb. Osteoarthritis is the most common form. It is caused by wear and tear over time, which causes the cartilage around the bone in the joint to weaken. Rheumatoid arthritis can also affect the thumb.

How do I know if I have thumb arthritis?

The most common symptom of thumb arthritis is pain at the very base of the thumb (close to the wrist joint). This is often accompanied by stiffness, weakness and/or swelling. Your symptoms may be worse after activities that use your thumb.

You may find that even simple tasks, such as opening a jar or turning a key, become difficult. If this is the case, it’s time to seek medical advice.

Your doctor will likely give you a physical examination as well as asking for your medical history. They will consider your symptoms and may also run tests, such as X-Rays, before giving a diagnosis.

These X-rays typically show bone spurs, which are a hallmark of arthritis, as well as narrowing of the joint.

What are the treatment options for thumb arthritis?

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Most people with arthritis of the thumb will not require invasive treatment. For many people, the reassurance of a diagnosis is one of the most important things.

If your arthritis of the thumb is not very advanced, modifying your activities or taking mild painkillers can usually help. Other conservative treatments include splinting, or physiotherapy and hand therapy.

If these treatments are not effective, and you find that the pain and discomfort in your thumb is really affecting your quality of life, you might be offered joint injections. Surgery is always the very last resort.

Can you have surgery for thumb arthritis?

Surgery would only be considered as a treatment for thumb arthritis if all other options have been exhausted.

Traditionally, the main options have been joint excision without replacement (also known as a trapeziectomy), or fusion of the joint (arthrodesis). While both these operations are excellent at relieving pain, they do come with downsides. Risks include loss of range of motion or strength in your thumb.

You’ve probably heard of hip or knee replacement surgery, and it is possible to replace a thumb too. We use similar technology, just on a much smaller scale, to replace thumb joints, as well as other arthritic joints in your fingers.

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During joint replacement surgery, the damaged parts of your thumb joint are replaced by an implant (also known as a prosthesis), which is designed to match your original joint as closely as possible.

The benefit of a thumb joint replacement is that you should retain much of your movement and strength.

The operation itself is done as a day case procedure and results in just a small scar.

Recovery from thumb joint replacement surgery

You will be encouraged to begin moving your joint and rebuilding its strength the very next day after surgery. You’ll have a lightweight splint in place to help protect your thumb.

Return to more demanding activities, including sports, takes two to three months.

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