By Carmella Fernandez MD, MBA
Do you have thumb pain with opening doors and jars? Have you noticed that your strength has diminished when you try to pinch or grasp objects? If any of these sound familiar to you then there is a possibility you may be experiencing the debilitating symptoms associated with thumb arthritis.
The base of our thumb metacarpal sits on a bone called the trapezium, and together form a saddle joint called the thumb carpometacarpal (CMC) joint, which allows motion in three planes. The increased mobility at this joint predisposes it to the development of arthritis, in conjunction with the fact that we depend on our thumbs for 50% of our overall hand function.
1. Who gets thumb arthritis?
The honest answer is that anyone can get thumb arthritis, and the majority of the time is that it is idiopathic. However, there are certain individuals who are predisposed to the development of thumb CMC arthritis and they are as follows:
– age over 40
– history of prior trauma to the thumb CMC joint
– inflammatory joint disease (ie. Rheumatoid arthritis)
– history of joint laxity
– occupations that require repetitive use of the thumb
2. What signs and symptoms should I expect to see if I have thumb CMC arthritis?
People with early onset of thumb arthritis may experience discomfort when grasping door knobs, opening jars, pinching and squeezing shampoo bottles, or when placing pressure over the palm of the hand during activities such as yoga. The pain can typically be localized to the base of thumb and it is often activity dependent, and improves with rest. As the arthritis progresses there can be a noticeable prominence at the base of thumb which is referred to as a “shoulder sign” because it resembles the contour of one’s shoulder. I often see patient’s in my office once the symptoms have become more constant and affect their ability to work and enjoy hobbies such as golf and tennis.
3. How is thumb CMC arthritis diagnosed?
The diagnosis is made based on clinical examination in conjunction with radiographs of the thumb.
4. What are my treatment options?
After receiving a diagnosis of thumb CMC arthritis the mainstay of treatment is conservative, consisting of activity modification, NSAID’s, and splinting. Quite often these treatments have been exhausted by the time someone comes to my office, and the next step on the treatment spectrum would be a injection of corticosteroid into the joint which can be performed in the office setting. The pain relief obtained from an injection is very variable from one person to the next, and can range from a few days to months and maybe even years.
5. When is surgery considered?
I do not consider surgery for a patient until all conservative treatment has been exhausted. If a patient is no longer experiencing relief from the corticosteroid injections, or they have had three or more injections in the past I would discuss surgical options with my patient as repeated injections can weaken the capsular integrity of the joint and potentially weaken the surrounding tendons and ligaments.
6. What is involved in the surgery?
The surgery is very similar to other salvage surgeries for arthritis in that the arthritic bone is removed, however the hand and wrist differ dramatically from that of a knee and hip in that we do not weight bear through our upper extremities. Therefore the bone that is removed does not need to be replaced with implants. There are numerous variations of the surgery for thumb CMC arthritis, and I prefer to perform a suspensionplasty which limits the number of incisions made, does not require harvest and sacrifice of a tendon, and also does not require any drilling of bone. The technique I utilize allows my patients to begin early range of motion of the thumb at two weeks following the surgery.
Carmella Fernandez MD, MBA
Dr. Fernandez is a dual fellowship trained orthopedic surgeon specializing in surgery of the hand, wrist, and elbow. Her clinical interests focus on developing personalized treatment plans to restore pain-free function to her patients through a variety of non-surgical and surgical solutions.
Fernandez Upper Extremity Institute
730 Goodlette Frank Road N., Suite #204
Naples, Florida 34102