Treatment for Basal Thumb Arthritis

Most people don't realize the basal joint exists until thumb pain forces a trip to the doctor. The basal joint connects the base of the thumb to the wrist and facilitates the thumb motion required to grasp and hold objects. Although an injury may cause damage to the basal joint, most of the problems are caused by arthritic damage to the cartilage that covers the ends of the bones. Missing cartilage will cause the bones to rub together, which damages the joint, causing pain and restricted movement.

Nonsurgical Treatments

• The goal of nonsurgical treatment is to reduce the symptoms so that normal activity can be resumed with a minimum of pain.

  Medications--Although acetaminophen taken in high dosages over a long period of time may cause liver damage, it generally has fewer side effects than other arthritis medications and may ease the joint pain. Ibuprofen and naproxen are over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDS) used to help decrease inflammation and reduce pain, but they can have serious side effects. Diclofenac, nabumetone and ketoprofen are prescription-strength NSAIDS and are believed to provide a higher degree of relief. These stronger drugs have a corresponding higher potential for side effects including ulcers, gastrointestinal bleeding and cardiovascular problems.

  Heat and cold--Alternating between heat and cold may provide relief. Heat may soothe the joint and ease the pain and allow more movement. Cold packs may reduce swelling.

  Physical therapy--A hand therapist can design exercises that move the thumb through its range of motion and help to improve mobility.

  Splints--Support can be provided to the thumb and wrist by using a splint. Splints can aid in proper positioning and limit pain by restricting movement. They can be found in medical supply stores and drugstores or be custom built as directed by a physician.

  Injections--Cortisone can be injected into the joint to provide pain relief and reduce inflammation. These injections are a temporary solution and may ease the pain for several weeks.

Surgical Procedures

• Several surgical procedures have been developed to alleviate the symptoms caused by basal joint damage.

  Joint fusion--Surgeons can fuse together the bones of the joint to reduce the pain and improve stability of the thumb. The fused joint will not have the flexibility or mobility of a healthy basal joint but can bear weight with little or no pain.

  Osteotomy--In this procedure often called bone cutting, the basal joint bones are repositioned and realigned to correct deformities.

  Trapeziectomy--The trapezium bone is one of the wrist bones at the base of the thumb. In some cases basal joint pain can be significantly reduced by the removal of the bone.

  Excisional arthroplasty--This is the traditional operation for treating deterioration of the basal joint. All or part of the damaged joint is replaced with soft tissue (tendon) generally removed from the wrist area. During healing the tendon turns into tough, flexible scar tissue connecting the bones similar to a joint.

Post Surgery Rehabilitation

• Most basal thumb surgery is done on an outpatient basis, and recovery can take a significant amount of time. Normally the thumb and wrist are put in a cast or splint for up to six weeks after surgery. As much as eight weeks of physical therapy may be necessary to regain hand movement and strength after the cast has been removed. Although surgery has proved to be an effective method to reduce pain and restore the use of the hand, patients must allow six to 12 months for complete recovery.