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Base of Thumb Arthritis

Definition

Arthritis is a chronic condition where the joint surface (the cartilage) gets thinned and worn away allowing the bone ends to rub against each other. This results in inflammation of the lining of the joint and therefore pain. Most commonplace for arthritis in the hand.

Pathology

Most commonly there is no specific cause identified, known as idiopathic or primary osteoarthritis. It can be related to trauma, rheumatoid disease or other connective tissue disorders.

Symptoms

  • Pain, usually the most disabling.
  • Deformity due to the joint moving out of position and hyperextension of the next joint to compensate.
  • Loss of dexterity, difficulty with fine motor activities, e.g. doing up buttons.
  • Weakness of the hand due to loss of muscle power in the muscles at the base of the thumb e.g. opening jars.

Signs

  • Tenderness over the joints involved and with loading the joint.
  • Decreased muscle power in the thumb.
  • Swelling of the joint, due to inflammation and also joint subluxation.

Investigations

  • Plain x-rays are usually all that is required.
  • May perform CT scan if mild arthritis and possible loose bodies.

Non-operative treatment

  • Panadol Osteo and Anti-Inflammatories.
  • Splinting and Hand Therapy.
  • Steroid injections into the joint. Work best when some joint space remains. A way of delaying possible surgical intervention.

Operative treatment

  • Depends on the severity of the disease.

Early

  • Arthroscopy +/- bone resection.
  • Ligament Reconstruction.
  • Osteotomy.

Moderate

  • Joint resurfacing.
  • Arthroscopy and partial bone resection.

Severe

  • Suspensionplasty.
  • Fusion.

Typical post op course

  • Immediately post operatively the hand is usually quite numb due to local anaesthetic used for the surgery.
  • The thumb and wrist will be in a plaster backslab and the fingers will be free.
  • It is important to keep the hand elevated after surgery especially in the first 72 hours post op to reduce / limit swelling.
  • Keep the fingers moving, all the way straight and bent into a fist to limit stiffness and help reduce swelling.
  • May use the hand for light activities as comfortable but avoid heavy activities.
  • Keep the dressing clean and dry.
  • Review at 2 weeks for wound check and to get a removable splint. Gentle motion only at this stage.
  • Begin Scar massage to soften wound and desensitise scar.
  • At 6 weeks begin more range of motion.
  • Most base of thumb arthritis operations take 6-12 months to fully recover.

(Moderate Arthritis, note loss of space between bones)

(Severe Arthritis of Base of thumb and STT joint)

These notes have been prepared by orthopaedic surgeons at OrthoSport Victoria. They are general overviews and information aimed for use by their specific patients and reflects their views, opinions and recommendations. This does not constitute medical advice. The contents are provided for information and education purposes only and not for the purpose of rendering medical advice. Please seek the advice of your specific surgeon or other health care provider with any questions regarding medical conditions and treatment.