Basilar Thumb Arthritis

Overview:

Arthritis is a common condition involving localized pain and swelling of a joint. At the joint surfaces in our limbs, our bones are covered with a slick material called cartilage. Arthritis at the Base of the Thumb (a.k.a. 1st Carpometacarpal Arthritis, Basilar Thumb Arthritis) results from cartilage wear in a joint between a hand bone called the First Metacarpal and a wrist bone called the Trapezium. Sometimes, the joints between neighboring wrist bones are involved, (including the Trapezoid and the Scaphoid), at which point the condition is called Pantrapezial Arthritis. Most cases of basilar thumb arthritis are attributed to osteoarthritis, though it is possible for an inflammatory arthritis (such as Rheumatoid Arthritis) to affect this area of the hand.

Symptoms:

Note: The following symptoms are not meant to diagnose a condition. If you have these or other symptoms, you should be evaluated by a qualified healthcare provider.

  • Pain, stiffness, and / or swelling at the base of the thumb.
  • Pain can also be perceived on the thumb side of the palm.
  • The pain can be made worse by activities such as pinching, gripping, and opening jars.
  • Hand weakness can result due to the pain.
  • In advanced arthritis, the thumb metacarpal can be drawn into the palm.

Treatment:

  • History and Physical Exam: The doctor or midlevel provider will obtain a history of the problem and perform an appropriate physical exam to find the area of concern.
  • Imaging: Usually, imaging of the hand begins with x-rays. If more information is needed, the doctor or midlevel provider may order a CT scan or an MRI.
  • Non-surgical Management:The goal of treatment is to decrease pain in the basilar thumb joint. Often, symptomatic treatment is initially prescribed, including the use of splints, ice, moist heat, and over the counter (OTC) pain medicines (as allowed by the patient’s primary care provider). The use of chronic pain medicine is deferred to the primary care provider.Another non-surgical option is a steroid injection into the joint. The steroid is an agent that decreases inflammation in the joint, and thus helps with pain. It is important to understand that steroids do not fix the joint, and the pain relieving effect may be temporary. Steroids can cause tissue breakdown, so there is a limit on the number of injections that can be given.
  • Surgical Management: The primary goal of surgery for basilar thumb arthritis is pain relief. A common procedure performed for this problem is a Ligament Reconstruction Tendon Interposition arthroplasty (LRTI). In this procedure, a wrist bone called the Trapezium is removed and replaced with a tendon taken from the patient’s forearm. This eliminates one bone from the arthritic joint, thus decreasing the cause of the pain. As described, a bone in the wrist is replaced by soft tissue, therefore a common side effect of this surgery is weakness in the thumb. Again, this procedure is for pain control, generally reserved for cases that do not respond to other treatments. Other surgeries may be performed for Basilar Thumb Arthritis as well, depending on surgeon preference and experience.

Pre-operative Care:

  • If you have thumb pain from a recent trauma, you should have it evaluated for an acute injury.
  • If you have nagging pain in the base of the thumb that did not result from a recent trauma, you may choose to seek medical attention.
  • Be sure the doctor or midlevel provider is familiar with all of the possible causes of basilar thumb pain.
  • If a decision for surgery is made after seeing one of our Orthopaedic Hand Surgeons, you may require pre-operative medical clearance by our Anesthesia department or your Primary Care Provider. This depends on your other medical conditions.

Post-operative Care:

  • Recovery is variable depending on the patient’s medical history. Generally, the patient is immobilized in a cast postoperatively, eventually transitioned to a removable splint. Total time for splint immobilization is approximately 3 months, with restrictions on use of the hand during that time.
  • After surgery, you will be placed in a post-operative dressing/splint which you must wear until your first post-operative visit with one of our providers. You must keep the dressing CLEAN and DRY to avoid risk of infection and other wound healing complications.
  • Someone should be with you for the first 24 hours after surgery.
  • You will be given a prescription for post-operative pain medicine. Do not take it with other pain medicines unless directed by your doctor. Do not drive, drink alcohol, or make important decisions while taking the pain medicine.
  • Do not smoke, use smokeless tobacco, nicotine gum, or nicotine patches. Nicotine is a vasoconstrictor, and can impede healing by limiting blood flow to the surgical site(s).
  • You must remain non-weight bearing (no use) with the surgical hand and arm until cleared by one of our providers. This may be several weeks to months, depending on your healing. Your doctor will provide you with specific restrictions.
  • At the first post-operative visit, your stitches will be removed. You will be placed into a short forearm-based cast that goes out your thumb, called a thumb spica. You will remain in a cast for a number of weeks to months (depending on your healing), until transitioned to a removable splint. If your cast becomes wet or soiled, you should come into the office for a new cast.
  • After several weeks to months of immobilization, you will likely be stiff and weak in your hand / wrist. Patients are sent to an Occupational Therapist, with the goal of regaining functional use of the operative hand. Remember, you are an active participant in your care, and part of your recovery depends on your desire to participate in therapy.