What Is Thumb Basal Joint Arthritis
Arthritis at the base of the thumb is one of the most common degenerative conditions of the hand and wrist. Thejoint at the base of the thumb is called the carpometacarpal joint. It is responsible for the thumbs positionaway from the rest of the hand. Its double saddle shape is what permits us to move our thumb in multiple planes,allowing us to hold items such as a pen or eating utensil, open jars or doors, or manipulate fine objects. Owing toits great freedom of mobility, the cartilage in the joint can commonly wear out and lead to symptoms. It istheorized that women are more commonly afflicted than men because the soft tissues around the joint are not assupportive.
Purpose Of A Trapeziectomy
A trapeziectomy is commonly performed for arthritis of the thumb that does not improve with conservative treatment options, including:
- Activity modification:Resting and avoiding painful activities, especially repetitive gripping, grasping, and pinching, can reduce inflammation in the thumb to promote recovery.
- Adaptive equipment: Using special tools to help with tasks like opening jars and using utensils can help reduce strain and inflammation of the thumb joint.
- Medications:Anti-inflammatory and pain-relieving medications are often prescribed to help manage symptoms.
- Cortisone injections: A healthcare provider may inject cortisone into your thumb to locally decrease pain and inflammation.
- Bracing or splinting: A thumb brace or splint can be used to externally support the thumb joint to decrease thumb strain while using your hands to complete everyday activities.
- Physical or occupational therapy: Physical or occupational therapy can help strengthen the hand and wrist muscles to support the carpometacarpal joint of the thumb to improve hand use and function. Treatment modalities can also be applied to help with pain relief.
Pain On Load And Weakness Remains To Some Extent 1year After Surgery For Trapeziometacarpal Joint Arthritis
In a February 2020 study from Sweden, doctors reporting in the journal BioMed Central Musculoskeletal Disorders wrote:
- One year postoperatively, mean pain at rest was reduced from 50 to 12 of maximum 100. However, pain on load and weakness had not abated to the same extent . The mean improvement in Passive Range of Motion did not differ between age groups or gender. The result was similar after trapeziectomy with ligament reconstruction and tendon interposition and simple trapeziectomy but few patients were operated on with the latter method. Pain on load and weakness remains to some extent 1year after surgery for trapeziometacarpal joint arthritis.
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What Stands Out About Yale Medicines Approach To Thumb Arthritis
The physicians in Yale Medicines Hand & Upper Extremity Surgery Program specialize in evaluating and treating injuries and musculoskeletal disorders that affect your daily movements. We offer the latest technological advances and we are active in research that can lead to better treatments.
At Yale Medicine, we offer the complete range of care to patients, with occupational therapists on site at multiple locations and a new state-of-the-art outpatient surgery center at Yale New Haven Hospitals St. Raphael Campus, Dr. Luo says.
What Type Of Surgery Is Best For Basal Thumb Arthritis
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Suture Button Suspensionplasty For Basal Joint Arthritis
Dr. Yao collaborated to develop a suture-and-button implant. After years of biomechanical, safety, and durability studies performed in concert with the manufacturer and his peers, Dr. Yao has perfected the SBS technique using this device.
Surgery begins like all thumb CMC joint arthritis procedures, with the surgeon removing the trapezium bone. But thats where the SBS technique diverges. The remaining thumb metacarpal bone is then suspended or kept in its normal place by using the implant that remains underneath the skin.
The implant suspends the thumb above the space where the trapezium was, anchoring the thumb and second metacarpal to one another. A button on each of the metacarpals is attached to either end of the suture to secure the bones in the correct position.
The device stabilizes the joint and helps to avoid any potential sinking or caving. Its like having a boat tethered to a dock, Dr. Yao explains. The suture holds the thumb in place by attaching it to the stable, immovable object which is the adjacent metacarpal. The space previously occupied by the trapezium ultimately fills with scar tissue, which further cushions and supports the thumb metacarpal.
Injury To The Thumb Joints
Injuries to the thumb joints can increase the risk of developing osteoarthritis because joints that have been damaged tend to generate more friction and are more prone to sustaining more damage. Therefore, people who have a history of multiple injuries to the thumb joints may develop osteoarthritis of the thumb at a younger age than they otherwise would have.
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The Combined Use Of Prp And Prolotherapy
When a patient presents a more advanced case of osteoarthritis we may suggest a more aggressive treatment including the PRP preparation. Why? The PRP has been shown in many studies, including the one we just cited to be more effective in cartilage degeneration. More so even than the simple dextrose Prolotherapy injections. In our clinic, based on over 27 years of experience in treating patients with thumb osteoarthritis, we have found that injecting PRP to attack the cartilage breakdown and injecting Prolotherapy to tackle the instability of the joint by addressing and strengthening weakened ligaments provide the patients with superior results. In the right patient, PRP, and Prolotherapy as a combined treatment would be favored.
Armstrong Amerika Thumb Spica Splint
- Price: $$
A thumb spica splint is one of the most heavy-duty braces on the market, best for those with more advanced conditions who require more restriction of movement. This one goes the extra mile by also offering adjustable wrist support.
Its made out of a neoprene blend material, which allows it to be durable, while also adding some level of breathability. It also comes in options for both right and left hands, and in two sizes: small/medium or large.
With 4.5 stars out of over 900 reviews on Amazon, this spica splint checks a lot of boxes for reviewers. Many appreciate the firm support it offers. They also like the adjustable straps, which make it more comfortable to wear.
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What Thumb Brace Is Best For Thumb Arthritis
Updated: 9-2-21: All you have to do is go online or visit your local drug store to see how many options there are for thumb braces. Custom made, ready made, splints for resting your thumb, braces to support your thumb the list is long! So how do you find the answer to the question what thumb brace is best for thumb arthritis? Read on for tips on what to look for in a thumb brace and which thumb braces are best for your thumb arthritis pain and different activity levels.
Preparation For Thumb Arthroplasty
Your health care provider will talk to you about how to prepare for surgery. He may tell you not to eat or drink anything after midnight on the day of your surgery. He will tell you what medications to take or not take on the day of your surgery before surgery you will need to obtain clearance from your regular doctor if you have medical problems. You may be required to obtain some basic tests for screening before the surgery. Basic blood tests, a chest x-ray, and an EKG may be required depending on your health.
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What Are The Symptoms Of Thumb Arthritis
Pain in the thumb is the most common symptom of thumb arthritis. You might feel pain when you are pinching or gripping objects, Dr. Luo says. You may also notice a little bump at the base of your thumb, he adds, explaining that this would be a bone spur, or a projection that develops along joints as a result of inflammation, including osteoarthritis.
Other symptoms may include the following:
- Swelling and tenderness at the base of the thumb
- An ache after prolonged use of the thumb
- Loss of strength when gripping or pinching with your thumb
- Limited motion
Joint Replacement Can Be Considered In Selected Patients Who Require Greater Strength And Range Of Motion Although It Has Been Associated With A Higher Complication Rate
Doctors at the Hand Surgery Unit, Department of Orthopedic Surgery, University Hospital, in Granada, Spain, wrote in the medical journal Orthopedics:
- Numerous surgical procedures have been described to treat trapeziometacarpal osteoarthritis, but no approach is currently considered superior.
- Good long-term outcomes have been reported with multiple procedures.
- No studies have been published comparing outcomes of the Arpe joint replacement with those of ligament reconstruction and tendon interposition .
- Pain relief and functional improvement were similar between groups.
- Pinch strength and range of motion were superior in the joint replacement group.
- Metacarpophalangeal hyperextension appeared to be prevented in the joint replacement group but increased over the follow-up period in the ligament reconstruction group.
- However, the complication rate was higher in the joint replacement group.
- Conclusion: Joint replacement can be considered in selected patients who require greater strength and range of motion, although it has been associated with a higher complication rate.
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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 , or fusion of the joint . 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.
Youve 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.
During joint replacement surgery, the damaged parts of your thumb joint are replaced by an implant , 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.
What Does Surgery To Treat Thumb Basal Joint Arthritis Involve
If your symptoms have not responded to bracing, steroid injections, oral anti-inflammatories, or diet and activity modifications, you may be a candidate for surgical treatment.
The most reliable and successful surgical option for thumb basal joint arthritis has been given several names, the most common being suspensionplasty or LRTI . This is an outpatient procedure performed with light general anesthesia and regional anesthesia, also referred to as a block, which temporarily numbs the arm to allow for painless surgery. The block also reduces and delays the need to take narcotic medication, thereby reducing the risk of unpleasant side effects of narcotics, including nausea, constipation, and cognitive impairment.
The surgery involves removing a small arthritic bone at the base of your thumb called the trapezium. This is performed through a 3 cm incision on the back of the thumb. I then use a tendon from your forearm to reconstruct the supporting ligaments at the base of the thumb and to serve as a cushion in lieu of the removed bone.
The procedure is often referred to as a suspensionplasty because the thumb looks suspended on the x-ray after surgery .
It takes about one hour to perform the surgery. You can expect to be at the surgery center for 3-4 hours .
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Looking For More Information On Thumb Braces
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The Best Thumb Braces For Arthritis
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Arthritis affects millions of people in the United States. For some individuals, arthritis pain can be severe and affect their ability to perform daily tasks. A thumb brace may help reduce pain resulting from arthritis and other conditions.
The American Society for Surgery of the Hand states that thumb arthritis is the second most frequently occurring form of arthritis in the hand.
This article discusses thumb braces and when to contact a doctor. It also answers some frequently asked questions.
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What Are The Symptoms Of Thumb Basal Joint Arthritis
Symptoms of arthritis at the base of the thumb include pain, swelling, deformity, stiffness, loss of strength, anddifficulty with everyday tasks such as writing, typing, twisting open tight lids or jars, using scissors or pliers, andsqueezing or pinching items between the thumb and the other digits .
What Are The Treatment Options For Arthritis At The Base Of The Thumb
Less severe thumb arthritis will usually respond to non-surgical care. Pain medication, topical agents, splinting, and limited use of corticosteroid injections may help alleviate pain. A hand therapist might provide a variety of rigid and non-rigid splints to support the thumb during activities.
Patients with advanced arthritis or who do not respond to non-surgical treatment may be candidates for surgical reconstruction. A variety of surgical techniques are available that can successfully reduce or eliminate pain and improve thumb position and function. Common surgical procedures include removal of arthritic bone and joint reconstruction , bone fusion or realignment techniques, and even arthroscopic procedures in select cases. A consultation with your treating surgeon can help decide the best options for you.
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What Are The Risk Factors For Thumb Arthritis
Thumb arthritis typically occurs after age 40. It is more common in women, but it can affect men, too. There is a genetic predisposition that makes people more likely to develop thumb arthritis.
Thumb arthritis is unbelievably common, and if we look at the X-rays of people in their 50s, 60s, and 70s, 30 to 50 percent of that population can have it, Dr. Luo says. But not everyone will have symptoms that are severe enough to require any treatment.
Who Gets Arthritis At The Base Of The Thumb
Arthritis at the base of the thumb is more common in women and usually starts after age 40. The cause of this form of arthritis is unknown in most cases. Past injuries to the joint, such as fractures or severe sprains, and generalized joint laxity may increase the chances of developing this form of arthritis at a younger age.
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Thumb Osteoarthritis Is Caused By Joint Instability Due To Ligaments That Are Weakened Or Damaged By Overuse Or By A Traumatic Injury To Restore A More Natural Movement To The Thumb Joint You Have To Examine And Explore The Repair Of The Thumbs Ligaments
To restore a more natural movement to the thumb joint, you have to examine and explore the repair of the thumbs ligaments. Repairing the thumb ligaments should be the main objective of treatment. We are going to discuss this below.
Research: Thumb osteoarthritis is caused by joint instability due to ligaments that are weakened or damaged by overuse or by a traumatic injury.
This is according to researchers from Indiana University School of Medicine, Tufts University School of Medicine, University of Bristol, Bristol, and the Dutch university researchers who made this statement in their paper: Yet more evidence that osteoarthritis is not a cartilage disease, published in the British Medical Journal.
Causes Of Thumb Arthritis And Risk Factors
Basal joint arthritis of the thumb is more common in females over the age of 40. The exact cause of thumb arthritis is unknown, but researchers have postulated that its a combination of factors including joint ligament laxity, deformed joints, prior fracture or injury to the thumb, and repetitive load to the joint.
In the normal joint, cartilage covers the ends of bones to allow for smooth glide with movement of the thumb and act as a shock absorber. The thumb basal joint is a specialized joint that is saddle-shaped and allows for significant amount of motion for everyday activities involving pinching and grasping.
With progressive wear and tear , the cartilage becomes thinner and there is direct contact between the bony surfaces .
In advanced stages, bone spurs, or osteophytes, can form in the joint, causing the thumb metacarpal to slide out of the saddle. Hyperextension instability can also occur in the adjacent joint .
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Why Is Trapeziectomy Done
The primary reason to undergo trapeziectomy is to resolve pain at the base of the thumb that becomes worse with movement or activity . If left untreated, the pain may be felt even during inactivity or rest and result in deformity at the base of the thumb.
Other indications for trapeziectomy can be:
- Tenderness, swelling, and stiffness at the base of the thumb.
- A thumb that appears crooked with limited range of motion.
- Difficulty in gripping or grasping objects or in pinching.
- Feeling of a crunchy sound at the thumb base with certain movements.