Treatment Options for Thumb Arthritis
What is arthritis?
Arthritis is an umbrella term that encompasses more than 100 conditions. The term refers to a joint in the body being irritated by the breaking down of the cartilage surfaces of the bones. The cartilage surfaces start out smooth and with relatively low friction through movement of the joint. The fluid in the joint, or lubricating synovial fluid, additionally allows the joint surfaces to move past each other without friction.
The cartilage surfaces can wear thin or wear completely through to the underlying bones. This causes irregular surfaces that rub against each other, which can lead to pain, inflammation, swelling and often decreased range of motion.
The breaking down of the cartilage produces an“unhealthy” joint fluid that causes a snowball effect in the joint. Irritating chemicals become present and continue the breakdown of the joint. Most patients experience this described type of wear and tear arthritis, also known as osteoarthritis, which is the most common type of arthritis. However, arthritis may also be caused by autoimmune diseases such as rheumatoid arthritis, previous injury, gout, infection and psoriasis.
Where does arthritis occur in the hand?
Any joint can develop arthritis, but it is very common in the hand. This occurs due the repetitive activities of the hand and the high forces that are transmitted across the joints of the hand with pinching, twisting and grasping. Some joints see as much as 14 times the force applied at the finger tips. For example, pinching something with 10 pounds of pressure at the fingertip, like a key, translates to 140 pounds of pressure at the joint at the base of the thumb.
What are the symptoms of hand arthritis?
A person with hand arthritis will most commonly experience stiffness, transient swelling and pain at the affected joints. Arthritis in the fingers can cause the last two knuckles of the hand to become permanently enlarged and lose motion. Thumb arthritis, or basilar arthritis, can cause an aching pain at the base of the thumb. The symptoms are worse with forceful gripping or pinching with the thumb, such as turning a key or opening a jar.
What are the treatments for hand arthritis?
Most of the symptoms of hand arthritis can be treated without surgery. The primary goals of treatment are to diminish the pain and to allow normal use of the hand. Anti-inflammatory medications can decrease the irritation of the joint. Resting the arthritic joint can also help with the pain. Braces or splints should be worn during activities that aggravate the symptoms to help support the joint and provide relief. Warm wax and paraffin baths also can help arthritic hands. Steroid or cortisone injections into the arthritic joints can be effective for decreasing the pain and inflammation in the joints.
New and innovative ways of treating these common conditions include different injection therapies, such as hyaluronic acid and growth factor injections. These show some promising results but are not established as the standard treatment and have a higher cost. Early comparative results to cortisone show greater benefit and less potential for adverse effects.
In Dr. Lehman’s experience, thumb arthritis doesn’t respond to the growth factor injections when it is severe and doesn’t respond as well as other joints, in general, to most conservative treatments. She keeps this in mind when recommending a treatment plan.
When does hand arthritis need surgery?
Surgery is recommended to a patient when the patient’s pain is not controlled by nonsurgical interventions or their ability to have good hand function has been too compromised by the pain or deformity. Thus, the goals of surgery are to restore function and reduce if not eliminate the pain.
There are many surgical options to address the pain and loss of function. Joint replacement or joint reconstruction involves removing the rough surfaces of the joint and replacing them with either tendon, metal, or plastic. Another option is to fuse the arthritic joint in a position of function thereby eliminating the abrasive motion between the arthritic bones. Both of these options can be accomplished through fairly limited incisions and downtime. After surgery the patient also works very closely with a hand therapist to maximize and speed their recovery.
If you are seeking treatment for your thumb arthritis, request an appointment at Carolina Orthobiologics. We can lay out your treatment options and help you decide which is right for you.
18 Medical Park Drive
Asheville, North Carolina 28803