Thumb arthritis is a common cause of pain at the base of the thumb. It can make everyday activities such as opening jars, turning keys, lifting pans or gripping objects uncomfortable and difficult.
Mr Robert Farnell is an experienced specialist Consultant Orthopaedic Hand and Wrist Surgeon who has been working in Leeds for over 25 years. He exclusively treats conditions affecting the adult hand and wrist, including carpal tunnel syndrome, trigger finger and thumb, thumb arthritis and Dupuytren’s disease.
What is osteoarthritis?
Arthritis is a condition that results in damage or destruction of a joint. Osteoarthritis is the most common type of arthritis and is often referred to as degenerative joint disease or “wear and tear”.
Normal joints are lined by cartilage, which allows the bones to move smoothly over each other. In osteoarthritis, this layer of cartilage becomes thinned or absent. This can lead to joint stiffness, swelling, deformity and pain.
What is thumb arthritis?
Thumb arthritis usually refers to osteoarthritis affecting the joint at the base of the thumb. This joint is also known as the basal thumb joint, the first carpometacarpal joint or the CMC joint.
The joint at the base of the thumb is very mobile. It allows the thumb to move through a large range of movement, including opposition, where the thumb moves across the palm to touch the little finger. This movement is important for normal hand function, grip and pinch strength.
The basal thumb joint is saddle-shaped and is formed by a small wrist bone called the trapezium, and the thumb metacarpal bone. Arthritis at this joint is more common in women and typically occurs over the age of 40. However, the presence of arthritis on an X-ray does not always mean that symptoms will be present.
Symptoms of thumb arthritis
Pain at the base of the thumb is the most typical symptom of thumb arthritis. Patients often describe a background ache at the base of the thumb which is present most of the time.
The pain is often worse during activities that involve pinching or gripping with the thumb. These may include:
- Opening jars
- Turning keys
- Lifting heavy items
- Lifting a kettle
- Writing or using small objects
- Using scissors or tools
Loss of thumb movement is often present, although patients do not always notice this at first. Some people also notice a grinding, cracking or grating sensation when moving the thumb. This is known as crepitus.
How is thumb arthritis diagnosed?
Your doctor will usually be able to make the diagnosis after listening to your symptoms and examining your thumb. The examination may assess tenderness at the base of the thumb, pain with movement, grip strength, pinch strength and thumb mobility.
An X-ray will usually confirm the diagnosis and show the degree of arthritis affecting the basal thumb joint.
Find out what to expect at your outpatient appointment.
Treatment for thumb arthritis
Treatment depends on the severity of your symptoms, how much the arthritis affects day-to-day activities and whether non-surgical treatment has already been tried.
Non-surgical treatment
Many people respond well to non-surgical treatment. This may include:
- Activity modification and rest
- Pain relief medication
- Anti-inflammatory medication, if tolerated
- A thumb splint
- A steroid injection into the joint
A thumb splint can help support the joint and reduce pain during activities. A steroid injection may reduce inflammation and pain, although the amount and duration of improvement can vary.
Surgical treatment
Surgery may be considered when symptoms remain troublesome despite non-surgical treatment.
Several surgical procedures have been described for thumb arthritis, but the gold standard operation has been to remove the trapezium bone. This procedure is commonly known as trapeziectomy.
Some surgeons also use part of a wrist tendon to reconstruct the thumb ligaments and provide a mass of tissue to fill the space where the bone has been removed. Mr Farnell will discuss which operation is most suitable for you, based on your symptoms, examination findings and X-ray appearances.
More recently, a thumb joint replacement has become available. This may be suitable for some patients acknowledging the long-term results are still evolving.
Read more about trapeziectomy surgery.
What happens during thumb arthritis surgery?
Surgery for thumb arthritis is usually performed as a day case procedure. It is often carried out using regional anaesthesia, where the limb is temporarily anaesthetised.
After surgery, many surgeons immobilise the thumb in a plaster cast for up to six weeks before mobilisation is started. The aim of surgery is to relieve pain while maintaining useful thumb movement.
Recovery after thumb arthritis surgery
Recovery after surgery takes time. The thumb is commonly protected in a plaster cast or splint during the early recovery period. Hand therapy or guided exercises may be used to help restore movement, strength and function.
Surgery is usually successful at reducing or removing thumb pain while maintaining thumb mobility. Recovery times can vary depending on the operation performed, the severity of the arthritis and the physical demands of the patient’s normal activities.
Read more about post-operative care.
Possible complications of surgery
Surgical complications are fortunately uncommon. Possible complications include:
- Infection, which occurs in approximately 1% of cases
- Temporary scar tenderness
- Numbness or sensitivity over the back of the thumb
- Finger stiffness
Concerned about pain at the base of your thumb?
If thumb pain is affecting your grip, pinch strength or day-to-day activities, Mr Robert Farnell can assess your symptoms and advise whether splinting, injection treatment or surgery may be appropriate.
Thumb arthritis FAQs
These answers are provided to help patients understand the key points about thumb arthritis, symptoms, diagnosis and treatment options.
What is thumb arthritis?
Thumb arthritis is osteoarthritis affecting the joint at the base of the thumb. This joint is called the basal thumb joint, first carpometacarpal joint or CMC joint.
What does thumb arthritis feel like?
Thumb arthritis usually causes pain at the base of the thumb. The pain is often worse with pinching, gripping, opening jars, turning keys or lifting heavy objects.
What causes pain at the base of the thumb?
Pain at the base of the thumb is commonly caused by osteoarthritis of the basal thumb joint. Other hand and wrist conditions can also cause thumb pain, so assessment is recommended if symptoms persist.
Who gets thumb arthritis?
Thumb arthritis is more common in women and typically occurs over the age of 40. However, arthritis seen on an X-ray does not always cause symptoms.
How is thumb arthritis diagnosed?
Thumb arthritis is usually diagnosed through clinical examination and confirmed with an X-ray.
Can thumb arthritis be treated without surgery?
Yes. Many people improve with non-surgical treatment such as activity modification, rest, pain relief medication, anti-inflammatory medication, a thumb splint or a steroid injection.
Does a thumb splint help arthritis?
A thumb splint can help support the basal thumb joint and reduce pain during activities that involve gripping or pinching.
Can a steroid injection help thumb arthritis?
A steroid injection into the thumb joint may reduce pain and inflammation. The amount and duration of symptom relief can vary between patients.
When is surgery considered for thumb arthritis?
Surgery may be considered when pain remains troublesome despite non-surgical treatment and the arthritis is affecting everyday hand function.
What is the gold standard operation for thumb arthritis?
The gold standard operation for arthritis at the base of the thumb has been removal of the trapezium bone. This operation is commonly known as trapeziectomy. As the newer joint replacements become more established, this may change in the future.
Is thumb arthritis surgery successful?
Surgery is usually successful at relieving thumb pain while maintaining thumb mobility. The exact recovery depends on the operation performed and the patient’s individual circumstances.