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By David Singer, MD, Plastic and Reconstructive Surgeon
The Chester County Hospital
Published: March 26, 2007
People with thumb pain quickly realize how often they use their hands. Daily activities can become difficult, even disabling. Turning a door knob, opening a pickle jar, and turning the key in the car ignition are all continual reminders of their problem. Most patients learn to accept the discomfort, adapting their hand use to minimize the provoked pain. Progression of the symptoms often leads a patient to seek consultation by a hand surgeon.
The most common diagnosis is thumb basal joint arthritis. Due to the fact that the thumb's base joint is such a mobile structure, there is a predisposition to develop severe arthritis. Alternative diagnoses must be excluded such as carpal tunnel syndrome, tendonitis, and wrist arthritis. Interestingly, women with the disorder outnumber men by a ratio of almost ten to one. Furthermore, people with mechanical loading activities, such a massage therapists or manual laborers, have a greater tendency to develop the disorder. Basal joint arthritis can occur in both hands, typically with one side more severe in symptoms. The common complaints are painful pinch activities (such as clipping nails) and limited breadth of grasp as in pulling things from a grocery shelf). More advanced disease can lead to a slipping sensation at the thumb base and an enlarging prominence of this area.
The clinical exam of the hand and x-rays, along with the severity of symptoms will direct the treatment of this disorder. Conservative management is the general approach, as many patients respond well to these measures. Initial treatment is a multi-faceted regimen between the hand surgeon, hand therapists, and modification of normal activities. Anti-inflammatory medication combined with steroid injections of the joint can alleviate symptoms. These measures are coupled with proper thumb splints and protecting the thumb from the movement that leads to provoking symptoms. Hand therapists play a vital role in educating the patient on joint protection techniques, work modification principles, and an exercise program focusing on strengthening the muscles around the joint. The therapists can also use modalities to reduce pain and inflammation. The majority of patients can avoid surgery, with successful improvement of symptoms.
In the patient who fails conservative therapy, surgical intervention is determined by factors such as pain, deformity, weakness that interferes with daily activity, and x-ray changes. The radiograph helps guide the treatment approach. In addition, the hand dominance and work/leisure activities must also be considered. The surgical techniques include interposition of spacers into the joint, reconstruction of the ligaments around the thumb base with excision of the joint/bone arthritis, and joint fusion. Surgery requires a period of convalescence, allowing for healing and surgical swelling to subside. By two to three months, most patients will have undergone hand therapy and are returning to normal daily hand activities. When symptoms are severe and surgery is elected, most patients have a profound improvement in quality of life and relief of pain. Most importantly, patients must be carefully evaluated for how the disease impacts their lifestyle, matching the treatment to optimize the outcome.
This article was published as part of the Daily Local News Medical Column series which appears every Monday. It has been reprinted by permission of the Daily Local News.
Last Updated: 7/27/2009