Arthritis of the Thumb
The bones that make up the hand and the wrist provide the body with support and flexibility in order to manipulate objects in many different ways. With the support of the ulna and radius of the forearm that support many of the hand's muscles, the 27 bones in the hand have an incredibly precise range of motion. The hand can be considered in four segments:
- Fingers - digits that extend from the palm of the hand, making it possible to grab the smallest of objects
- Palm - the "high-five" side of the hand
- Dorsum - the back side of the hand where a web of veins is often visible
- Wrist - the point of connection between the hand and the forearm which facilitates proper motion of the hand
These four segments, along with a network of muscles, tendons, and tissues work cohesively to enable the hand to perform the most complicated activities. Unfortunately, like the rest of the body, hands and wrists are susceptible to number of different injuries and conditions.
Arthritis of the thumb, also known as basal joint arthritis, is the most common form of osteoarthritis that affects the hand. Osteoarthritis occurs when the protective cartilage on the ends of the bones wears down over time. It's often called a degenerative joint disease where the cartilage experiences a significant amount of wear and tear over a long period of time. Basal joint arthritis occurs more frequently in women than in men, frequently after the age of 40. Though it is a condition that develops over time, previous injuries or fractures to the joint may increase the likelihood of developing this condition in the future.
Individuals who have developed basal joint arthritis experience some of the following symptoms:
- Pain or loss of strength when performing activities that require gripping or pinching motions
- Swelling or tenderness at the base of the thumb
- Discomfort or pain after prolonged use of the thumb joint
- A visible bump over the thumb joint
Early diagnosis and treatment of arthritis of the thumb can greatly help in reducing symptoms. Therefore, it is advised to visit a physician if an individual experiences any of the aforementioned symptoms or suspects basal joint arthritis.
Diagnosis of basal joint arthritis is generally made entirely upon a physical examination. After taking a full history of the symptoms and any prior injuries, the physician will examine the thumb for the symptoms mentioned above and to determine the range of motion. The physician might hold the joint firmly while moving the affected thumb to look for signs of pain or grinding sound - this indicates bone on bone friction which means the cartilage cover the joints have experience thinning and overall damage. Often, individuals who develop basal joint arthritis are also susceptible to developing carpal tunnel syndrome, so it is likely that the physician will look for signs of that as well. The physician may then order an X-ray of the thumb to identify the severity of the deterioration of the joint as well as any calcification or bone spurs that may have developed as a result of the arthritis.
Early diagnosis of the basal joint arthritis will typically respond quite well to non-operative treatment. The main objective of treatment is controlling inflammation and preserving or restoring the function of the joint. Operative treatment is always a last resort after non-operative approaches have been exhausted.
Ice - Placing ice (with a barrier such as a towel) on the most painful areas of the thumb joint for up to 15 minutes (less if the skin becomes numb) several times a day can greatly soothe the pain and keep the swelling down.
Medication - Pain relief medication such as acetaminophen as well as non-steroidal anti-inflammatory medicines (NSAIDs) can significantly reduce pain and swelling.
Splint - The physician might recommend the use of a supportive splint worn over night or throughout the day to limit the movement of the thumb in order to allow the joint to rest and heal naturally.
Steroid Injections - Injecting the thumb joint with cortisone, a powerful anti-inflammatory medicine, might aide in decreasing pain for several months, however, the pain is likely to return.
Surgery - Surgery may be an option when more-conservative treatments don't relieve pain caused by severe basal joint arthritis. Options must be discussed extensively with the physician to identify the appropriate surgical procedure.
Recovery, especially after a surgery, can take several months. Each patient is unique and their recover will depend on the treatment method prescribed by the physician. If surgery is deemed necessary, the individual may be in a cast or splint for up to eight weeks depending on the severity of the condition and the complexity of the procedure. Full recovery from surgery will take several months at which point the individual may return to their prior level of activity.
CALL 911 IMMEDIATELY IF YOU ARE HAVING A MEDICAL EMERGENCY!
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