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Arthritis of the Thumb Base

Arthritis of the Thumb base Fundamentals

The basilar joint of the thumb, or carpometacarpal (CMC) joint, is unique because it provides mobility and stability. However, years of use or injuries may cause dysfunction and pain in this joint. This problem occurs when the cartilage buffer between the bones that permits pain-free movement is worn away and the bones rub against each other. This cartilage loss can result in bone-on-bone friction, arthritis, and pain at the thumb base. Arthritis at the small joint at the thumb base is also referred to as "CMC Arthritis" or "Basal Joint Arthritis."

What are the causes?

The disease usually develops over a period of several years. Occasionally, it is accelerated by an injury or fracture. However, arthritis conditions are typically the result of the natural aging process and the wear and tear that comes with daily use. Women over 40 generally are more often affected by arthritis of the thumb base than men are by a ratio of 10 to 1.

Swelling at the thumb base, occasional warmth about the area, tenderness to the touch and pain when pinching or grasping, can indicate arthritis of the thumb base. Turning door knobs or jar lids and opening car doors can become difficult for those with this condition. The pain limits function and its intensity varies depending on your activity level. As the disease progresses, the joint at the thumb base may appear enlarged and swollen. Eventually it becomes more difficult to open the hand around large object.

What are the benefits of treatment?

Early symptoms of arthritis often respond to splinting, rest or injection of anti-inflammatory medication into the thumb base. Eventually, however, like other forms of arthritis, this degenerative disease will worsen over time. If the arthritis becomes so painful that it limits daily activities, surgery is the only option for definitive relief. Following surgery, most patients experience complete or near-complete pain relief along with the recovery of a satisfactory range of motion.

What are the risks of treatment?

Risks include nerve injury, infection, bleeding, and stiffness. Reflex sympathetic dystrophy is a rare condition individuals could develop and results in generalized pain, swelling and stiffness of the entire hand.

How do I prepare for surgery?

Always ask your surgeon for complete pre-operative preparation instructions. Typically, these may include:

  • Complete any pre-operative tests or lab work prescribed by your doctor.
  • Arrange to have someone drive you home from the hospital.
  • Refrain from taking aspirin and non-steroidal anti-inflammatory medications (NSAIDs) one week prior to surgery.
  • Call the appropriate surgery center to verify your appointment time.
  • Do not eat or drink anything after midnight the night before surgery.

What do I do the day of surgery?

  • If you currently take any medications, take them the day of your surgery with just a sip of water.
  • Refrain from taking diabetic pills or insulin.
  • Do not wear any jewelry, body piercing, makeup, nail polish, hairpins or contacts.
  • Leave valuables and money at home.
  • Wear loose-fitting, comfortable clothing.

What happens during surgery?

Several surgery options are available. One method is to remove the destroyed joint surfaces, and create a substitute joint – a procedure known as arthroplasty. The procedure requires an incision in the forearm and over the arthritic joint. Almost all surgeries require removal of all or part of the small wrist bone, the trapezium. In most cases, the space created by removing the trapezium will be filled with tendon material, which can be used to suspend and stabilize the base of the first metacarpal so that the reconstructed thumb will regain strength.

What happens after surgery?

The wrist and thumb are immobilized in a large bandage with a rigid splint to protect the thumb and prevent mobility. The fingers are left free and the tip of the thumb is permitted to move.

Once you return home, rest and elevate your affected joint and apply ice. Be sure to move your arm frequently and keep it dry. Use of hand is allowed only with the splint on. However, activity will be limited with this temporary splint. This will be replaced with a removable custom splint or cast 7 to 14 days following surgery(depending on the recovery), and worn full time for one full month. Thereafter exercise will begin and the splint will be used for protection during activities.

How long is the recovery period?

Within three months, restoration of thumb motion begins and pain is diminished. Most normal activities can resume in about six months and even earlier for some patients. Strength recovery takes 3-6 months and improves depending upon the amount of weakness prior to surgery and the intensity of the strengthening exercises during rehab.

What is the rehab after surgery?

Thumb exercise therapy at home typically begins four to six weeks after surgery. Elevation of the hand for several days as well as vigorous finger motion is vital to prevent swelling and stiffness. Use of the hand ranges in the individuals toleration level. Performance of most daily activities should return. Therapy lasts 3-4 months with the physician and the remainder is done at home.

How can I manage at home during recovery?

The post-operation splint is worn full time and must be covered in showers. The activity level is based on the patients tolerance. This splint will be changed to a removable splint or cast after 7-14 days. The removable splint can be worn in the shower. The results depend on patient exercise and involvement in the therapy.

How frequently should I schedule follow-up appointments with my doctor following surgery?

The first follow up appointment should be scheduled 7-14 days after the surgery. Two more should be scheduled for 3 months and 6 months following the operation.

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This information is provided by Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition.

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