Everything you need to know
What is base of thumb arthritis?
The joint at the base of your thumb, which is called the thumb carpometacarpal joint, is crucial for many daily activities, including gripping, pinching, and grasping objects. The joint connects your thumb to the wrist and is responsible for providing stability and wide range of motion. However, the joint can be susceptible to wear and tear osteoarthritis (when the smooth covering of the joint – the cartilage – wears away), injury, and inflammatory conditions such as rheumatoid arthritis.
Base of thumb osteoarthritis is very common but is more prevalent in older people and in women. Arthritis can also be caused by an injury or previous surgery to the joint.
Normal activity and exercise don’t cause osteoarthritis, although repeating very hard activities over and over again may increase your risk of developing it.
What are the symptoms of base of thumb arthritis?
Osteoarthritis leaves the thumb joint unable to move as smoothly as it should. This causes pain, swelling and restriction of movement. It is not possible to predict how osteoarthritis will develop and progress in each individual.
Your symptoms may vary for no clear reason – you may have good and bad days. However, some patients do notice that certain activities make their symptoms worse.
Common symptoms include:
- Pain – This tends to feel worse when you move your thumb or at the end of the day.
- Stiffness – Your thumb may feel stiff after rest, but this usually wears off with movement. The joint may also creak or crunch when you move it.
- Restricted movement – Your thumb may not move as freely or as much as normal. You may find everyday tasks difficult, such as texting, opening jars or turning a key.
- Appearance – In advanced cases, there may be a bump at the base of the thumb and the middle thumb joint may bend back, looking like a zigzag. The muscles around your joint may look thin and your thumb may swell.
Before
Firstly, you will need an appointment with one of our Hand & Wrist consultants. Your consultant will make an assessment, discuss your symptoms and review your medical history. They may also order imaging tests, such as X-rays, to assess the extent of the damage to your thumb joint.
Doctors will always try to manage a problem with non-surgical treatments first. If you have base of thumb arthritis, there are a number of options:
Self-Help
- Consider using heat (hot water bottle or heat pack) and taking a painkiller before going to bed.
- Consider adapting your work environment.
- Eat a well-balanced, healthy diet. Some people find getting additional nutrients from food supplements can be helpful. Important vitamins and minerals to consider when you have arthritis are calcium, vitamin D and iron. Turmeric, glucosamine, selenium, and vitamin C are also potentially helpful supplements, but don’t help everyone.
Hand Therapy
A hand therapist can provide you with a home exercise programme to help reduce joint stiffness and improve thumb movement. When you have arthritis, it is important to keep your joints moving and improve the strength of the muscles which control the thumb.
Your therapist may also educate you on activity modification, joint protection, adaptive equipment, and splinting.
Our hospital has an excellent hand therapy service which can support you.
Pain Management
Paracetamol, anti-inflammatory medications (such as aspirin and ibuprofen) or anti-inflammatory gels may help reduce pain. This should always be discussed with a doctor or pharmacist who can give you appropriate advice.
Joint injections
If you are still struggling with pain after trying other non-surgical interventions, a steroid injection may provide temporary relief.
It’s important to note that:
- Injections are not always successful in relieving pain, and the length of time for which they work varies from patient to patient. They can take 2-3 weeks to take effect.
- Injections carry a risk of infection, increased pain, and skin changes.
Your consultant will discuss whether an injection is an appropriate treatment for you.
Surgery is usually only considered when less invasive treatments have not provided sufficient relief.
During
Thumb joint replacement replaces the painful arthritic joint at the base of the thumb with an artificial joint. The aim is to give good pain relief and a better quality of life. After the operation, patients can resume activities such as writing, gripping, and lifting without experiencing discomfort.
Alternatives to a thumb joint replacement, such as a trapeziectomy, will be discussed with you. Like any surgical procedure, a thumb joint replacement carries some risks. Your surgeon will discuss the risks and benefits of the procedure with you so you can make an informed decision.
Pre-Assessment
If you decide to have a thumb joint replacement, before your surgery, you will need to come into hospital for a pre-assessment, where we can check your fitness for surgery. This is a standard check and includes a physical exam, blood tests, heart, and lung function tests.
If you take any blood thinners—for example, warfarin or aspirin, tell your doctor straight away, as you may need to stop taking these or modify your intake from a week before surgery. Your doctor will give you specific instructions if this is the case. You should also tell your doctor if you take nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen.
Surgery day
You will receive anaesthesia on the day of surgery to help manage pain and keep you comfortable during the operation. Your consultant will discuss your options for anaesthesia, such as general anaesthesia and/or regional block anaesthesia, and help you choose the best option for your needs.
For both general and regional anaesthesia, you should stop eating six hours before surgery. Two hours before, you should stop drinking (including water), chewing gum and sucking boiled sweets. Brush your teeth with toothpaste only on the morning of surgery.
Wear loose, comfortable clothes and bring a small bag with things you might need during your stay. Items to remember include a toothbrush and toothpaste, your phone and a charger, and any prescription medications. Your doctor will let you know if you can take any medications with a sip of water before surgery or if you should wait until after.
Once you have arrived and are settled in your room, a nurse will monitor your vital signs (such as body temperature and blood pressure) and run through your medical history, medications and emergency contacts.
Your doctor will then once again run you through the procedure and ask you to sign a consent form for surgery.
The surgery
The surgery will start with a cut in the skin near the thumb so your surgeon can access the joint. The surgeon will then remove any damaged cartilage and bone from your thumb and wrist and replace it with an artificial implant made from metal and plastic. Your surgeon will close your incision with stitches and cover it with bandages. The procedure usually takes one hour and most patients can return home the same day.
After
Once we’re happy you’re doing well, we will take you to your private room where you can start your recovery. When you are ready to leave, you will need someone to collect you from hospital as you will not be able to drive.
If you had general anaesthesia, someone will need to help you at home for 24 hours as you will be very tired. You should not drink alcohol, cook or make important decisions during this time.
Recovery time varies from patient to patient, but most people can expect some discomfort and swelling in their hand for the first few weeks after surgery.
Two weeks after surgery, you will need to have a check-up with your consultant where your stitches will be removed. You will then need to wear a splint or a thumb cast for several weeks to protect the new joint and aid healing.
Specialist hand therapy is often recommended after surgery to help strengthen the hand and improve movement. Our hand therapy service can support patients with their recovery.
Recovery from a thumb joint replacement typically takes several months to a year, with a gradual return to normal activities and optimal hand function. Your exact timeline will vary depending on individual factors and adherence to rehabilitation.
Medically reviewed by Mr Alistair Hunter - MA MBBS MSc FRCS (Tr&Orth) FHEA Dip Hand Surg on 13/11/2023
How to pay for your treatment
If you’re… paying for yourself
Did you know you don’t need private medical insurance to come to St John & St Elizabeth Hospital? As a self-pay patient, you can access safe, outstanding quality health care at times to suit you.
For scans and tests, as well as to see most consultants, you’ll still need to be referred by a medical professional like your GP, but as a self-pay patient, the process is more straightforward. You won’t need authorisation from an insurance provider, and you’ll have greater choice of consultant and appointment times.
If you’re… insured
St John & St Elizabeth Hospital is approved by all major medical insurance companies. If you have a personal private health insurance policy, or your company provide it for you, you can use it to pay for your care from your initial consultation through to treatment, surgery and aftercare such as physiotherapy. Not all private health insurance plans cover the same things. It’s very important to check exactly what you are covered for with your insurance provider.