Base of thumb arthritis is the most common form of osteoarthritis in the hand, second only to arthritis affecting the Distal Interphalangeal Joints (DIPJs). It is commonly associated with Nodal arthritis, which is a type of arthritis that tend to run in families. I’ll often say to my female patients that they will often end up with their mothers hands. That sometimes doesn’t make me popular, but allows people to have an idea of what the future may hold.
Thumb arthritis will often start affecting ladies in around the 40s or 50s, sometimes around the menopause.
Use of painkillers is always useful. Obviously some have side effect versus others and should be discussed if you have concerns with your GP.
They can be used to some extent prophylactically – if you know you are going to be using your hands heavily (eg gardening). Most people will pay some price for this sort of work and it’s good to have some pain killers on board both during and after the activity.
Denervation – this is a surgery where the nerves that supply the joint, and therefore send pain signals, are cut. The theory is that the pain signals are then not sent and the pain improves. The results can be variable amongst patients. It’s rare to get somebody totally pain free after the operation, but on average in my hands a 70% improvement in about 70% of the people that have the procedure.
The advantage of this surgery is that it is quicker to get over, the bone is left behind and it doesn’t burn any bridges for future surgery (or steroid injections).
The disadvantages are the unpredictable outcome, the fact the arthritic process is still on going and also the fact that the mechanics and position of the thumb aren’t altered.
Trapeziectomy is an operation to remove the trapezium (-ectomy, to remove). This means that the two worn out surfaces are no longer rubbing together and producing the pain.
However that does mean that structurally there is not a bone underneath the thumb supporting it, so a soft tissue envelope or sling is produced to keep the thumb where it should be.
Most people will say that their thumb isn’t as strong after the surgery as it was before the operation. However most people say they can use it much more as it doesn’t hurt and has a better range of movement.
This is where the worn out ends of the bone are removed to reveal a raw, cut surface. These two surfaces are then put together and squeezed with a plate and screws. These conditions will normally cause the bones to heal together. This therefore gets rid of the pain causing joint.
As you can imagine it means that the movement in the thumb is less (as the joint has been obliterated), but it will be very strong as the thumb is still supported by bone rather than soft tissue. Thumb movement is produced at other joints. One concern with this treatment is that it puts more force or stress on the remaining moving joints. Also if the adjacent joints get arthritis in them then this can be more difficult (but not impossible!) to manage.
The thumb carpometacarpal joint is an extremely mobile and intricate joint. So far the world of hand surgery hasn’t quite got the perfect joint replacement as a result. Lots of joint replacements have been described which is often because one great one hasn’t been found yet!
In Derby we are currently undertaking a trial with the Cartiva implant – a video of the implant can be seen here to see if it makes a significant difference to symptoms. The advantage of this implant is that if it fails, you can progress to trapeziectomy.