Health Matters 2/28: Treatment can ease pain of stiff, achy thumbs

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By Jon Ark, M.D.

Your thumbs have an incredible range of motion. Just consider how many things you do that require them to pinch, poke, grip, bend, or twist.

Because many of these actions tend to be repetitive, like texting and typing, osteoarthritis in the thumbs is a common problem, particularly as you grow older.

And it can be debilitating, impairing your ability to perform even the most basic every day activities from turning a doorknob to buttoning your shirt.

Once diagnosed, however, treatment – ranging from medication to surgery – can help decrease pain and increase mobility.

Common With Age 

In healthy thumbs, cartilage cushions the joints so they move smoothly, but repetitive motion can cause this slippery cushion to wear away, leaving the joints exposed, causing friction and damage to the bones.

The condition is common, particularly as you age and become more prone to develop arthritis in your joints.

Moreover, according to the American Academy of Orthopaedic Surgeons, a combination of factors beyond age may increase the likelihood of developing thumb arthritis, including:

• Past injuries, such a sprains or fractures, of the thumb
• Prior instances of trigger finger of the thumb
• Obesity
• Hereditary conditions, such as loose ligaments or malformed joints
• Rheumatoid arthritis
• Any activity that puts high stress on the thumb

In addition, women are more likely to experience thumb arthritis than men, and many people with thumb arthritis may also suffer from carpal tunnel syndrome.

Losing Your Grip

Early symptoms of thumb arthritis include pain and swelling around the wrist and the base of the thumb.  The pain may be worse early in the morning and lessen during the day.

Other symptoms of thumb arthritis include:

• Limited range of motion in the thumb joints
• Swelling or bony growth at the thumb base
• Loss of strength in the thumb joint

If you experience symptoms of thumb arthritis, see your doctor for an accurate diagnose and treatment. Arthritis is a progressive and degenerative disease, which means it worsens over time.

Thumbs Up for Treatment 

Diagnosing thumb arthritis typically begins with a physical exam in which your doctor will look for noticeable swelling or lumps on your joints.

Your doctor may hold the joint while rocking your thumb back and forth. If this causes pain or a grinding sound, it means the bones are rubbing directly against each other.

An x-ray can identify deterioration of the joint and bone spurs or calcium deposits and confirm the diagnosis.

Treatment for thumb arthritis typically starts with anti-inflammatory medications, bracing with a splint to rest the joint, and using ice. If that doesn’t offer relief, steroid injections may be recommended. Treatment with steroids can make a difference for a period of time, however long-term steroid use is not recommended.

If the condition remains debilitating, surgery by an orthopaedic surgeon may be
necessary. Surgery is normally performed on an outpatient basis.
There are two primary surgical options:

• A thumb arthroplasty and tendon transfer, which relieves pain and restores functional motion, involves removing part or all of the affected joint and replacing it with a graft from one of your other tendons.

• A fusion of the carpometacarpal joint (the joint at the base of your thumb) may be considered for anyone involved in heavy labor, as it helps preserve strength.

In most cases, a cast will need to be worn for four weeks and a splint for an additional two weeks after surgery. To regain movement and strength, physical therapy is recommended. Full recovery usually takes several months.

The Orthopaedics Program at Penn Medicine Princeton Health offers care for patients with a range of orthopaedic conditions, including thumb arthritis. Care is provided by board-certified physicians with fellowship training in key sub-specialties such as hand surgery. Additionally, high quality hand rehabilitation services are offered by a certified hand therapist.

Living With Thumb Arthritis

Living with thumb arthritis can be challenging, especially because you use your thumbs for almost everything.

In addition to treatment, these arthritis-friendly tools recommended by the Arthritis Foundation can help you regain your grip with less pain:

• Automatic jar openers
• Keyless car starters
• Wide handle tools for kitchen and garden
• Extra chubby writing pens, knives, forks, and spoons
• A hook to help button buttons
• Extra-large pulls for zippers
• Cell phones and television remotes with oversized buttons for easy pushing
• Lamp switch turners
• Gloves that provide mild compression and warmth

To find a physician with Penn Medicine Princeton Health, call 888-742-7496 or visit www.princetonhcs.org.

Jon Ark, M.D., is board certified in orthopaedic surgery and surgery of the hand. He is Chair of Orthopaedics at Penn Medicine Princeton Medical Center.