Arthritis of The Thumb
Arthritis is an inflammatory condition of joints. There are several types of arthritis; the most common type is osteoarthritis or wear-and-tear arthritis that affects the joint at the base of the thumb. Thumb arthritis is more common in women than men, and usually occurs after the age of 40 years. Patients who have arthritis of the base of the thumb commonly have pain with strenuous grasping activities initially, and as the disease progresses they can have pain at rest and even pronounced tenderness at the site.
The diagnosis of thumb arthritis can be made by physically examining the thumb area. X-rays of the joint may be taken to note the severity of the disease and to help determine the appropriate treatment.
Nonsurgical treatment methods for relieving pain in an arthritic joint include activity modification, non-steroidal anti-inflammatory pain medications, and use of splints, and steroid injections. Surgery is usually considered if nonsurgical treatment fails to give relief. There are different surgical procedures that can be used and may include:
Synovectomy: This surgery is usually indicated for early cases of inflammatory arthritis where there is significant swelling (synovitis) that is causing pain or is limiting the range of motion of digits and thumb. Synovectomy is a surgical removal of the inflamed synovium (tissue lining the joint). The procedure may be performed using arthroscopy.
Arthroplasty: In this procedure, your surgeon removes the most diseased portions of the joint and replaces them with an anatomic artificial implant. This type of implant is not suitable for these severely damaged or unstable joint, nor can it be used when arthritis is also present in other nearby joints. In this case, the trapezium is removed. In patients with post-traumatic arthritis and osteoarthritis where the bone is hard and demand on the hand is moderate, new ceramic implants are used.
Arthrodesis: A fusion, also called an arthrodesis involves removal of the joints and fusing the bones of the joint together using metal wires or screws. Even though this surgery eliminates all motion at the base of the thumb, the resulting fusion is very hard.
This surgery is usually indicated when the joints are severely damaged, when there is limited mobility, damage to the surrounding ligaments and tendons, failed previous arthroplasty, and sometimes when heavy manual use is suspected.
Your surgeon will discuss the options and help you decide which type of surgery is the most appropriate for you.
Rehabilitation
Following surgery, a rehabilitation program, often involving a physical therapist may help to regain hand strength and movement. You may need to use a post-operative splint for a while after surgery that helps to protect the hand while it heals. Depending on which surgical procedure you have performed, activities may need to be restricted for 2-12 weeks to allow for proper healing. Depending upon one’s ability to successfully rehab, normal activities should be able to be resumed between 1 and 3 months following surgery.
