Roughly a quarter of American adults have arthritis, an inflammatory condition that progressively degrades the cartilage that protects your bones from rubbing against each other in your joints. Over time, the bones wear away, causing pain, stiffness, and limited mobility in the joints.

The thumb joint – or carpometacarpal joint – is a common site for arthritis to develop. This complex joint allows for a wide range of motions, including extension, flexion, adduction, and abduction in all directions. It is critical for pinching and grasping motions and overall hand function. Without proper stabilization, flexibility, and coordination of the muscles and ligaments in this joint, patients with thumb arthritis find themselves unable to grasp objects. Patients with thumb arthritis also commonly have pain, stiffness, and achiness in the joint. Advanced stages of thumb arthritis may cause disfiguration of the joint due to painful bone spur growths and disability.

There are several types of arthritis that can affect the thumb joint including osteoarthritis, rheumatoid arthritis, and psoriatic arthritis.

Osteoarthritis is the most prevalent type of arthritis in the hand, usually affecting the joints at the base of the thumb, the knuckles, and the joints at the end of the fingers. This form of arthritis occurs when the cartilage that cushions the joints wears down, leading to bone-on-bone contact and the development of bone spurs in the finger joints. Rheumatoid arthritis and psoriatic arthritis are chronic autoimmune diseases that cause the joint lining, or synovium, to swell. Whereas rheumatoid arthritis usually occurs symmetrically in both thumbs, psoriatic arthritis may only affect one.

Treatment approaches for hand arthritis depend on the severity of the condition and the patient’s individual needs. Conservative measures such as rest, ice, heat, and physical therapy may be effective for mild cases of hand arthritis. For more severe cases, surgery may be necessary to alleviate pain and restore mobility.

Diagnosing Thumb Arthritis

Our hand surgeons diagnose arthritis in the hand with X-rays and blood tests. On an X-ray, your doctor will look for signs of bone cartilage loss, tenderness, swelling, stiffness, and the formation of bone spurs in the hand. Blood tests can help determine if your arthritis is caused by rheumatoid arthritis versus other conditions.

Non-Surgical Thumb Arthritis Treatments

When you meet with your hand surgeon, you will discuss a variety of treatment options for your thumb arthritis. Our goal is to decrease your carpometacarpal joint discomfort and improve overall hand function. Your surgeon may recommend a variety of treatment options, ranging from at-home treatments to surgery:

• Splinting and Braces: Wearing a splint or brace helps you protect the joint with added stability. A brace can also keep your hand in a good position for joint alignment, which can alleviate pain and discomfort.
• Over-the-Counter Medication: Acetaminophen can help relieve pain, and Ibuprofen may help relieve pain while reducing swelling in the affected joints. Topical non-steroidal anti-inflammatory drugs are often used to treat osteoarthritis symptoms in the hand.
• Corticosteroids: Oral or injected steroid medications can help reduce inflammation in the affected joints.
• Fat Grafting: Fat injections into the affected joints can help relieve symptoms of osteoarthritis. We perform this procedure in our clinic under a local anesthetic.
• Antirheumatic Drugs: Patients with rheumatoid arthritis may get relief from symptoms after taking an antirheumatic drug, such as methotrexate, hydroxychloroquine, or sulfasalazine.
• Hot and Cold Compresses: Applying hot and cold compresses for 20 minutes at a time can help alleviate pain, swelling, and stiffness in the joints.
• Rest: Resting the affected joints will reduce inflammation and can alleviate pain.
• Hand Therapy: Working with a hand therapist can help you strengthen and stretch muscles in your hand to improve symptoms and overall hand function.

Hand Surgery for Thumb Arthritis

If non-surgical approaches aren’t effective, then your hand surgeon may recommend surgery. Based on your symptoms, type of arthritis, and severity of the condition, we have a few surgical approaches we can choose from:

• Volar Ligament Reconstruction: Patients with pre-arthritic inflammation in the synovium due to carpometacarpal joint laxity or thumb hypermobility may benefit from reconstructive surgery to reinforce the volar ligament and stabilize the thumb joint.
• Metacarpal Extension Osteotomy: During this procedure, we remove a dorsal wedge of the metacarpal bone and then lengthen the bone to change the joint mechanics and relieve tension on the arthritic compartments of the thumb joint.
• Joint Fusion: Arthrodesis, or joint fusion surgery, is a common procedure for treating hand arthritis. We use a plate and screws to keep the joint in place, improving joint stability while reducing pain and discomfort. Joint fusion surgery is commonly used to treat arthritis in the base of the thumb, the distal interphalangeal joints, and the proximal interphalangeal joints. Fused joints are stronger and pain-free, but have very little flexibility and a limited range of motion.
• Carpometacarpal Arthroplasty: This procedure involves removing the arthritic bone at the base of the thumb and resuspending the joint with new ligament tissue in the joint space. This alleviates pain and preserves motion. This treatment option is effective for patients with advanced stages of carpometacarpal joint osteoarthritis.

Thumb arthritis surgeries are typically performed on an outpatient basis at our ambulatory surgery center in Flagstaff, AZ. The procedures are usually done under local anesthesia or a nerve block. You can go home on the day of the procedure. After the surgery, we may ask you to follow up with a hand therapist to continue to strengthen the hand and alleviate symptoms. You may need to wear a cast or splint to limit movement in the hand after your procedure to promote healing. Most patients can resume everyday activities within a few months of thumb surgery.

Medical Review: This procedural information has been medically reviewed by plastic and reconstructive surgeon, Brian A. Cripe, M.D.