Osteoarthritis of the Thumb – 1st CMC Joint

Osteoarthritis of the thumb is a long-term condition that leads to stiffness, pain and occasional swelling or clicking in the joint at the thumb base, referred to as the carpometacarpal (CMC) joint. It can make everyday tasks like chopping food difficult and uncomfortable. The likelihood of developing thumb osteoarthritis rises with age. It typically progresses gradually, often without a clear cause, beginning with mild pain and stiffness.

Symptoms

Common symptoms of thumb osteoarthritis include:

• Stiffness, swelling, and tenderness at the base of the thumb.
• Pain and weakness experienced during pinching or gripping objects, especially using a pincer grip between the thumb and index finger.
• Joint enlargement, thickening, or bony appearance at the base of the thumb.

Causes and Risk Factors

First CMC joint osteoarthritis occurs due to the gradual breakdown of cartilage cushioning the thumb joint. Factors that can contribute to this degeneration include:

• Aging: As people age, cartilage naturally wears down, making osteoarthritis more prevalent among older adults.
• Repeated use: Frequent pinching, gripping, or repetitive thumb movements can speed up cartilage deterioration.
• Genetics: A family history of arthritis may increase the likelihood of developing thumb osteoarthritis.
• Previous injuries: Past fractures, dislocations, or joint trauma can raise the risk of osteoarthritis in the thumb.
• Sex: Persons assigned female at birth (AFAB) are more prone to thumb osteoarthritis, possibly due to joint structure differences and hormonal factors.
• Underlying health conditions: Autoimmune diseases such as rheumatoid arthritis and lupus can contribute to joint damage and elevate the risk of first CMC joint osteoarthritis.

Tests and Diagnosis

The Joint Pain Clinic often diagnoses first CMC joint osteoarthritis through:

Physical examination:

The doctor will evaluate the thumb for swelling, pain and tenderness and may manipulate the joint to look or test for the following:

• Pain or discomfort.
• Crepitus or grinding sound.
• Gritty sensation.
• Range of motion and strength.

Ultrasound:

Ultrasound imaging may be recommended to view soft tissues, detect inflammation and assess tendon or ligament damage near the thumb joint. These diagnostic methods help determine the severity of the condition and develop an appropriate treatment plan.

Management and Treatment

Our treatment approach for first CMC joint osteoarthritis varies based on symptom severity. However, most patients respond well to physiotherapy, which normally includes a combination of thumb stretching and strengthening exercises to improve mobility and reduce pain.

Other management strategies include:

• Ice and heat therapy: Applying ice packs for 5 to 15 minutes several times a day can reduce swelling, while heat therapy can help relax stiff joints. Patients may experiment with both to identify the one that gives a better relief.
• Steroid injections: Injecting a corticosteroid solution directly into the thumb joint can give significant pain relief for many months.

Treatment and Management

Non-surgical options:

When it comes to treating and managing wrist osteoarthritis, non-surgical treatments are usually our first choice. In most cases, we may recommend the following:

• Adjusting daily activities or using immobilization techniques
• Wearing a brace
• Injecting steroids into the wrist
• Taking painkillers or anti-inflammatory drugs
• Physical therapy

Surgical options:

Surgery might be necessary if non-surgical treatments for wrist osteoarthritis are ineffective, and the discomfort gets worse. Our surgeons will guide you in choosing the most suitable procedure, which usually includes the following:

• Total wrist arthroplasty (wrist replacement): This procedure is done to replace the damaged wrist joint with an artificial one made of plastic, metal, silicone or other components. It enhances the range of motion and stability. Usually conducted under general anesthesia, surgery may necessitate an overnight hospital stay. Your surgeon will inform you of the procedure process, and explain its risks and benefits.
• Total wrist fusion: Recommended for younger persons who rely heavily on hand function for their job. This procedure involves fusing all wrist bones to eliminate movement. While it eases pain and fixes deformities, it also results in the permanent loss of wrist mobility.

Prevention

While aging and wear are typical causes of osteoarthritis, maintaining overall well-being can help minimize the risk of the condition. You can thus prevent first CMC joint osteoarthritis by:

• Refraining from smoking and tobacco use.
• Engaging in regular physical activity at least thrice per week.
• Sticking to a healthy, balanced diet.
• Wearing protective gear and seatbelts during physical activities to prevent thumb injuries.
• Scheduling regular check-ups with a doctor.