The thumb-a frequent arthritis target

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The thumb—a frequent

arthritis target

Of all the fingers, the thumb has the greatest

range of motion—it can swivel and pivot, and it enables a person to grasp

items. But such skillful movement comes at a price. With age or overuse, the

cartilage lining the carpometacarpal joint

(the thumb joint nearest the wrist) is often damaged or worn away, leading to

osteoarthritis. Eventually, everyday chores, such as opening a jar or turning a

key, may become uncomfortable or impossible. If you have pain, stiffness, and

swelling at the base of your thumb, have it evaluated

by a doctor—before

cartilage damage goes too far.

A variety of remedies

If arthritis is indeed to blame for your

symptoms, the doctor may first recommend that you modify the activities that

trigger discomfort. If writing is painful, for example, you might benefit from

using a thicker pen. If holding a golf club is uncomfortable, you could try

refitting your golf clubs with thicker grips.

Your doctor may also recommend that you apply

heat to the painful joint and take an over-the-counter anti-inflammatory drug

such as aspirin, ibuprofen, or naproxen. If discomfort persists, the doctor may

fit you with a small splint designed to restrict movement of the thumb joint

and thus reduce pain. In many instances, you’ll need to wear the splint

only while performing tasks that have proved uncomfortable. Corticosteroid

injections may be given to provide temporary relief of pain and inflammation.

Surgery, a last resort

A surgical procedure called tendon suspension

interposition arthroplasty is sometimes an option

when other treatments fail. The surgeon removes all or part of the trapezium,

the small wrist bone at the bottom of the joint. To stabilize the remaining

bones, part of the wrist tendon is repositioned. After the operation, the area

must be immobilized in a cast for several weeks. Then, a removable splint is

worn for another month while the patient undertakes physical therapy. It can

take a while, but many people find they can eventually return to activities

they used to avoid.

Changes

ahead?

Several promising treatments are being

studied, including one in which the ends of the thumb bones are resurfaced to

recreate a cushion of cartilage that will prevent the wear and tear caused by

bones rubbing against each other. It may be some time, however, before such

therapies are available. So, the mainstays of treatment remain lifestyle

changes, heat, over-the-counter medications, splinting, and, if all else fails,

surgery.

From The Cleveland Clinic Arthritis Advisor

Published: May/Jun 2004