Mr Prash Jesudason MB, ChB, MSc., FRCSEd (Trauma & Orth), Dip. Hand Surg (Br)
Basal Thumb Joint Arthritis
The base of thumb is the commonest site of for osteoarthritis in the hand and wrist. It is commoner in women than men, and usually presents in patients after the age of 50.
What are the symptoms?
It usually presents with pain at the base of the thumb, worse on activity. Patients also complain of deformity, stiffness and loss of function.
What is the cause?
As with all osteoarthritis, it is generally a genetic predisposition. However arthritis can be secondary to injuries, fractures or a long history of manual work.
How is it treated?
Mild symptoms and early arthritis is generally treated without surgery. I tend to advise the use of painkillers, an occupational therapy functional assessment to help with activity modification and a custom made splint. I also offer a steroid injection into the joint, which I tend to perform under X-ray control.
For severe symptoms that don’t respond to the above, surgery can be offered, and this is tailored to the age of the patient, functional demands and severity and pattern of the arthritis.
•Trapeziectomy & LRTI (Ligament reconstruction / tendon interposition)
•Basal thumb joint replacement
What are the results?
If the correct operation is chosen for the correct patient and stage of arthritis the results of all these operations are generally good.
Both fusion and trapeziectomy can give excellent pain relief, with success rates of around 90%.
Arthroscopy of the thumb base is less predictable, but with good patient selection most do improve.
Joint replacement tends to give excellent pain relief and motion, but the complication rate is higher than with trapeziectomy. The main risks are dislocation of the joint, and loosening of the implant over time
What is the likely recovery period?
With any of the above procedures the recovery period is 6 to 12 weeks, with most patients being unable to drive for around 6 weeks. The exception to this is arthroscopy, which generally has a quicker return to function.
Copyright © All Rights Reserved