Q & A: ARTHRITIS OF THE CARPOMETACARPAL JOINT

by Lorenzo G. Walker, M.D.

Surgery of the Hand and Upper Extremity

QUESTION: I am recently retired, but I do a lot of work at home including gardening, cleaning, and refinishing furniture. Over time, I have developed an increasing feeling of pain and swelling in my right thumb which increases with use. I have also noticed swelling around the base of my thumb. I have tried taking aspirin and this gives me some relief, but I notice myself becoming less and less active because of the pain. What should I do?

ANSWER: Pain about the thumb is very common in both elderly and middle-aged active patients. There are two problems associated with the thumb which cause very similar symptoms, and are often hard to differentiate. Arthritis of the carpometacarpal joint occurs primarily in older patients and is associated with significant swelling at the base of the thumb and an arthritic type grinding pain, whereas de Quervain's tenosynovitis is more common in a younger population and is due to an inflammation of the tendons which extend the thumb within their protective sheath. With the proper diagnosis and treatment plan, pain resulting from both these disorders can be relieved and the previous activity level restored.

Osteoarthritis is very common in adults. It is estimated that 38% of people are afflicted by this disorder at one time or another. Under the age of 45 years, men are affected more than women, and over the age of 45, women are affected more than men. Within the hand, the carpometacarpal joint of the thumb is often afflicted with osteoarthritis. Due to the fact that the thumb is constantly used in pinching and writing activities, this condition can be extremely disabling. The cause of osteoarthritis is unknown, although at times it can be a secondary process arising in joints affected initially by trauma. Symptoms include joint pain, loss of motion, and decreased function. X-rays document the degree of arthritic joint collapse, and are helpful in formulating a prognosis.

Initial treatment consists of splinting and aspirin or nonsteroidal anti-inflammatory agents. If this is not effective in reducing the pain, steroid injections can be given directly in the joint. They often settle down the temporary inflammation in the joint, however do not offer a long lasting solution. Patients who fail to respond to conservative therapy and who have persistent pain which diminishes their activity level are offered the option of surgery. Results of the corrective procedure are generally excellent and most patients are happy with their renewed pain-free function.