Thumb Joint Pain

Over a lifetime, the basal joint of the thumb experiences intense use. It is prone to everyday wear and tear from pinching and gripping, which the joint structure is specially equipped to perform. However, for many people the overuse or injury of this area leads to thumb joint pain.

In this article by Dr. Joshua A. Kilpatrick DC, ART, learn about the complaints, causes, and treatments of associated with osteoarthritis (or degenerative arthritis) of the thumb joint. The joint at the base of the thumb is the second most common joint to develop osteoarthritis.

Osteoarthritis of the trapezio metacarpal

By Dr. Joshua A. Kilpatrick DC, ART
Sports & Family Chiropractic & Acupuncture, PA
www.drjoshkilpatrick.com

Osteoarthritis (OA, for short) is a common problem that plagues much of the population. It's brought on by age, overuse of an area, or repetitive trauma to an area. The most common places in the body for OA are these:

• Weight bearing articulations of the spine, hips, and knees
• Acromioclavicular joint (top of shoulder)
• First metatarsal phalangeal joint (big toe)
• Distal interphlangeal joints of the hand (tips of fingers)
• First metacarpal trapezium (base of the thumb)

I would like to specifically address OA of the last of these. That's the trapezio-metacarpal joint, or basal joint as we will call it in this article. This joint is located at the base of the thumb.

Basal joint pain is more common in women than men. Most complaints relate to pinching and swelling at the base of the thumb. It also encompasses changes to the joint that would include:

• Instability
• Loss of motion
• Loss of strength

Are you experiencing these symptoms? Well, first things first! Get a good diagnosis from a qualified doctor. Osteoarthritis can be the main cause of pain - or it can be secondary to another cause. You want to find out which of these it is.

How does a doctor do this? During the physical examination, your doctor will observe for any signs and symptoms that are commonly associated with OA, such as:

• Joint swelling
• Joint tenderness
• Decreased range of motion in joints
• Visible joint damage (i.e., bony growths)
• Crepitus (popping)
• Pattern of affected joints (Is it in one joint or several, and does it affect joints on the other hand?)

As part of your exam, your doctor may perform x-rays, which are typically used to confirm the diagnosis of OA. X-rays can reveal osteophytes at the joint margins, joint space narrowing, and subchondral bone sclerosis. Subchondral bone is the layer of bone located just below the cartilage. Sclerosis is hardening of the bone.

After you have received a good diagnosis, your doctor will discuss your treatment options. These will depend on the severity of the condition. Before we discuss those, let's take a look at some of the anatomy of the thumb.

How the Basal Joint Works

The basal joint is made up of the first metacarpal and the small carpel bone called the trapezium. The unique shape of these two bones gives this joint (also known as a saddle joint) its wide of range of motion. This is quite possibly the most important joint of the hand. This range of motion allows the thumb to oppose the fingers and gives you the ability to grasp.

What causes this type of arthritis? Generally, it occurs because of overuse or some kind of trauma to the area. Over time, the ligaments that hold the thumb in place become loose. This permits the cartilage in the joints (a stiff connective tissue) to slide on each other. This friction causes them to wear down. When this happens you then get bone on bone, and at this point bone spurs develop along with pain, swelling, and signs of inflammation.

Now, back to treatment:

In the early stages of arthritis at the basal joint, anti-inflammatory medication, cortisone injections into the joint, chiropractic treatment, physical therapy, or splinting of the wrist and thumb may be helpful to reduce inflammation and regain lost motion.

It is important to note that the splints used for this condition should extend well up on the thumb. Most commercially available, "drug-store" wrist splints leave the thumb free and may actually worsen the discomfort at the base joint.

When these conservative methods of treatment are no longer beneficial to the patient, surgery may be warranted.

Therapy Options

Working with a therapy professional may help you find which home treatment options, if any, are suitable for your condition. They may also assist in alleviating pain through various professional techniques, and help you determine when more serious options, such as injections or surgery, are worth exploring with a medical professional.

Home Treatment Options

Some things you can do at home to ease discomfort include:

• Educate yourself. Assess what causes your pain and avoid it. The more you know about your condition, the better you'll be at recognizing the motions that produce pain - whether immediately or hours later.
• Perform range-of-motion exercises. Exercises that move your thumb through its full range of motion can help improve your joint's mobility (see below).
• Modify household equipment. Consider purchasing adaptive equipment, such as jar openers, key turners and large zipper pulls. Enlarge the grasp on garden tools, kitchen utensils and writing devices - or buy items with large handles. Replace traditional door handles, which you must grasp with your thumb, with levers.
• Apply heat or cold.
  Heat can help ease pain, decrease joint stiffness and relax tense muscles. Different forms of heat work better for different people. Experiment with hot packs, electric heating pads on their lowest settings, soaking your hands and wrists in bowls of warm water or paraffin wax, or simply taking a shower or bath.
  Cold can be effective for reducing pain during flare-ups or after you've had too much physical activity. Applying ice packs or soaking your hands in cool or cold water has a numbing effect that can be effective for dulling hand and wrist pain.
  When applying heat or cold, take care not to burn yourself or get frostbite.

This is where a wonderful product like Dromeo Pain Relief Analgesic Lotion comes in to help with pain and inflammation. Although less well known than products like Biofreeze and Blue Emu, I have found Dromeo to be much more effective for my practice. It uses more emu oil than Blue Emu, and is less greasy than Biofreeze. Dromeo also seems to provide longer-lasting relief for my clients, so they require application less often than other analgesics.

Surgical Options

While I truly believe that conservative treatment is always the best option when possible, you may not be able to avoid surgery forever. If conservative treatment fails, then by all means get a surgical consult with a reputable hand surgeon. Several types of surgery are used to treat this condition, ranging from minimally invasive to very invasive. The important thing is to try all of your conservative options first and to get good advice from your physician.