Thumb Arthritis

Diagram of the thumb bones including the metacarpal, basal joint, and trapezium
Diagram of the thumb bones
Illustration of a thumb grind test performed during examination
A grind test that your hand surgeon may perform

Thumb arthritis, also known as basal joint arthritis, occurs when cartilage at the base of the thumb deteriorates.

A joint is formed when two bones meet and articulate, allowing movement. Joints are lined with smooth cartilage that allows one bone to move easily relative to another. Osteoarthritis, or degenerative arthritis, is a process that occurs with aging and describes deterioration of joint cartilage.

Thumb arthritis is the second most common type of arthritis in the hand; the most common hand arthritis involves the last joint in each finger. Thumb arthritis is more common in women, though men can also develop it. Degenerative arthritis of the thumb typically occurs sometime after 40 years of age. Genetics, prior trauma to the thumb, and inflammatory arthritis such as lupus or rheumatoid arthritis can also contribute to deterioration of the joint at the base of the thumb.

Signs and Symptoms

Activities that rely on the thumb may cause pain at the base of the thumb, particularly in an arthritic joint. Common painful activities include pinching, grasping, or gripping.

Signs and symptoms of thumb arthritis may include swelling or stiffness at the base of the thumb. As arthritis progresses, pain and weakness may increase along with decreasing range of motion at the base of the thumb. As arthritis advances further, bone spurs may develop, resulting in an enlarged appearance at the base of the thumb.

Diagnosis

If pain starts to interfere with activities of daily living, a visit with a hand surgeon could be helpful. During a physical examination of an arthritic thumb, the physician may notice grinding when maneuvering the thumb in a certain way. X-rays can be used to confirm the diagnosis.

Treatment

Treatment options are based on the severity of symptoms. There is no convincing evidence to support the use of any medications or supplements to prevent progression of thumb arthritis. X-rays show that basal joint arthritis will generally get worse with time, but the rate of progression varies from person to person. Even though thumb arthritis advances with time, symptoms do not always get worse, and in some people symptoms may decrease significantly.

Nonoperative treatment for thumb arthritis can involve:

  • Anti-inflammatory medications, after consulting your doctor first
  • Heat or ice
  • Bracing
  • Exercises
  • Ergonomic adjustments
  • Avoidance of irritating activities
  • Steroid injections into the basal joint
  • Occupational therapy

When nonoperative treatment fails and the patient is sufficiently symptomatic, surgery is an option. Surgery can involve removing part or all of the trapezium, one of the bones in the thumb joint, and cushioning or suspending the thumb joint with a variety of possible techniques. Fusing the thumb joint is also an option. Complete recovery after traditional thumb surgery can take anywhere between 8 weeks and one year. Newer treatments aimed at replacing the articular surface with a total joint replacement of the thumb CMC joint may provide improved pain relief, more anatomic function, and a decreased recovery time. Ask your provider what options are best for you.

This mobile-friendly version is adapted from patient education content originally provided by the American Society for Surgery of the Hand.