Base of Thumb Arthritis – OUCH, but I can help!
Dealing with base of thumb joint arthritis (the wear-and-tear kind at the base of your thumb) often goes beyond just pain. The weakness, stiffness, and awkward instability can significantly hinder your daily activities and quality of life. If conservative treatments aren’t cutting it anymore, modern joint replacement surgery might be the key to getting your strong, stable thumb back. I am a thumb arthritis specialist so let’s explore these options, including how new designs are leaving traditional approaches in the dust.
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Ali Phillips | Hand & Wrist Specialist
Pain at the base of your thumb?
I'm Ali Phillips. I understand that pain at the base of your thumb can be incredibly frustrating, making simple daily tasks feel difficult. My passion is to help people like you understand your condition and work together to find the best solution, so you can get back to living a full and active life.
What is Base of Thumb Arthritis?
This condition affects the joint at the base of your thumb, called the carpometacarpal (CMC) joint. This important joint is covered with a smooth, slippery surface called cartilage, which acts like a cushion and allows the bones to glide smoothly against each other.
In arthritis, this cartilage starts to wear away, causing the bones to rub together. This friction can lead to pain, stiffness, and weakness, making everyday activities like opening jars, turning keys, or even writing quite difficult.
It's a very common condition, especially in women, and can often run in families. Taking action early can help slow down the progression and preserve your hand function.
What are the symptoms of Thumb Arthritis?
Pain at Thumb Base
A dull ache or sharp pain, especially when gripping, pinching, or lifting objects like a jar or key.
Stiffness & Swelling
Your thumb may feel stiff, especially in the morning. You might also notice swelling or a bump at the base.
Grinding or Weakness
You may feel a grinding or clicking sensation with movement, and notice weakness when trying to grip things securely.
Does this sound like you?
Jacqui's Story: Early Stage
Jacqui, a vibrant 55-year-old, first noticed a nagging ache in her thumb. It wasn't excruciating, but it was a constant dull ache that got worse when she tried to grip anything tightly, like her bicycle handlebars. Concerned it might worsen, she sought advice and was diagnosed with early-stage thumb arthritis. With hand therapy to strengthen the muscles and a supportive splint for certain activities, Jacqui has managed her symptoms effectively and continues to enjoy her active life.
Mr. Jones' Story: Mid-Stage
Mr. Jones, a retired teacher, had been experiencing increasing pain and stiffness for several years. Simple tasks like turning a doorknob or buttoning his shirt had become a struggle. After discussing his options, he opted for a steroid injection into the joint. He was a bit apprehensive, but the procedure was quick and he hardly felt a thing. The injection took most of his pain away, allowing him to regain mobility and even start some light gardening again.
How will I diagnose your thumb pain?
When you come to see me, I'll listen to your story, and a careful examination and an X-ray are usually all that's needed for a diagnosis. A common test I use is the Grind Test. You can try a very gentle version at home, but please stop immediately if it causes pain.
1️⃣
Hold your affected hand with your other hand.
2️⃣
Gently hold your thumb and push it towards your wrist.
3️⃣
Carefully rotate your thumb in a small circle.
If this causes pain or a grinding feeling at the base of your thumb, it's an indicator of arthritis. An accurate diagnosis from me is the most important first step to getting you on the road to recovery.
How can I help you get better?
There is so much we can do before I ever come at you with a needle or scalpel! We'll create a treatment plan together, starting with the simplest options.
Activity Modification We'll find ways to do things differently to reduce strain on your thumb, sometimes using helpful assistive devices.
Splinting Wearing a supportive splint can help stabilise your thumb joint and reduce pain during activities.
Hand Therapy A therapist can teach you gentle exercises to improve flexibility and strength. Remember, pain should never be part of your therapy!
Medications & Gels Over-the-counter pain relievers like paracetamol or ibuprofen, or topical gels, can help manage mild to moderate pain.
Steroid Injections For more persistent pain, injecting corticosteroids into the joint can reduce inflammation and provide temporary relief. The vast majority of patients can be managed this way for a very long time.
Surgery is always a last resort, but it can have fantastic results when other treatments fail and your quality of life is significantly impacted.
What does the surgery involve?
My preferred option for active individuals is a Dual Mobility Total Joint Replacement. This procedure is like a miniaturised hip replacement for your thumb. I replace the damaged joint surfaces with a modern prosthesis that allows for a greater range of motion and stability. It generally offers a much faster recovery than traditional surgery and allows you to get back to your activities sooner.
Benefits
- Significant and lasting pain relief
- Improved thumb strength and function
- Increased stability and range of motion
- Faster recovery than traditional options
Small Risks
- Implant loosening over time (about 1 in 15 cases)
- Dislocation of the new joint (about 1 in 200 cases)
- Nerve irritation causing numbness (about 1 in 75 cases)
- Infection (less than 1 in 200 cases)
The decision to have surgery is one we make together. I will ensure all your questions are answered so you feel confident in our plan.
Understanding Consent for Surgery
If we decide surgery is the right path, it is imperative that you understand the process, the risks, and your rights. This is a partnership, and your informed consent is the most important part.
You have every right to choose not to have surgery, even after we have discussed it. We can always explore other treatment options, or decide on no treatment at this time. The decision is yours and will be respected.
It is critical to appreciate that all surgery has risks. The decision to proceed is a fine balance between the potential benefits and these risks.
The only person who can judge that balance is you. My role is to give you the clearest possible information so you can make the choice that is right for you.
While thumb joint replacement is a very successful procedure, I want you to be fully aware of the potential issues. Most complications, if they happen, can be managed successfully. Potential issues include:
- Implant Loosening: In about 1 in 15 cases, the implant may become loose over time, which can sometimes require further surgery.
- Dislocation: The new joint may come out of place in around 1 in 200 cases.
- Nerve Symptoms: Occasionally, a nerve near the surgery site might become irritated, causing temporary numbness or tingling. This happens in about 1 in 75 cases.
- Other Uncommon Issues: There's a very small chance (less than 1 in 100) of complications like infection, implant failure, tendon problems, or fractures.
Your Personalised Corner ✨
Get some helpful, personalised ideas from our friendly AI assistant. Just answer the question below!
Gentle Exercise Helper
Disclaimer: This AI assistant provides suggestions, not medical advice. Please always follow the specific guidance I give you during our consultations.
Frequently Asked Questions
Like other forms of osteoarthritis, the exact cause is often unknown. Factors include wear and tear over time, a previous injury to the joint, genetics (it can run in families), and certain medical conditions.
Surgery might be recommended when non-surgical options like hand therapy, splints, and injections fail to adequately control your pain and the condition starts to significantly limit your daily life.
It's a surgical procedure where the worn-out, arthritic joint surfaces at the base of the thumb are replaced with a prosthesis. The modern implants I use are like a miniaturised total hip replacement and are very effective at relieving pain and restoring function.
Recovery timelines differ, but joint replacement often has a much faster recovery than traditional surgery. It may require one or two weeks of immobilisation, followed by hand therapy. You will likely be pain-free and using your thumb for lighter activities well before the full restoration of strength, which can take about three months.
Currently, no cure exists for the underlying osteoarthritis. However, the treatments we have, especially surgery, can improve your pain and hand function very significantly, effectively giving you back your quality of life.
There is no good evidence that cracking your knuckles or thumb is linked to developing osteoarthritis.
Some people report that their symptoms change with the weather, particularly feeling more uncomfortable in the cold. While there's no definitive scientific proof, we think this might be because scarred tissues expand and contract at different rates to the surrounding tissues, causing a feeling of pressure.
Test Your Knowledge!
Base of thumb FAQs
Base of thumb arthritis, or CMC joint arthritis, is a type of osteoarthritis that affects the joint where the thumb’s metacarpal bone meets the trapezium (a small wrist bone). This results in pain, stiffness, and loss of function BUT it interferes with life disproportionately as your thumb is SO important for almost everything that we do with our hands.
Common symptoms include a lump and pain at the base of the thumb (worsening with gripping, pinching), stiffness, decreased range of motion, swelling, and a grinding or crackling sensation.
Like other forms of osteoarthritis, the exact cause is often unknown. Factors include wear and tear over time, previous injury to the joint, genetics, and certain medical conditions.
Diagnosis starts with a physical examination and your medical history. X-rays are the main imaging used to confirm osteoarthritis and the amount of damage within the joint. It’s usually quite obvious just looking at the thumb.
Activity Modification:
Changing how you do tasks can lessen stress on the joint. Analyse what you do that hurts and try and change the way you do it.
Hand Therapy:
Hand therapists teach exercises, offer custom splints for support and pain relief, and provide training with adaptive equipment.
Medication:
Over-the-counter pain relievers (paracetamol, nonsteroidal anti-inflammatory drugs like ibuprofen, if you’re safe to take them) or prescription options.
Steroid Injections:
Cortisone injections directly into the joint can offer temporary pain relief.
Newer injections:
PRP (Platelet rich Plasma) injections are very successful in the knee and other joints but as yet the literature has not extended to the base of the full stop it does hold great promise though. Arthrosamid is an even newer type of injection that turns off the lining of the joint (synovium) and therefore you experience less pain. These injections would have to be self-funded and are expensive. I can give you more details on request
When non-surgical options fail to adequately control pain and limit daily life, surgery might be recommended. I usually say that “if the pain is causing you to lose JOY in your life” then come and see me so I can see what I can do.
Trapeziectomy:
This involves removing the trapezium bone at the base of the thumb. Modifications (with tendon reconstruction) offer more stability.
Joint Replacement (Arthroplasty – like a hip):
The latest implants that I use are as good as a hip replacement! These are so amazing, I would choose never to do a trapeziectomy again!
ELiS represents the latest generation of CMC joint replacements. There are three Dual Mobility options on the market at the moment and there is no evidence of one over the other. They are all fantastic at maximising pain relief while enhancing mobility.
Potential benefits include a reduction in pain, better hand function and much faster return to work, increased preservation of range of motion, and quicker recovery due to a less invasive procedure.
ELiS could be an option if you have severe base of thumb arthritis and non-operative measures have failed. We can discuss if this advanced treatment is right for you.
Overall success rates vary but newer joint replacements are promising, And the latest evidence is that they are as good as a hip replacement. After all, we did simply miniaturise the hip replacement to use in the thumb! Factors like surgical technique, severity of your arthritis, and your rehabilitation commitment all play a role.
Any surgery carries risks:
- infection,
- implant loosening,
- changes in feeling around the thumb,
- dislocation,
- continued pain.
Risks should be thoroughly discussed with me and I have evidence-based consent informaion leaflets for you.
Recovery timelines differ, but often require one or two weeks of immobilisation, followed by hand therapy. Full restoration of strength can take months.
Equally, you will essentially be the same at four weeks after a joint replacement as a trapeziectomy is after four months!
Currently, no cure exists for osteoarthritis. However, treatments like the joint replacements I do, can improve pain and function significantly.
No specific diet reverses osteoarthritis, but maintaining a healthy weight and eating anti-inflammatory foods might positively impact overall joint health. A low carb diet may improve symtoms but the jury is out on this one.
While you can’t entirely prevent it, protecting your joints, and managing risk factors like obesity might lessen the development and progression of arthritis.
There’s no evidence thumb cracking is linked to osteoarthritis.
Some people report their symptoms fluctuate with weather changes, but there’s no definitive scientific proof.
Evidence for using supplements is limited. Talk to your GP before self-treating.
