Thumb Osteoarthritis

Thumb osteoarthritis is a common type of osteoarthritis ^{(8, 9, 12, 13, 17, 21)}. It usually occurs in the carpometacarpal joint at the base of the thumb, which is the joint between the thumb metacarpal bone (first thumb bone) and a carpal bone of the wrist called the trapezium. It is degeneration of the cartilage that covers the ends of the bones that form the joint which creates stiffness ^{(7, 20)}, as well as pain with gripping and pinching ⁽⁷⁾.

Bony growths called osteophytes can form in and around the joint as osteoarthritis progresses ^{(10, 15, 3)}, which can become visible as bumps or nodes on the thumb ⁽⁶⁾. Sometimes the position of the thumb can change and deform ^{(6, 11, 18, 19, 22)}. Therefore, osteoarthritis can impact the mobility and function of the thumb, meaning some daily activities, such as writing, picking up small objects or opening jars/bottles ⁽¹¹⁾ may be more of a challenge.

To summarise the pathology of osteoarthritis, it involves changes in the material that lines the ends of joint bones. This material is called articular cartilage and it is a layer of smooth, hard tissue covered in a lubricating fluid that allows joints to move and glide freely without friction. As a result of ageing and loading of the joint, the cartilage layer can become thinner to expose the bone underneath, introducing it to more stress and pressure. This is how thumb OA can develop over time, leading to the symptoms you may be experiencing, such as pain and loss of range of movement.

It has been reported that due to the broad range of motion of the thumb, the ligaments and muscles that support the thumb joint must be strong to provide stability during daily activities. Therefore, if these structures are put under increased strain meaning they can no longer stabilise the thumb joint, then degeneration of the joint can occur and contribute to the development of thumb osteoarthritis ^{(12, 23)}.

Thumb osteoarthritis is a common condition ^{(8, 9, 12, 13, 17, 21)} affecting 7% of men and 15% of women ⁽⁹⁾. It is more prevalent in older people over 55-60 years of age, but especially women who are postmenopausal ^{(11, 14, 20)}.

To form a precise diagnosis, your physiotherapist will retrieve an accurate history of your symptoms and then complete a physical and functional assessment of your thumb. Reaching a timely diagnosis will allow your rehabilitation process to begin as soon as possible to avoid any worsening of symptoms and to achieve positive outcomes.

Usually, a diagnosis can be made following a detailed assessment with the physiotherapist. However, in some cases, further confirmation of diagnosis or severity of osteoarthritis is required and imaging, such as X-rays, can be used.

There are treatments available to assist in managing your symptoms and reduce pain, however, you can effectively self-manage your symptoms. Your physiotherapist can talk you through how to make lifestyle changes and modify your daily activities to avoid aggravation ⁽¹³⁾, ease pain and reduce swelling. They may suggest using a thumb splint when performing day to day activities as this will protect and support the thumb joint whilst still allowing your hand to move as usual ^{(5, 17)}. Therefore, splinting can help improve pain, stability, hand function and grip or pinch strength ⁽¹⁸⁾ by reducing the load on the joint ⁽²²⁾. In addition, it can help maintain a stable position of the thumb to reduce any further deformity ^{(18, 20, 22)}. Adapting your daily routine in this way can help you stay active because your symptoms may be more under control and less activity limiting.

Dietary supplementation has also been reported as a beneficial adjunct to osteoarthritis self-management. Specifically, there is research to support the use of turmeric extract in osteoarthritis treatment ⁽⁴⁾. Turmeric extract contains a component called curcumin, which has anti-inflammatory properties so it can help reduce pain and inflammation and improve function in osteoarthritic joints ⁽⁴⁾. Therefore, this supplement alleviates osteoarthritis symptoms in a comparable way to non-steroidal anti-inflammatory medications (NSAIDs), such as ibuprofen, but it has minimal side effects and can be used for longer periods of time ⁽⁴⁾. Other available supplements for osteoarthritis include ginger and pepper, but turmeric is often better tolerated as the flavour is less spicy ⁽⁴⁾.

Keeping moving by following your individualised exercise programme is important as this helps to strengthen the thumb and hand muscles, and maintains joint mobility. However, always ensure you find a level of activity and exercise that works for you personally as this is when management is most effective. Pacing yourself each day is important to ensure tasks remain manageable and you can control your symptoms.

For patients wanting to achieve a high level of function or return to sport, we would encourage a consultation with a physiotherapist as you will likely require further progression beyond the advanced rehabilitation stage.

As part of a comprehensive treatment approach, your musculoskeletal physiotherapist may also use a variety of other pain-relieving treatments to support symptom relief and recovery. Whilst recovering, you might benefit from further assessment to ensure you are making progress and to establish appropriate progression of treatment. Ongoing support and advice will allow you to self-manage and prevent future reoccurrence.

Corticosteroid injections can also be used as an adjunct to physiotherapy if symptoms are more severe and pain cannot be managed, or if pain is excessively exacerbated by exercise. This is injected locally into the thumb to provide short-term pain relief ^{(8, 19)}. Again, this might enable you to move your thumb more so you can progress with your rehabilitation.

Conservative treatments are recommended as they are non-invasive and have positive outcomes on function. However, if you have sufficiently tried all other non-surgical treatments and they have not been successful in reducing your symptoms ⁽²¹⁾, or if your osteoarthritis is particularly advanced, then specialist opinion with a view of surgery could be a last option ⁽¹³⁾. If appropriate, it could help reduce pain and improve function and strength ^{(20, 21)}.

https://www.nhs.uk/conditions/osteoarthritis/

https://www.csp.org.uk/public-patient/keeping-active-healthy/love-activity-hate-exercise-campaign/being-active-long-term-0

https://southtees.nhs.uk/content/uploads/MICB4531-V1-Osteoarthritis-Thumb-Joint-9.pdf