Mr Apurv Sinha 

Consultant Trauma and orthopaedics 

 

 

OSTEOARTHRITIS OF THUMB BASE / CMC JOINT AND TRAPEZIECTOMY 

 

What Osteoarthritis?

Osteoarthritis (OA) is a degenerative joint disease which causes the cartilage surrounding the bones to wear away. Cartilage is tough but flexible and surrounds the ends of your bones allowing them to move over one another forming a joint. When the cartilage wears away bone rubs on the bone which gives rise to a painful inflamed joint.

 

About the thumb.

The thumb is a very complicated joint and moves in several directions.

The base of the thumb is where the thumb bone (Metacarpal bone) attaches to one of the small bones (Trapezium) in the wrist to allow some of this complex movement. Sometimes, due to wear and tear/ injury the cartilage around the bottom of the thumb wears away and the bone begins to rub on the little wrist bone causing pain, discomfort and reduced function.

Why does it occur?

Osteoarthritis is a common degenerative disease affecting joints. Anyone can get it but there are a number of factors that may increase the risk of osteoarthritis:

  • Age: tends to affect people aged 40+ as muscles become weaker and joints gradually wear over time

  • Gender: Osteoarthritis is more common in females than males (particularly in the hands and knees)

  • Weight: being overweight puts more stress on your joints and can increase your chance of developing arthritis

  • Family: some forms of osteoarthritis run strongly in families and can be linked to genetics

  • Previous injury: an injury or operation on a joint can lead to osteoarthritis in a joint. Similarly, some hard repetitive activities or physically demanding jobs can increase the risk of the condition

  • Other joint diseases: such as rheumatoid arthritis/gout can increase the risk of developing osteoarthritis

 

What are the symptoms?

The main symptom of OA at the base of the thumb is a pain on movement (e.g turning a key, opening jars).

People may also experience:

  • swelling

  • difficulty gripping/ weakness

  • Stiffness

  • The enlarged appearance of the bone

  • Limited movement

  • Wasting of some of the thumb muscles

  • Altered positing of the thumb bones

 

What tests might be done?

Your surgeon can often tell you have arthritis by performing simple tests, by looking at your thumb or by asking you about your symptoms.

You may be sent for an X-Ray to confirm the diagnosis or to check that the problem isn’t coming from elsewhere.

What is the treatment?

Non-Operative Treatments:

  • Medication: such as non-steroidal anti-inflammatories such as ibuprofen can help with swelling/ inflammation and pain killers can help alleviate pain

  • Splinting: Sometimes splints can be used to protect and support the joint to help alleviate some of the pain

  • Joint protection advice/ aids: Sometimes advice on how to protect your joints throughout everyday tasks can help to alleviate pain

  • Steroid Injections: Localised injections directly into the affected joint to help reduce inflammation and pain

When non-operative treatments have failed to control the pain and the pain is:

  • Moderate to severe

  • Constant/ all the time

  • Affecting sleep

  • Stopping you from carrying out activities of daily living

What to expect after your ‘Trapeziectomy’ operation.

Trapeziectomy’s are normally performed as day case surgery under a general anaesthetic or a regional block (where the arm is made numb using an injection).

You will be sent home with dressings or a POP on the hand and will be seen in 1-2 weeks time. 

At this point you may be seen by a hand therapist who will:

  • Provide a splint to be worn as protection as your thumb heals

  • Give exercises to help you regain movement in your thumb

  • Give advice on what kind of activity you should/shouldn’t be performing

  • Give advice on strengthening your thumb

Things to consider before having a Trapeziectomy:

  • Risk of infection through surgery

  • Risk of nerve injury/ neuroma. A small nerve running through the region where the surgeon is operating can be damaged during surgery. It may form a painful spot on/near the scar (a neuroma)

  • Rehabilitation can take between 4-12 months

  • Results from trapeziectomy vary depending on many different factors i.e the individual, other health problems, the severity of arthritis etc.

  • 80% of patients experience decrease in pain following surgery, 15% experience little or no change in pain and function and 5% are worse than before they had surgery

  • Risk of problematic scar tissue. After the operation, there is a risk that you may have problems with scarring including tender/ sensitive scarring. Thick/ hard scarring causing reduced movement

  • Risk of problematic scar tissue. After the operation, there is a risk that you may have problems with scarring including tender/ sensitive scarring. Thick/ hard scarring causing reduced movement