Friday, February 21, 2014

Osteoarthritis of the Thumb: Diagnosis and Treatment

Osteoarthritis of the Thumb
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Thumb arthritis is one of the forms of Osteoarthritis which affects the joints which are located at the base of the thumb also known as basal joint or carpometacarpal joint. 

Osteoarthritis of the thumb is common in women than men and usually develops after 40 years of age.

Osteoarthritis of the thumb occurs when the smooth cartilage which usually enables the joints and the bones to glide wears out resulting to friction and bone and joint damage. You are more likely to develop osteoarthritis of the thumb if you had joint fractures before. Osteoarthritis of the thumb has several symptoms. These include:

i. Swelling and tenderness at the base of the thumb.
ii. Limited motion
iii. A bone growth over the joint
iv. A bigger than usual joint
v. Experiencing pain when involved in activities such as opening the door, snapping your fingers, carrying a bag, gripping and punching.
vi. Discomfort after a long time use.
vii. Loss of strength when pinching or involved in gripping activities.
viii. Loose carpometacarpal joint  which can bend back (hyper-extension)

Osteoarthritis of the thumb can be diagnosed by physical examination and also can be based on the affected person medical history. Osteoarthritis commonly occurs in the thumb if you suffered hand injuries especially the thumb in the past. 

Physical examination usually reveals the unusual range of motion in the carpometacarpal joint, tenderness at the base of the thumb and swelling.

Sometimes a grinding sound may be heard when moving the joints (crepitus). The sound is caused by bone ends which rub against each other. X-ray can also be used to check if the joints have been damaged.

People who have osteoarthritis of the thumb will complain of pain when performing duties such as gardening, opening the door, pinching and grasping things.

During examination of the patient the doctor should ensure to rule out other causes of thumb pain such as deQueruain’s disease, metacarpophalangeal arthritis and carpal tunnel syndrome.

There are several available treatments for osteoarthritis of the thumb. They include the surgical and non-surgical treatment.

Non surgical treatments are usually effective in cases where the condition is not in its early stages.

These non-surgical treatments include:

i. Icing the joint - You can place ice on the affected joint for about 5 to 10 minutes several times in a day. This helps in reducing the swelling and inflammation. 
ii. Wearing a supportive splint - The splint helps in limiting the movement of the thumb and also allows the joint to rest and heal. Splint can help in protecting both the thumb and the wrist. They can be worn during the day at intervals and during the nights.
iii. Use of anti inflammatory medication such as ibuprofen and aspirin - These medicines usually help in reducing inflammation and swelling.
iv. Corticosteroids can also be injected at the affected joint Corticosteroids are usually effective especially in the early stages of the condition. The effects of corticosteroids can be for a long period of time to people who experience inflammation only.

Surgical treatments are used when the non-surgical treatments have not been effective. The surgical treatment should be started when you experience pain, when there is a deformity or when you can no longer be able to perform daily tasks using your hand. The surgery to be performed depends upon the radio-graphic stage of the disease and the activities of the affected person.

The surgical procedure can be divided into two:

I. Surgery for early stage.
II. Surgery for late stage.

The symptoms are usually caused by resultant inflammation and joint laxity to patients who experience cartilage softening and fibrillation but no cartilage loss.

The surgical treatment usually involve the reconstruction of the palmar beak ligament so that to achieve a stable joint. This can be done by use of a slip of Flexor Carpi Radiatis (FCR) tendon which is attached to its insertion on the index metacarpal base and passed through a bone tunnel on a bone that has been created in the thumb base and back around so as to be sutured to itself. The reconstruction has been very effective especially in the early stages of arthritis.

In cases of late stage arthritis arthrodesis is effective. Arthrodesis is effective in young patients who still perform a lot of duties using their hands.

Other procedures which can be performed include trapezial excision and trapezial excision with reconstruction of the palmar break ligament.

Before choosing which surgery best suit you, a discussion with your physician can be helpful.

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