Osteoarthritis and your thumbs

You don’t really notice your thumbs until something makes you take notice. You whack one with a hammer, jam it in a door, or you get arthritis.

You then realise how often you use your thumbs every day 😖.

Your thumbs are more flexible than the rest of your digits. They can rotate, flex and touch the tips of your fingers. This allows you to perform all sorts of simple and complex movements.

So when something happens that impacts your thumb’s ability to move smoothly and painlessly, it gets your attention very quickly.

Arthritis

Many types of arthritis can affect your thumbs; however, osteoarthritis (OA) is the most common. OA occurs when the cartilage that covers the ends of the bones in a joint becomes brittle and breaks down. Healthy cartilage acts like a slippery cushion that absorbs shock and helps your joints move easily. When it breaks down, bone rubs against bone, causing pain and restricted movement. Your body tries to repair this damage by creating extra bone, called bone spurs. They may also cause pain and limited joint movement.

Other conditions such as rheumatoid arthritis, psoriatic arthritis, gout and lupus can also affect your thumbs.

This article will focus specifically on OA and thumbs.

Who gets OA in the thumbs?

You’re more likely to develop OA in your thumbs if you:

• are female
• over the age of 40
• have had trauma or damage to the joints in your thumb
• are obese
• do work or activities that put stress on the thumb joints.

Symptoms

The symptoms of OA in the thumbs are:

• pain
• stiffness or limited movement of your thumb
• joint swelling (inflammation)
• grinding, rubbing or crunching sensation (crepitus)
• loss of thumb strength.

Diagnosis

If you’re experiencing pain in your thumb that’s affecting your ability to do everyday activities, it’s important that you discuss this with your doctor. Getting a diagnosis as soon as possible means that treatment can start quickly. Early treatment will give you the best possible outcomes.

Your doctor will:

• take your medical history – this will include finding out about your symptoms, how long you’ve had them, what makes them better or worse
• examine your thumb – this will include feeling for warmth, listening and feeling for grinding or crunching (crepitus), and moving your thumb through it’s range of movement.

Your doctor may also request x-rays of your thumb to get a better look inside the joint and check for bone spurs.

Treatment

There’s no cure for thumb OA, but it can be managed effectively using self-care, splints, medications, and in some cases, surgery.

Self-care

• Exercise – as with all musculoskeletal conditions, exercise is one of the most important things you can do to manage your pain and keep your joints moving. A study published in the BMJ Open from researchers at The University of Sydney found that hand exercises, when used with pain relief, splints and education, increased hand function and decreased pain in people with thumb OA. In Appendix 2 of the article, you can access the exercises used in this study.  You can also see a hand therapist, a physiotherapist or an occupational therapist for exercises specifically tailored to you.
• Heat and cold – cold packs/gels can help reduce inflammation, and heat packs/gels can loosen stiff muscles, both providing temporary pain relief.
• Aids and equipment – such as jar openers, book holders, tap turners, button hook and zipper aids and easy-grip utensils can make tasks easier and more efficient by reducing the stress on your thumbs and eliminating tight grasps. You may need to speak with an occupational therapist about what equipment is best for you.
• Avoid repetitive or repetitive activities that strain the thumb – e.g. hand sewing.

Hand therapy
A hand therapist is an occupational therapist or physiotherapist who has undergone advanced training to become experts in assessing, diagnosing, and treating upper limb problems (shoulder to hand). They can provide advice on joint protection and energy conservation (e.g. splints) as well as recommendations for adaptive devices/equipment to improve thumb and hand function. You can find a hand therapist via the Australian Hand Therapy Association website or talk with your doctor.

Splints
A splint can support your thumb, reduce your pain, protect your thumb while you do your everyday activities, and rest the joint. A hand therapist can give you advice on splints.

Medications
Your doctor may suggest medications such as analgesics (pain killers) and/or non-steroidal anti-inflammatory medications (NSAIDs) for temporary pain relief. Topical creams and gels are preferred over oral NSAIDs because less medication is absorbed into the bloodstream. Your doctor or pharmacist can advise you on the best medication to use for your specific health needs.

Your doctor may recommend a cortisone injection into the joint if other strategies such as medications, the use of a splint, and self-care activities haven’t reduced your pain. These injections can reduce pain and inflammation for several weeks to months. However, you can only have a limited number of injections into the same joint in the space of a year.

Surgery

If conservative treatments haven’t helped and arthritis in your thumb is causing significant pain and distress and impacting your quality of life, surgery may be an option. A referral to a specialist hand surgeon is usually required. https://muscha.org/surgery/

The most common types of surgery for thumb OA are:

• Joint fusion (arthrodesis) – involves fusing two or more bones together. This essentially turns them into one bone and relieves pain because the joint no longer moves. However, you do lose flexibility in the thumb.
• Osteotomy – involves cutting, shaping and repositioning bone to help correct joint alignment.
• Trapeziectomy – involves removing one of the bones in your thumb joint (trapezium) to relieve pain.
• Joint replacement (arthroplasty) – all or part of the affected joint is removed and replaced with an artificial implant.

Osteoarthritis in the thumb can be a painful and distressing condition. But the good news is that there are many things you and your healthcare team can do to manage your pain and keep you doing the things you love to do. The important thing is that you seek treatment early and follow your treatment plan.

Contact our free national Help Line

If you have questions about managing your pain, your musculoskeletal condition, treatment options, mental health issues, COVID-19, telehealth, or accessing services be sure to call our nurses. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

More to explore

• 11 facts about the thumb
  Mental Floss
• Efficacy of combined conservative therapies on clinical outcomes in patients with thumb base osteoarthritis: protocol for a randomised, controlled trial (COMBO)
  BMJ Open
• Five surgeries for thumb arthritis
  Arthritis Foundation (USA)
• Hand conditions and tips for joint protection
  Musculoskeletal Australia
• New approach to treating thumb osteoarthritis
  The University of Sydney
• Thumb arthritis
  Mayo Clinic
• Thumb arthritis: What to know
  Medical News Today
• Why does my thumb hurt and how to remedy it
  Medical News Today