thumbs - Musculoskeletal Health Australia (MHA)

08/Apr/2024

It’s all in the hands!

Hands…they tend to be two things we take for granted. They really do an awful lot for us. But what happens when using our hands is painful or difficult?

Hand osteoarthritis – signs and symptoms

Osteoarthritis (OA) is the most common form of arthritis. It commonly affects the hands, fingers, base of the thumb and the wrist. OA causes the cartilage on the ends of your bones to become thin and rough. When this happens, bones don’t move as smoothly as they should causing pain and stiffness. OA of the hand most commonly affects women over the age of 50.

For more detailed information click here.

What are the hand signals?

As mentioned, pain and stiffness can be the first sign. You may also notice changes in the shape and structure of the joints in your hand. Some people will develop firm, knobby swellings on the finger joints which means the bones are trying to repair themselves but as a result there is excess bone developing.

Thumbs up – what to do

Unfortunately, there is no cure for osteoarthritis of the hand. So, the focus is on relief of symptoms and trying to avoid excess strain on your hand joints. As we all know, doing something that we know is going to be painful usually means we avoid it, but it is really important to exercise these joints. Other things we can do include using pacing strategies and avoiding lifting or carrying heavy weights.

A hand therapist can help with this as well as advice on aids and other strategies.

Latest updates

A new study using an existing drug called methotrexate for the treatment of osteoarthritis of the hand with synovitis (inflammation of the lining of the joint) is showing some promising results especially with improvements in pain. The study looked at the safety as well as the benefits of a 6-month course of methotrexate. 97 participants were randomly given 20mg of methotrexate once a week as compared to placebo. The methotrexate group had a moderate but clinically significant reduction in pain providing important evidence that it could have a role in treating this condition. This is a small study, and further trials are needed to see if the benefits continue after 6 months as well as how long treatment is needed. But it is a promising start!

As with all medications, and as part of discussions with your health care team, you will need to weigh up any possible side effects of methotrexate.

The lead researcher of the study, Prof Cicuttini, is planning an extension trial and hopefully answer these and other questions like can it prevent joint damage which is often quite severe in post-menopausal women with OA of the hand with inflammation.

So…grab life by the hands

Whilst OA hand is very painful there are things that can help.

putting less strain on the joints
implementing simple strategies like pacing and
using practical and well researched aids to provide support and assistance can help.

Making sure you are up to date with the latest information, support and research (through MHA of course) is essential. As well as working with your health care team about options including the use of medications like methotrexate to provide relief.

Also, make sure you register for MHA’s upcoming webinar Understanding and managing thumb arthritis on 23rd April at 7 pm. Click here to register

References

https://versusarthritis.org/about-arthritis/conditions/osteoarthritis-of-the-hand-and-wrist/

https://ard.bmj.com/content/78/1/16

A well-established drug can improve hand osteoarthritis symptoms: study – Monash University

Contact our free national Help Line

Call our nurses if you have questions about managing your pain, musculoskeletal condition, treatment options, mental health issues, telehealth, or accessing services. They’re available Monday to Thursday between 9am-5pm (excluding public holidays) on 1800 263 265, email helpline@msk.org.au or via Messenger.

Lisa Bywaters

09/Feb/2022

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.