Arthritis of the base of the thumb remains a challenging condition to treat. It is one of the more common conditions in the hand that requires treatment by a Hand Surgeon. Not all patients require surgery and conservative measures work well for many patients. Supplements, activity modification and topical anti-inflammatory gels can offer patients significant benefits. Splints may help when joints are particularly painful, but they often limit movement which is why they work. Regular steroid injections can control symptoms in patients with more advanced thumb base arthritis.
When patients find that steroid injections are no longer effective, surgical options need to be considered. The surgical options have been fairly limited in the past. The operation that is still considered by many Hand Surgeons to be the Gold Standard of treatment is the Trapeziectomy. This operation involves the removal of a bone from the base of the thumb. This is an excellent operation for pain in the majority of patients. It however takes 3 months for the patient to notice the full benefits of surgery. The range of movement after this operation is usually very good but the thumb may be slightly weaker and shorter than before the arthritis developed.
Fortunately there have been a number of recent surgical advances that may make a difference to patients with base of thumb arthritis.
1. Denervation Procedures
It is becoming increasingly evident that dividing all the little nerves to a painful joint may result in significant improvement in pain scores for patients with this type of arthritis. The procedure is much less invasive than Trapeziectomy surgery and results in improvements in over 80% of patients. The anatomy of the bones is preserved and movement and strength is maintained. Overall feeling in the hand will remain unchanged but the pain in the base of thumb resolves over a few months.
2. Joint Replacement Surgery
Joint replacements at the base of thumb are giving patients very good outcomes. These joint replacements are like little mini hip joint replacements and are made of three components which are implanted into the joint. These joint replacements offer good early return of movement and maintain thumb strength. Not all patients with base of thumb arthritis are suitable for a joint replacement, but those that are can have very good outcomes. All joint replacements wear out at some point and in the thumb this is likely to be in 7 to 10 years. The operation that is performed to revise a thumb joint replacement is the trapeziectomy procedure.
For more information or to book an appointment to see Mr Schreuder please contact his private medical PA, Lucy Wade, on 07876 870702.