Living With and Treating Thumb Arthritis " Anna a 59-year-old woman with pain at the base of her right thumb "

Case study ( 6829 views as of December 2, 2023 )

Anna is a 59-year-old woman who visits her doctor with gradual onset of pain at the base of her right thumb. Her symptoms started several years ago, after opening multiples jars when making preserves. Her symptoms have progressed to the point that she has difficulty pinching most objects, and activities such as squeezing a towel or opening a bottle have become impossible. Although splinting her thumb and anti-inflammatories have improved her symptoms, they have nevertheless progressed and she currently has pain in her thumb with most activities of daily living.

On examination, she appears to have localized pain emanating from the base of her thumb at the carpometacarpal joint. There is some dorsal prominence of that joint and any stress applied to the area causes crepitus and pain. X-rays are performed confirming significant joint space narrowing and other arthritic changes at the thumb carpometacarpal joint.

Anna could potentially benefit from seeing a physiotherapist for mobilization of the joint, an orthopedic surgeon to assess if surgery is necessary, and her local pharmacist for pain control medications. Also, seeing a rheumatologist may be prudent to help treat her arthritis. A bracing specialist may also be able to help with joint stabilization which may help her in her daily activities. Lastly, seeing a nutritionist may help her choose foods that help reduce inflammation caused by arthritis.


Conversation based on: Living With and Treating Thumb Arthritis " Anna a 59-year-old woman with pain at the base of her right thumb "

Living With and Treating Thumb Arthritis " Anna a 59-year-old woman with pain at the base of her right thumb "

  • Carpal Tunnel Syndrome (CTS) is a condition that may worsen over time if left untreated. As people age, the flexor tendons in the wrist can naturally increase in size, putting more pressure on the median nerve in the carpal tunnel. Non-surgical treatments can help slow down the progression of symptoms, but they may not completely stop it. Using a brace or splint at night to keep the wrist in a neutral position can reduce pressure on the nerve. Wearing a splint during the daytime can also be beneficial to avoid extreme wrist positions. Modifying job or recreational activities that may contribute to CTS can also help slow down the condition. Anti-inflammatory medications and cortisone injections may offer temporary relief from pain and inflammation associated with CTS, but they rarely lead to a permanent resolution of symptoms. If symptoms of CTS occur on a daily basis and non-surgical treatments have failed, surgery may be recommended. Ideally, surgery should be performed before constant numbness occurs in the hands, as this may indicate permanent nerve damage. The surgical procedure for CTS is called a Carpal Tunnel Release. It involves cutting the transverse retinacular ligament to release the pressure within the carpal tunnel. The procedure is typically performed under local anesthesia and takes less than 15 minutes. Most patients do not require narcotic pain medication after surgery, and the wound is usually closed with sutures. Recovery from surgery involves avoiding soaking the wound and engaging in light washing for the first 10 to 14 days. Patients are encouraged to move their fingers actively to reduce swelling and prevent stiffness. Most patients can resume light activities within 3 weeks and heavier activities within 6 weeks. The surgical site may remain tender for several months, and deep massage is recommended after 2 weeks to accelerate scar softening. Grip and pinch strength usually return within 3 to 6 months after surgery, and intermittent symptoms of numbness typically resolve rapidly. However, if constant numbness was present before surgery, it may not completely resolve over time. Infection at the surgical site is a possible complication, but it can be treated with oral antibiotics if detected early. Any concerns should be discussed with the surgeon or a healthcare provider promptly.
  • Dupuytren's Disease is a condition characterized by the progressive thickening and tightening of the connective tissue in the palm of the hand, resulting in the formation of nodules and cords that can cause flexion deformities of the fingers. While many people with Dupuytren's Disease may not require treatment, in cases where the contracture becomes significant and interferes with hand function, intervention may be necessary. There are three main categories of intervention for Dupuytren's Disease: Palmar Fasciectomy: This is a traditional surgical procedure that involves the excision of the abnormal tissue in the palm. It is usually successful in achieving greater extension of the affected digits. The skin is closed with sutures, which are typically removed within two weeks. Splinting may be required post-surgery for more significant contractures, particularly involving the proximal interphalangeal (PIP) joints. Percutaneous Aponeurotomy: This is a less invasive surgical technique where multiple small incisions are made along the course of the abnormal fascia. The tissue is sequentially released to restore finger extension. While this procedure allows for a faster recovery, it has a higher recurrence rate compared to palmar fasciectomy. Collagenase Injections: This treatment involves injecting a solution called collagenase into the abnormal tissue. The collagenase dissolves the cords within the hand, and then a manipulation of the digits is performed 24 to 72 hours later to tear the pre-dissolved cords. It is important to note that collagenase is currently not available in Canada, although it was previously available before July 2020. Each form of treatment has its advantages and disadvantages, and it is recommended that patients discuss these options with their surgeon to determine the most appropriate course of action for their specific situation.
  • The case study mentions the patient's symptoms occurred after opening multiple jars. Does this infer that arthritis can be caused by repeated movements?
    • My aunt has arthritis and finds that any repetitive motion increases her pain. Especially griping motions.
    • I think that Arthritis can definitely be aggravated by repeated actions that stress the joints.
  • Osteoarthritis is a degenerative joint disease that can affect any area of the body. Osteoarthritis of the hands is specifically involving certain areas, including the end joints and the middle joints of the hands, and the joint at the base of the thumb.
    • I am a guitar player and I find that the joints in my left hand can get tender and sore. I don't know if this is due to overuse, or whether this is the starting of osteoarthritis. What signs should I look for to understand the difference? Thank you
    • Is it common for osteoarthritis to show up in one finger ? Or does it usual affect the entire hand at once ?
  • To answer your question Chantal- there are several different types of arthritis (osteoarthritis, rheumatoid arthritis, psoriatic arthritis, etc.) The most common form of arthritis is osteoarthritis and it has 2 ways of developing. Primary osteoarthritis occurs in the body over time and will typically affect more than one joint. Secondary osteoarthritis occurs after a trauma of some sort- a fall, surgery, etc and is usually confined to the joint involved in the trauma. The best course of action is to seek out a general practitioner who can then refer you to have x-rays taken. An x-ray is one of the easiest ways of identifying the type of arthritis you may have. Once the diagnosis in made, you can seek out the appropriate type of treatment. Pain is not something you have to live with! As a chiropractor, I see patients on a daily basis with all types of arthritis. Aside from adjustments, a large part of my job is to provide lifestyle choices to increase quality of life.
    • Are there really options to eliminate all pain from arthritis ? I have an aunt with severe rheumatoid arthritis and she lives with pain on a daily basis. She is just grateful for days where the pain doesn't interfere with her everyday life and remains just "background noise"
  • I think that joint pain can be a normal part of aging but sensitivity to cold can be a sign of arthritis
  • I'm just wondering if it is typical to have arthritis only in the thumb? If you have arthritis in the thumb would this be an indicator that you are likely to have it elsewhere in the body? I have experienced sore finger joints, usually when it is cold out, but typically feel joint pain elsewhere as well ie: in ankles, feet, hips
  • Can thumb arthritis be related to carpal tunnel syndrome ? My Uncle had carpal tunnel surgery last year and has been experiencing numbness in his thumb the last few months. The doctor suspects this may be the onset of arthritis in the thumb. Are there specific tests that should be run ?
  • Are there specific exercises that can be done to help prevent thumb arthritis ?
  • It's good to learn about ways to reduce stress on your thumb. I like the track-ball suggestions below. Does anyone have any other good ideas?
    • Lowering the mouse/mouse pad can help with thumb pain due to computer use.
    • @Bernadette after my car accident I was told to train myself to use my left hand more (the un-injured one). I know mouse with my left hand instead of my right. It has greatly improved my ability to work without pain
  • I have had collagen injections for my hip arthritis, I'm wondering if maybe this could be an option for the thumb also?
  • I didn't realize you could have arthritis in only one finger. Is it only the thumb ?
    • @Kimberley, if it gets worse, definitely get it looked at. My mom has osteoarthritis but her right middle finger is worse. She followed up with an x-ray and a specialist and it was actually a bone spur. Her option is to tolerate the stiff joint or surgery. The spur may return with surgery, so she opted to tolerate for now.
    • @Yuan Lew - I have had increasing amounts of pain in the ring finger of my left hand for a few years. It is especially painful when exposed to cold.
    • I was told my other fingers are showing initial signs of osteoarthritis, so no, I don't think it's just the tumb.
  • A very useful video describing thumb arthritis, what it is and the causes of it.
  • I have pain in both my thumbs from I believe too much computer. I think I hold my thumb at an angle away from my fingers when I use the mouse. I also think I tense my hand and thumb when I use the mouse. Anyone else going through this. I have tried a brace and that works well but I lost the brace.
    • @Michelle Kaarto why do you not always use your non dominant hand to mouse ?
    • I switch my mouse to the non-dominant hand every month. It only takes a day for me to adapt to using my left hand with the mouse, and then it's smooth sailing. It also gives my right hand a much-needed break as I feel similar tension and strain in my hand/wrist that @Jackson is reporting.
    • @Yuan Lew - we have a trackball mouse that requires less movement of the wrist of thumb. Also you can train yourself to use your less dominant hand to mouse with
    • I have seen certain products on the market to replace the computer mouse to address thumb arthritis or hand pain. Perhaps research alternatives to a mouse?
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