Case study ( 4345 views as of March 26, 2019 )
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.Author: Dr. Bertrand Perey