My kids tell me I'm a suspicious sort of person. I can't really help myself. I always wonder if I'm getting the right treatment or the best deal. My latest worry is about my thumb. The doc says I have arthritis at the base. She wants me to see a hand therapist before considering anything more drastic like surgery. Does this seem right to you?
Treatment for arthritis of the thumb usually does begin with conservative (nonoperative) care. This could include splinting, exercise, antiinflammatory medications, and steroid or hyaluronate injections. Patients who fail conservative care may benefit from surgery. The simplest procedure is a trapeziectomy (removal of the trapezium bone). More advanced procedures include trapeziectomy with ligament reconstruction, arthrodesis (fusion), or arthroplasty (joint replacement).
Given your interest in comparisons, you may find the results of a recent study helpful. In this study, outcomes of various treatments for basal thumb arthritis were investigated and compared with current trends in the treatment of this condition.
In order to find out how hand surgeons are currently treating this condition, the authors sent an on-line survey to active members of the American Society for Surgery of the Hand. They asked questions about conservative care, preferred methods of treatment for patients who failed conservative care, and most common surgical procedures used. Demographic information about the surgeon was also collected (e.g., geographical location, number of years in practice).
Surgeons from all regions of the United States participated with a wide range of experience. Half had been practicing less than 15 years; half had been practicing more than 15 years. Younger surgeons were more likely to recommend conservative care while the more experienced surgeons opted for trapeziectomy or trapeziectomy with ligament reconstruction. Steroid injection was favored by most (89 per cent) of the group.
Only a small number of surgeons (four per cent) used the more recent treatment of hyaluronate injections, which have not yet received approval from the FDA for the trapeziometacarpal joint. Insurance doesn't always cover this procedure and it costs more than steroid injection. Studies haven't really shown a benefit of hyaluronate injection over steroid injection. These factors may explain why this treatment is not more popular.
In general, surgery (and more involved procedures) was reserved for patients with more advanced cases of arthritis. There appears to be a trend toward returning to the simpler trapeziectomy procedure by many hand surgeons. Studies seem to show similar good results for all types of surgery. However, there is evidence that more advanced surgeries do not yield better outcomes than simple trapeziectomy. And those procedures involving ligament reconstruction have higher rates of complications.
Jennifer Moriatis Wolf, MD, and Steven Delaronde, MPH, MSW. Current Trends in Nonoperative and Operative Treatment of Trapeziometacarpal Osteoarthritis: A Survey of US Hand Surgeons. In The Journal of Hand Surgery. January 2012. Vol. 37A. No. 1. Pp. 77-82.
*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.