Question:Today for the first time, I couldn't turn my key in the lock to open the car door. I've had arthritis in that hand for a while but never this bad. Most of the trouble seems to be coming from the base of my right thumb. What can be done for this problem?
Answer:It sounds like you might be describing basal or carpometacarpal (CMC) thumb joint arthritis. The first step is to get an accurate diagnosis. See your primary care physician or an orthopedic surgeon.
The doctor will rely on you to describe when it hurts and where it hurts. Pay attention over the next few days of all your symptoms so you can report them. An x-ray may be taken but doesn't always show joint damage during the early phases (stage I). Joint narrowing, bone spur formation, and bone cysts are among some of the changes that begin to occur in stages III and IV.
Conservative care is usually advised first. Your doctor may recommend pain relievers and/or antiinflammatory drugs. A referral to the hand therapist is a good idea. The therapist (occupational or physical) will test and measure your grip and pinch strength, range of motion, and function.
A program of exercises to improve motion, restore strength, and increase function will be prescribed. Sometimes a resting splint is fabricated. This can be worn at night or during the day when you are engaged in a quiet activity such as reading or watching television. A functional splint may be made for you. This can be worn during activities to protect the joint from excess strain and load.
Surgery is a possibility but only if you have moderate-to-severe problems and you've tried at least six months of nonoperative care first. Surgery can involve fusion of the joint in a functional position. You'll have pain relief but loss of motion. You may not be able to open your hand all the way.
Ligament reconstruction is another choice. Part or all of the trapezium bone at the base of the thumb is scraped smooth or removed. A nearby tendon is harvested and placed in the empty hole from the missing trapezium. Many patients are very happy with the results of this operation. They get pain relief and function is preserved.Louis Catalano, MD, et al. Comparison of Ligament Reconstruction Tendon Interposition and Trapeziometacarpal Interposition Arthroplasty for Basal Joint Arthritis. In Orthopedics. March 2008. Vol. 31. No. 3. Pp. 228.
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