I have a thumb problem I don't quite know what to do about. The base of my thumb (where it connects to the wrist) is painful and arthritic. The next thumb joint (the big thumb knuckle) has too much motion but doesn't hurt. Is there a brace or some way I can keep these two problems from getting worse?
It sounds like you may have arthritis at the trapezial-metacarpal (TM) joint (thumb-to-wrist connection) but no arthritis at the metacarpophalangeal (MCP) joint (large knuckle joint). Excess motion at the MCP joint is referred to as hyperextension). The medical term for these two problems is MCP joint hyperextension associated with TM arthrosis.
The dilemma in this problem is how to treat the arthritic TM joint and the hyperextended MCP while preserving thumb motion and function. A custom-made splint may help stabilize the joint but it will likely reduce your function (ability to use the hand). Pinch grip for holding keys will certainly be limited. The splint won't change the underlying arthritis, joint deformity, or instability but it will protect the joints from further damage.
Recently a surgeon from Ohio State University Hand and Upper Extremity Center used a case report of a 58-year-old woman with a very similar problem to explore treatment options. In making a treatment plan, the surgeon looked at the current evidence. He found very few studies to guide him.
Most of the published papers were case series reporting the results of using one specific surgical technique. There were no studies comparing conservative (nonoperative) care like splinting with surgical treatment of MCP joint hyperextension. There were no studies comparing the different surgical techniques used for this problem.
He was able to see that most hand surgeons agree that when trapezial-metacarpal (TM) reconstruction surgery is done, the MCP hyperextension should be stabilized. The guideline is if there is more than 30-degrees of hyperextension of the MCP joint, then both problems should be surgically addressed at the same time.
If the MCP problem isn't addressed, then the force and load is transferred to the reconstructed TM joint and that can cause some problems. But before we go too far down that road, the first step for you is to see an orthopedic surgeon, have an evaluation, and get a proper diagnosis. At that point, a treatment plan that is most appropriate for you can be determined.
Ryan Klinefelter, MD. Metacarpophalangeal Hyperextension Deformity Associated with Trapezial-Metacarpal Arthritis. In The Journal of Hand Surgery. December 2011. Vol. 36A. No. 12. Pp. 2041-2043.
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