Thumb pain is common – and often fixable

When a person develops arthritis in their thumb joint, everyday activities like opening a jar, carrying a dinner plate or writing with a pen can become difficult and painful. The condition is so common that Orthopedic Hand Surgeon Brian Najarian, MD, and his physician’s assistant at Cape Cod Orthopaedics and Sports Medicine see between five to 10 patients a day with this complaint.

“The carpometacarpal (thumb) joint is the most commonly treated arthritic joint in the hand,” said Dr. Najarian. “You can get arthritis in other fingers, but in terms of ones that end up being painful and disabling enough to require surgery, it’s the most commonly treated.”

Women are a bit more likely to get it than men, he said. There is a genetic component to it so some people are more predisposed, but there is also a strong overuse component. While most jobs require us to use our hands, any job that requires a lot of repetitive pinching and grasping of tools with the hands, such as dental hygienists and electricians, is likely to accelerate the process, he said.

It’s a pretty easy diagnosis to make in most patients. A quick exam and an X-ray are all that is necessary.

Treatment Options

Surgery is not the first treatment route Dr. Najarian recommends. Early treatments include:

• Using heat or ice to mitigate the pain
• Using oral or topical anti-inflammatory medications
• Wearing a brace that is made for the thumb
• Cortisone injections for relief from pain for several months
• Occupational therapy, which can be very helpful by providing custom braces and education for things you can do in terms of stretching or strengthening your hand. Occupational therapists also teach techniques on how to perform activities without stressing the thumb as much.

“Often we will be able to stave off surgery by trying these treatments, especially in people with relatively mild to moderate disease,” Dr. Najarian said. “But then usually at a certain stage a lot of people will go on to develop pain they can’t control, even with all of those modalities, and then we start talking about surgery.”

The surgery takes about 30 minutes and it’s an outpatient procedure. Dr. Najarian removes a small bone called the trapezium that the metacarpal sits on. Once that is removed, there is no more arthritis because there is no more bone rubbing on another bone. That leaves a void that must be filled to stabilize the joint.

The traditional procedure that’s been used for over 40 years to stabilize the joint is called ligament reconstruction tendon interposition (LRTI) where the surgeon uses a nearby tendon to serve as a cushion for the thumb joint. He then takes a piece of the wrist flexor tendon to replace the damaged ligament. That procedure typically has an excellent outcome and Dr. Najarian still uses it often, especially in older patients who have had the surgery on one hand and are happy with the outcome.

Newer Technique

There is also a newer technique that he uses more often now than the traditional one, especially in younger patients. It uses a non-absorbent synthetic suture that is anchored in the same way the tendon was, but the suture is stronger than the tendon. This results in a better pinch strength than the tendon.

“They both work very well for pain relief, range of motion and pinch strength,” Dr. Najarian said. “The need to redo them is not a problem. Usually, they will last people the rest of their life because there are no artificial components that wear out.”

After the surgery, patients need to wear a post-op splint for 10 days and a removable brace after that. Recovery to achieve full range of motion and strength takes about 10 weeks, but people can start moving their thumb within a couple of weeks.

One of the things Dr. Najarian likes to impress on patients is that this surgery isn’t time sensitive. The outcome of the surgery won’t be any more complicated or worse if they decide to wait.

“This isn’t heart disease or cancer,” he said. “Arthritis isn’t going to kill you. It’s just a matter of your pain tolerance, how it’s affecting your life and how aggressively or not you want to manage that. When you get to the point where you have a daily constant ache that prevents you from either participating in your hobbies that you love or affecting your job and your ability to take care of yourself, then I think it’s time to consider surgery.”