By Laura Adair MS, PT, CHT
What if your wrist and thumb are sore but you don’t have the numbness and tingling? Have you developed aching or sharp pain at the base of your thumb over the years? Do your symptoms increase with activities such as knitting, opening jars, using tools, using a computer mouse, or turning a key in the lock? Does your hand feel weak or achy after use? Do you have increased pain when you rub where the thumb meets the wrist? These are complaints common to arthritis at the thumb carpometacarpal (CMC) joint.
CMC arthritis is basically a “wear and tear” arthritis that affects women more than men and usually starts after the age of 40. It is the most common form of arthritis in the hand. CMC arthritis is usually a result of aging, hormonal changes, injury or the stress of daily use of the hand.
As with Carpal Tunnel Syndrome, early diagnosis and treatment can prevent/ delay progression of CMC arthritis. The doctor will perform a thorough examination of your hand to rule out other conditions (like CTS). This exam may include palpating the joint and compressing the joint. X-rays are important to assess the amount of joint damage that has occurred. This, along with the patient’s symptoms will help the doctor determine th e level of appropriate treatment.
Initial treatment usually consists of protective splinting either with a premade splint or one that is fabricated by a therapist. It is critical to have the thumb immobilized along with the wrist in order to rest the CMC joint. Anti -inflammatory medication, rest and activity modification are also important initial treatments to help decrease CMC arthritis symptoms. Some doctors may recommend hand therapy to help treat the initial symptoms. If these measures are not effective, or the evaluation indicates further intervention the doctor may recommend an injection. A corticosteroid injection is often quite effective in providing significant relief of pain for an extended period of time. While the injection may provide relief, splinting and activity modification re- main important to help delay further damage to the joint.
In a small percentage of patients symptoms may persist, reoccur and/or interfere with daily function to the point that surgery is the only solution. A referral to a surgical hand specialist is very important. Surgeries usually consist of removing the damaged joint and rebuilding the joint with other tendons from the wrist and hand. The surgery is performed on an outpatient basis and usually requires complete immobilization in a cast for 4 to 6 weeks followed by hand therapy for splinting and progressive exercises for several weeks after the cast is removed. The majority of patients who undergo surgery and rehabilitation have excellent pain relief and in- creased functional use of the hand.
Excerpt…”Does Your Hand Hurt?”
© 2008 Laura Adair