Non-surgical management:
Activity modification: The first step in the management of osteoarthritis of the base of the thumb is to modify activities that cause pain. This may include avoiding repetitive gripping, pinching or twisting movements of the thumb.
Splinting: A splint or brace can be used to immobilize the CMC joint, providing support and reducing pain. Splints can be customized to fit the individual's hand and thumb and can be worn during the day or at night.
Medications: Non-steroidal anti-inflammatory drugs (NSAIDs) can be used to relieve pain and inflammation associated with osteoarthritis. Topical NSAIDs can also be used to avoid the side effects associated with oral medications.
Injections: Corticosteroid injections can be used to relieve pain and inflammation in the CMC joint. Hyaluronic acid injections can also be used to lubricate the joint and improve mobility.
Hand therapy: Hand therapy can help improve joint mobility, decrease pain, and strengthen the muscles around the thumb. This therapy may include exercises, stretching, and modalities such as ultrasound or heat therapy.
Surgical management:
Arthroplasty: Arthroplasty involves the removal of the damaged joint surface and replacement with a prosthesis. This procedure can restore joint function and reduce pain. The prosthesis can be made of metal, plastic, or silicone and can be secured with screws or cement.
Arthrodesis: Arthrodesis involves fusing the bones of the CMC joint, eliminating the joint and creating a stable platform for the thumb. This procedure is typically reserved for patients with severe joint damage and instability. Although arthrodesis eliminates joint motion, it can provide pain relief and improved function.
Denervation: Denervation involves cutting the nerves that supply sensation to the joint, reducing pain. This procedure is typically reserved for patients who have failed non-surgical management and are not candidates for joint replacement or fusion.
Tendon Interposition Arthroplasty (TIA): TIA involves the creation of a space between the bones of the joint by removing a portion of the trapezium bone, followed by placement of a cushioning material (usually a tendon graft) in the space created. This procedure has been shown to provide significant pain relief and improved function.
Joint distraction: Joint distraction involves temporarily separating the joint surfaces to allow the growth of new cartilage. This technique has shown promise in early studies and may offer an alternative to joint replacement.
Conclusion:
Severe osteoarthritis of the base of the thumb can be a debilitating condition, affecting a person's ability to perform daily activities. Non-surgical options, including activity modification, splinting, medications, injections, and hand therapy, can help manage pain and improve function. Surgical options, including arthroplasty, arthrodesis, denervation, tendon interposition arthroplasty, and joint distraction, may be necessary in patients who have failed non-surgical management or have severe joint damage. The choice of treatment depends on several factors, including the degree of joint damage, the patient's age and overall health.