One thing that separates us from most animals is the ability to use tools and hold objects. However, an injured or debilitated hand can render you helpless. The most common complaint regarding hand injury or pain is due to osteoarthritis, specifically basal thumb pain.
Basal thumb pain
The area at the base of the thumb is the most common location in the hand for arthritis to develop, particularly in women. This joint, called the carpometacarpal joint, is at the base of the thumb where the bone is connected to the hand, close to the wrist. This disorder usually starts when the carpometacarpal joint begins to loosen a bit and slides in and out.
When the joint repeatedly slides in and out, the cartilage wears down, becoming soft and frayed and ultimately wearing down to the bone. When that occurs, raw bone grinds on raw bone, which may progress to form cysts or bone spurs around the joint. This can be painful and makes it difficult to pinch, grab, and essentially use your thumb for almost everything.
This can significantly impact daily function. Initial treatment choices are to immobilize the thumb joint, hold it in place, and treat with anti-inflammatory medication to ease the pain in the inflamed arthritic joint. A rigid splint may also be used for a limited time to assist in reducing the pain. Application of a soft material splint and use of anti-inflammatory medications may also be recommended.
If little or no improvement is made, or the patient does not want to continue wearing the splint, injecting steroids into the joint is another option for temporary improvement. Alternative treatments are surgical. Options include joint replacement, fusion or a resection arthroplasty in which the arthritic bone and/or joint is removed and a portion of the ligament is put in its place. There are a variety of different designs for total joint replacements including a number that are still in development.
Excision Arthroplasty or Interposition Arthroplasty
Carpometacarpal joint replacement is an available treatment for basal thumb conditions. Excision arthroplasty removes the damaged part of the joint, interposition arthroplasty removes the arthritic portion of the joint, and replaces it with a piece of the patient's own tendon to act as a cushion. The patient generally goes home the same day as the surgery and will be in a splint for six weeks. After the six weeks, patients convert to a removable splint and start working on range of motion and strengthening the joint. It is a significant surgery, but it has been shown to be very effective.
Arhrodesis, which fuses the bones, can be successful. However, sometimes the body can be tricked into thinking that those two separate bones should be one and scar tissue can form in between. Patients can still be symptomatic and may need bone graft from another area of the body.