Osteoarthritis, the most common type of arthritis, frequently affects the joint at the base of the thumb where it meets the wrist. Known as basal joint arthritis or basal thumb arthritis, this condition is more common in women than men and is associated with aging.
Over time, the cartilage that covers the ends of the bones degenerates, and excess bone forms. Basal joint arthritis can also occur following an injury to the area.
Basal joint arthritis is a chronic condition that develops gradually. The most common symptoms are thumb pain and stiffness. Contrary to what one might expect, individuals having more pain do not necessarily have more severe arthritis. The pain of basal joint arthritis is frequently due to inflammation in the joint.
Fortunately, there are a number of treatments for inflammation that can be provided by therapists and physicians.
Physical and occupational therapists specializing in hand therapy provide a number of treatment options for basal joint arthritis. The goal of therapy is to teach individuals with this condition how to control pain and swelling and improve hand function.
Treatments include splints, education in joint protection techniques, home use of heat and cold, and in some cases, gentle exercise. For most individuals, only one or two visits are required. If pain and loss of function can not be improved by therapy, medical intervention may be required.
A physician or surgeon specializing in the treatment of hand problems such as basal joint arthritis may recommend oral anti-inflammatory medication, injections, and in the most severe cases, surgery. For individuals who do require surgery, therapists fabricate post-operative splints and provide treatments following surgery to help restore motion and strength.
Removable splints for the basal joint of the thumb are used for two primary purposes: providing support to improve hand function and providing rest to decrease inflammation and pain. Based on an assessment of the individual, a therapist determines what type of splint is most likely to help.
Soft, pre-made splints provide support while allowing hand use. Splints of this type are commonly worn during the day and may also be worn at night while sleeping. Rigid, custom-made splints provide rest. They are most frequently worn at night or until any severe pain and inflammation are relieved.
Because osteoarthritis of the basal joint is a chronic condition, it is important to protect and avoid irritating the joint. There are a number of products and techniques that can be used to decrease stress on the joint.
Symptoms of basal joint arthritis tend to be aggravated by forceful or repetitive pinching, grasping, and twisting. Using devices such as electric can openers, large grip pens, and large grip kitchen tools helps protect the thumb joints. Therapists provide guidance in maintaining or improving hand function while using techniques and devices such as these to minimize joint strain.
Warmth is often effective in temporarily relieving the stiffness and pain of basal joint arthritis. Warm water or a heating pad can be used at home, being careful not to burn the skin. However, if the joint is swollen and inflamed, a cold pack is a better choice. An aspect of the therapist’s role is to educate individuals in the home use of these modalities.
Because gripping and pinching tend to aggravate the symptoms of basal joint arthritis, squeezing a ball and similar exercises should be avoided. Some individuals respond well to gentle motion performed in warm water to alleviate morning stiffness. Therapists provide advice about specific exercises if they are appropriate for an individual.
While there is no cure for basal joint arthritis, there are simple treatments that effectively relieve the symptoms in many individuals. These treatments, including splints, heat and cold, joint protection techniques, and gentle motion, can all be used independently following instruction by a therapist.
Carol Page, PT, DPT, CHT
Hospital for Special Surgery