Clinical Review

Osteoarthritis at the base of the thumb

BMJ 2011; 343 doi: https://doi.org/10.1136/bmj.d7122 (Published 24 November 2011) Cite this as: BMJ 2011;343:d7122
  1. R E Anakwe, upper limb fellow1,
  2. S D Middleton, specialty registrar1
  1. 1Department of Trauma and Orthopaedic Surgery, Royal Infirmary, Edinburgh EH16 4SA, UK
  1. Correspondence to: R E Anakwe raymundus{at}doctors.org.uk
  • Accepted 25 October 2011

Summary points

  • Arthritis at the base of the thumb causes functional disability and pain, particularly with “pinching” actions

  • Pain reproduced on the axial grind test localises pathology to the base of the thumb—the trapeziometacarpal and scaphotrapeziotrapezoid joints should be assessed

  • Plain radiographs showing degenerative changes in affected joints are usually diagnostic but may underestimate disease

  • Non-operative treatments such as behaviour modification, pain relief, splinting, and corticosteroid injections can ameliorate symptoms and delay surgery in most patients

  • No single operative procedure has been shown to be superior but simple trapeziectomy has the lowest complication rate

  • Arthrodesis may be the best option for patients who value pain relief and reliable strength and stability more than mobility (such as younger manual workers)

Patients with osteoarthritis of the thumb carpometacarpal joint, or base of the thumb, commonly present to primary care practitioners and orthopaedic surgeons because of pain and disability. The prevalence of this condition increases with age and is greatest in postmenopausal women. There is broad agreement regarding the prevalence of base of the thumb osteoarthritis. The largest longitudinal cohort study found a 15% prevalence in adults in Finland,1 and a smaller British study of postmenopausal women found a prevalence of 33%.2 This is likely to increase as populations age and people stay active for longer. Presentation and diagnosis may be delayed because patients try to adapt by adjusting their hand position, using splints, and adopting preferential hand use to limit disability. For most patients the primary treatment is non-operative and can be delivered effectively by primary care doctors, physiotherapists, and occupational therapists. Patients with symptoms that persist despite conservative treatment require referral to a specialist and possibly surgery.3

Various studies have looked at osteoarthritis at the base of the thumb, including large epidemiological and patient cohort studies; biomechanical research; and smaller …

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