Practice 10-Minute Consultation

Pain at the base of the thumb

BMJ 2015; 350 doi: http://dx.doi.org/10.1136/bmj.h182 (Published 03 February 2015) Cite this as: BMJ 2015;350:h182
  1. David Robin Dickson, orthopaedic registrar1,
  2. Claire C L Dickson, general practitioner2,
  3. Robert Farnell, consultant hand and wrist surgeon1
  1. 1Hand Unit, Leeds General Infirmary, Leeds LS1 3EX, UK
  2. 2Wetherby Surgery, Wetherby, UK
  1. Correspondence to: D R Dickson davidrdickson{at}hotmail.com
  • Accepted 9 December 2014

The bottom line

  • Encourage patients to self manage the condition with simple analgesics, joint protection, and activity modification

  • Refer patients with a history or recent trauma or a red hot swollen joint for an urgent orthopaedic opinion

A woman in her 60s presents with progressive pain at the base of her thumb, which is exacerbated by writing, lifting pans, and turning door handles.

What you should cover

Osteoarthritis at the base of the thumb (the carpometacarpal joint) is common, usually idiopathic, and mostly affects postmenopausal women. The joint is subjected to considerable forces, particularly during pinching and gripping, making it prone to osteoarthritis.

Take a focused pain history:

  • Site: typically spread over a broad area around the base of thumb.

  • Onset: pain has usually progressed over a long period.

  • Exacerbating factors: activities requiring thumb pinch with twisting such as opening jars and doors, turning keys, and lifting pans.

  • Severity and effect on activities of daily living: ascertain the impact on the patient’s function, quality of life, occupation, mood, relationships, and leisure activities.1

Alternative or concomitant diagnoses to consider

  • Carpal tunnel syndrome (usually idiopathic but can be associated with basal thumb arthritis owing to compression of the median nerve by bony spurs and synovitis …

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