Thumb Osteoarthritis
1. Introduction
Thumb osteoarthritis is a common type of osteoarthritis (8, 9, 12, 13, 17, 21). It usually occurs in the carpometacarpal joint at the base of the thumb, which is the joint between the thumb metacarpal bone (first thumb bone) and a carpal bone of the wrist called the trapezium. It is degeneration of the cartilage that covers the ends of the bones that form the joint which creates stiffness (7, 20), as well as pain with gripping and pinching (7).
Bony growths called osteophytes can form in and around the joint as osteoarthritis progresses (10, 15, 3), which can become visible as bumps or nodes on the thumb (6). Sometimes the position of the thumb can change and deform (6, 11, 18, 19, 22). Therefore, osteoarthritis can impact the mobility and function of the thumb, meaning some daily activities, such as writing, picking up small objects or opening jars/bottles (11) may be more of a challenge.
Frequently Asked Questions
- Thumb osteoarthritis (OA) is the degeneration of the cartilage that covers the ends of the bones that form the joint, which creates pain and stiffness.
- Osteoarthritis is the most common form of arthritis, responsible for over 1 million GP appointments each year in the UK (2).
- Thumb osteoarthritis is a common condition, affecting 7% of men and 15% of women (9).
- No.
- Your musculoskeletal physiotherapist will help you to manage your symptoms by creating an individualised programme to improve your strength, mobility and pain.
- Women, especially those who are postmenopausal and over 55-60 years of age, develop thumb osteoarthritis more than men (11, 14, 20).
- Thumb pain usually at the base, reproduced during activity, especially with gripping and pinching (7).
- Stiffness (17, 19) and soreness/tenderness (11) of the thumb in the morning.
- Limited range of joint movement (12, 14). Swelling can occur episodically (having symptom-free periods that alternate with the presence of symptoms), but should not be red or warm.
- Bony growths in and around the affected thumb joint (osteophytes) (3, 10).
- Muscle weakness around the affected thumb joint (17, 19).
- Functional limitations of the thumb and hand that may affect daily tasks (18).
- There are treatments available to help but you can effectively self-manage your symptoms by making lifestyle changes and modifying your daily activities to avoid aggravation and ease pain and swelling.
- Being more aware of how you use your thumb and hand day-to-day, and adapting your routine can help you stay active without aggravating your symptoms. This is often called pacing.
- Keeping moving by following your exercise programme is important as this helps strengthen your muscles, reducing the load on the thumb joint and maintaining mobility.
- With osteoarthritis, it is about maximising function and lots of things can be done to help you get your symptoms under control.
- Outcomes are often better if osteoarthritis is diagnosed and treated as early as possible (1).
We recommend consulting a musculoskeletal physiotherapist to ensure exercises are best suited to your recovery. If you are carrying out an exercise regime without consulting a healthcare professional, you do so at your own risk.
2. Signs and Symptoms
Thumb osteoarthritis can present differently between people and vary in severity. The main and most common signs and symptoms can include:
- Thumb pain (17, 12), usually experienced at the base of the thumb. This pain can be exacerbated during activities (6, 14) that require thumb movement or loading, especially those that involve gripping or pinching (7).
- Stiffness (17, 19) and soreness/tenderness (11) of the thumb in the morning are common with thumb osteoarthritis. This stiffness should improve within 30 minutes. It is likely that your affected thumb will have a limited range of movement (12, 14) and an element of muscle weakness (17, 19), such as reduced grip strength (12, 14).
The combination of pain and reduced mobility and weakness may result in functional limitations (18) of the thumb, so your physiotherapist will aim to improve these to minimise the impact on activities of daily living. Other signs of thumb osteoarthritis can include episodic swelling around the thumb (but the thumb should not be red or warm to touch) and bony growths in and around the joint (osteophytes) (10, 3).
3. Causes
To summarise the pathology of osteoarthritis, it involves changes in the material that lines the ends of joint bones. This material is called articular cartilage and it is a layer of smooth, hard tissue covered in a lubricating fluid that allows joints to move and glide freely without friction. As a result of ageing and loading of the joint, the cartilage layer can become thinner to expose the bone underneath, introducing it to more stress and pressure. This is how thumb OA can develop over time, leading to the symptoms you may be experiencing, such as pain and loss of range of movement.
It has been reported that due to the broad range of motion of the thumb, the ligaments and muscles that support the thumb joint must be strong to provide stability during daily activities. Therefore, if these structures are put under increased strain meaning they can no longer stabilise the thumb joint, then degeneration of the joint can occur and contribute to the development of thumb osteoarthritis (12, 23).
4. Risk Factors
This is not an exhaustive list. These factors could increase the likelihood of someone developing thumb osteoarthritis. It does not mean everyone with these risk factors will develop symptoms.
- Female gender (13, 14), especially those who are post-menopause (11, 20).
- Older age (13, 15, 17).
- Those with occupations that require heavy manual labour (7).
5. Prevalence
Thumb osteoarthritis is a common condition (8, 9, 12, 13, 17, 21) affecting 7% of men and 15% of women (9). It is more prevalent in older people over 55-60 years of age, but especially women who are postmenopausal (11, 14, 20).
6. Assessment & Diagnosis
To form a precise diagnosis, your physiotherapist will retrieve an accurate history of your symptoms and then complete a physical and functional assessment of your thumb. Reaching a timely diagnosis will allow your rehabilitation process to begin as soon as possible to avoid any worsening of symptoms and to achieve positive outcomes.
Usually, a diagnosis can be made following a detailed assessment with the physiotherapist. However, in some cases, further confirmation of diagnosis or severity of osteoarthritis is required and imaging, such as X-rays, can be used.
7. Self-Management
There are treatments available to assist in managing your symptoms and reduce pain, however, you can effectively self-manage your symptoms. Your physiotherapist can talk you through how to make lifestyle changes and modify your daily activities to avoid aggravation (13), ease pain and reduce swelling. They may suggest using a thumb splint when performing day to day activities as this will protect and support the thumb joint whilst still allowing your hand to move as usual (5, 17). Therefore, splinting can help improve pain, stability, hand function and grip or pinch strength (18) by reducing the load on the joint (22). In addition, it can help maintain a stable position of the thumb to reduce any further deformity (18, 20, 22). Adapting your daily routine in this way can help you stay active because your symptoms may be more under control and less activity limiting.
Dietary supplementation has also been reported as a beneficial adjunct to osteoarthritis self-management. Specifically, there is research to support the use of turmeric extract in osteoarthritis treatment (4). Turmeric extract contains a component called curcumin, which has anti-inflammatory properties so it can help reduce pain and inflammation and improve function in osteoarthritic joints (4). Therefore, this supplement alleviates osteoarthritis symptoms in a comparable way to non-steroidal anti-inflammatory medications (NSAIDs), such as ibuprofen, but it has minimal side effects and can be used for longer periods of time (4). Other available supplements for osteoarthritis include ginger and pepper, but turmeric is often better tolerated as the flavour is less spicy (4).
Keeping moving by following your individualised exercise programme is important as this helps to strengthen the thumb and hand muscles, and maintains joint mobility. However, always ensure you find a level of activity and exercise that works for you personally as this is when management is most effective. Pacing yourself each day is important to ensure tasks remain manageable and you can control your symptoms.
8. Rehabilitation
Physiotherapy is a key component of thumb osteoarthritis management. Alongside activity and lifestyle modification as mentioned above, physiotherapy also involves exercise-based rehabilitation.
In general, exercising with osteoarthritis has been shown to have beneficial outcomes (3). For thumb osteoarthritis, there is evidence to suggest that hand/thumb exercises can improve grip and pinch strength, increase pain-free range of movement and function, sustain joint stability, and help prevent fixed deformities (11, 16). Exercises may include those to target flexibility/mobility, muscle strengthening, functional ability, proprioception, or neuromuscular control (11). A combination of hand exercises and splinting may be effective in decreasing pain and stiffness and promoting function (11). In turn, rehabilitation could improve your quality of life (3,16) and increase your tolerance of activities that load the thumb. Motion is lotion where osteoarthritis is concerned.
During your rehabilitation process, your physiotherapist will reassess your condition to check your progress and to make any adjustments to your plan if required. Your physiotherapist may also use a variety of other pain-relieving treatments, such as massage and manual techniques (16), to support symptom relief and recovery.
Below are three rehabilitation programmes, categorised into various stages created by our specialist physiotherapists. They contain recommended exercises to help you effectively manage your thumb osteoarthritis. We advise consulting with your physiotherapist prior to trying any of these exercises.
9. Thumb Osteoarthritis
Rehabilitation Plans
Our team of expert musculoskeletal physiotherapist have created rehabilitation plans to enable people to manage their condition. If you have any questions or concerns about a condition, we recommend you book an consultation with one of our clinicians.
What Is the Pain Scale?
The pain scale or what some physios would call the Visual Analogue Scale (VAS), is a scale that is used to try and understand the level of pain that someone is in. The scale is intended as something that you would rate yourself on a scale of 0-10 with 0 = no pain, 10 = worst pain imaginable. You can learn more about what is pain and the pain scale here.
This programme is focused on maintaining mobility and flexibility of the thumb’s soft tissues, which can help with daily functional movements such as gripping. It could also include exercises that simultaneously use the whole hand, wrist, elbow or shoulder which improves their range of motion too. This should not exceed any more than 4/10 on your perceived pain scale.
- 0
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 910
10. Return to Sport / Normal life
For patients wanting to achieve a high level of function or return to sport, we would encourage a consultation with a physiotherapist as you will likely require further progression beyond the advanced rehabilitation stage.
As part of a comprehensive treatment approach, your musculoskeletal physiotherapist may also use a variety of other pain-relieving treatments to support symptom relief and recovery. Whilst recovering, you might benefit from further assessment to ensure you are making progress and to establish appropriate progression of treatment. Ongoing support and advice will allow you to self-manage and prevent future reoccurrence.
11. Other Treatment Options
Corticosteroid injections can also be used as an adjunct to physiotherapy if symptoms are more severe and pain cannot be managed, or if pain is excessively exacerbated by exercise. This is injected locally into the thumb to provide short-term pain relief (8, 19). Again, this might enable you to move your thumb more so you can progress with your rehabilitation.
Conservative treatments are recommended as they are non-invasive and have positive outcomes on function. However, if you have sufficiently tried all other non-surgical treatments and they have not been successful in reducing your symptoms (21), or if your osteoarthritis is particularly advanced, then specialist opinion with a view of surgery could be a last option (13). If appropriate, it could help reduce pain and improve function and strength (20, 21).
References
- Andersson, S. et al. (2017) Arthritis management in primary care – A study of physiotherapists’ current practice, educational needs and adherence to national guidelines. Musculoskeletal Care. John Wiley & Sons, Ltd. https://doi.org/10.1002/msc.1176
- Okwera, A. and May, S. (2019) Views of general practitioners toward physiotherapy management of osteoarthritis—a qualitative study. Physiotherapy Theory and Practice. Taylor & Francis. 35(10). https://doi.org/10.1080/09593985.2018.1459987
- Anand, A. (2017) Management of Osteoarthritis – A Holistic View. Sharjah: Bentham Science Publishers Ltd.
- Daily, J. et al. (2016) Efficacy of Turmeric Extracts and Curcumin for Alleviating the Symptoms of Joint Arthritis: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. Journal of Medicinal Food. Mary Ann Liebert, 3705.
- Beaudreuil, J. (2017) Orthoses for osteoarthritis: A narrative review. Annals of Physical and Rehabilitation Medicine. Elsevier. http://dx.doi.org/10.1016/j.rehab.2016.10.005.
- Marshall, M. et al. (2011) Radiographic thumb osteoarthritis: frequency, patterns and associations with pain and clinical assessment findings in a community-dwelling population. Rheumatology. 50, 10.1093
- Wolf, J. et al. (2020) Occupational load as a risk factor for clinically relevant base of thumb osteoarthritis. Occupational and Environmental Medicine. 77.
- Trellu, S. et al. (2015) Intra-articular injections in thumb osteoarthritis: A systematic review and meta-analysis of randomized controlled trials. Joint Bone Spine. Elsevier Masson SAS. http://dx.doi.org/10.1016/j.jbspin.2015.02.002.
- Teo, I. and Riley, N. (2020) Thumb carpometacarpal joint osteoarthritis: Is there a role for denervation? A systematic review. British Association of Plastic, Reconstructive and Aesthetic Surgeons. Elsevier Ltd https://doi.org/10.1016/j.bjps.2020.02.043.
- Crisco, J. et al. (2019) Osteophyte growth in early thumb carpometacarpal osteoarthritis. Osteoarthritis and Cartilage. Osteoarthritis Research Society International. Elsevier. https://doi.org/10.1016/j.joca.2019.05.008.
- Duong, V. et al. (2017) Attitudes, beliefs and common practices of hand therapists for base of thumb osteoarthritis in Australia (The ABC Thumb Study). Hand Therapy. 23. 10.1177/1758998317731437.
- Henrique, P. et al. (2017) Differences in orthotic design for thumb osteoarthritis and its impact on functional outcomes: A scoping review Prosthetics and Orthotics International. 41. 10.1177/0309364616661255.
- Riley, N. et al. (2019) Injection therapy for base of thumb osteoarthritis: a systematic review and meta-analysis. BMJ. doi:10.1136/bmjopen-2018-027507.
- Cantero-Tellez, R. et al. (2020) Convergent validity and responsiveness of the Canadian Occupational Performance Measure for the evaluation of therapeutic outcomes for patients with carpometacarpal osteoarthritis. Hanley & Belfus. https://doi.org/10.1016/j.jht.2020.03.011.
- Villafañe, J. et al (2016) From art to science: the functional damage due to thumb osteoarthritis finely described by Velazquez 300 years before its clinical description. Reumatismo. 69. https://doi.org/10.4081/reumatismo.2017.1009
- Villafañe, J. et al. (2018) Educational Quality of YouTube Videos in Thumb Exercises for Carpometacarpal Osteoarthritis: A Search on Current Practice. 13. 10.1177/1558944717726139.
- Sillem, H. et al. (2011) Comparison of Two Carpometacarpal Stabilizing Splints for Individuals with Thumb Osteoarthritis. JOURNAL OF HAND THERAPY. Hanley & Belfus. 10.1016/j.jht.2010.12.004.
- Can A. and Tezel, N. (2020) The effects of hand splinting in patients with early-stage thumb carpometacarpal joint osteoarthritis: a randomized, controlled study. Turkish Journal of Medical Sciences. doi:10.3906/sag-1807-157.
- Abdelsabor Sabah, HM. et al. (2020) A Comparative Study for Different Types of Thumb Base Osteoarthritis Injections: a Randomized Controlled Interventional Study. Ortop Traumatol Rehabil. MEDSPORTPRESS. 22. 10.5604/01.3001.0014.6055
- Ahern, M. et al. (2018) The effectiveness of physical therapies for patients with base of thumb osteoarthritis: Systematic review and meta-analysis. Musculoskeletal Science and Practice. Elsevier. https://doi.org/10.1016/j.msksp.2018.02.005.
- Kennedy, A. et al. (2019) The use of the RegJointTM implant for base of thumb osteoarthritis: Results with a minimum follow-up of 2 years. Elsevier Masson SAS. https://doi.org/10.1016/j.hansur.2019.11.001.
- Marotta, N. et al. (2020) Comparative Effectiveness of Orthoses for Thumb Osteoarthritis: A Systematic Review and Network Meta-analysis. Archives of Physical Medicine and Rehabilitation. The American Congress of Rehabilitation Medicine. https://doi.org/10.1016/j.apmr.2020.06.012.
- Swigart, C. (2008) Arthritis of the base of the thumb. Curr Rev Musculoskelet Med. Humana Press. DOI 10.1007/s12178-008-9022-7.
Other Conditions in
, Long Term Conditions, Orthopaedics, Pain
Trigger Finger
A tendon issue in the palm of the hand affecting the ability to open/close the fingers, often giving a ‘stuck or triggering’ effect when trying to open.
Complex Regional Pain Syndrome
A rare condition where a person experiences persistent, severe and debilitating pain, often with a complex cause.
Carpal Tunnel Syndrome
Increased pressure irritating a nerve in the wrist, causing pain, loss of strength and tingling in your hand.
Benign Joint Hypermobility Syndrome
Common age related changes to the structure of the knee joint which may be associated with pain, stiffness and loss of function.