Thumb Joint Replacement
Also known as: thumb carpometacarpal joint arthroplasty for osteoarthritis
What is thumb arthritis?
Thumb arthritis is a common condition that affects the joint at the base of the thumb, known as the carpometacarpal (CMC) joint. This condition can cause significant pain, stiffness, and limited mobility, making everyday activities like gripping, pinching, and grasping challenging. Thumb arthritis often results from the natural wear and tear on the joints over time. However, other factors such as injury, genetics, and medical conditions like rheumatoid arthritis can also contribute to its development. The base of the thumb is particularly susceptible to arthritis due to its frequent use and the stress it endures during various hand movements.
Anatomy of the thumb base joint
The thumb base joint, or carpometacarpal (CMC) joint, is a complex structure that connects the thumb to the wrist. It comprises several bones, ligaments, and tendons that work together to provide a wide range of motion, allowing the thumb to perform various tasks. This joint’s unique saddle shape enables the thumb to move in multiple directions, making it highly functional but also prone to wear and tear. As we age, the cartilage that cushions the bones in the thumb base joint can deteriorate, leading to osteoarthritis (OA). This degeneration can cause pain, stiffness, and limited mobility, significantly impacting hand function.
Causes of thumb arthritis
Thumb arthritis can arise from a combination of genetic and lifestyle factors. Over time, the wear and tear on the thumb joints can lead to osteoarthritis, while injuries and certain medical conditions like rheumatoid arthritis can accelerate joint damage.
Base of thumb osteoarthritis is more prevalent among older adults and women.
Regular activities and exercise do not typically cause osteoarthritis, though repeatedly engaging in strenuous activities may increase your risk.
Symptoms of base of thumb arthritis
Arthritis can significantly hinder the smooth movement of the thumb joint, leading to symptoms such as pain, swelling, and restricted motion. The progression of this condition varies for each individual, making it challenging to predict. Symptoms often fluctuate without a clear reason, resulting in good and bad days, and certain activities may exacerbate these symptoms for some patients. Pain typically intensifies with thumb movement or towards the end of the day, while stiffness may occur after periods of rest but generally subsides with movement. The joint might produce a creaking or crunching sound during motion. Movement limitations can affect daily tasks like opening jars or turning keys. In advanced stages, a prominent bump may develop at the base of the thumb, accompanied by hyperextension of the middle thumb joint, resulting in a characteristic zigzag deformity. Additionally, muscles around the joint might appear thin, and swelling can occur.
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You will need to consult with a hand and wrist surgeon. Diagnosing your thumb arthritis typically involves a thorough physical examination, where your doctor will assess your thumb’s range of motion and look for signs of joint damage. Imaging tests, such as X-rays, are often used to visualise the extent of your arthritis and any changes in the joint structure. A detailed review of your medical history helps in understanding the underlying causes and planning appropriate treatment.
Initial treatment options may include:
Self-help
Incorporating everyday coping strategies can be beneficial in managing thumb arthritis. Using heat, such as a hot water bottle or heat pack, and taking a painkiller before bedtime can help alleviate discomfort. Depending on your occupation, you might need to adapt your work environment and seek specific advice to accommodate your condition. Maintaining a balanced, healthy diet is crucial, and food supplements may be helpful. Key vitamins and minerals for arthritis include calcium, vitamin D, and iron, while supplements like turmeric, glucosamine, selenium, and vitamin C might offer additional benefits, although not for everyone. Living with this lifelong condition can impact mental health, so talking therapies or support groups may provide valuable assistance.
Hand Therapy
A home exercise program might be provided to reduce joint stiffness and improve your thumb movement. Keeping your joints moving and strengthening the muscles that control your thumb is essential. Your therapist may provide guidance on modifying activities, protecting your joints, using adaptive equipment, and utilising splints. These strategies aim to enhance thumb mobility and alleviate discomfort, allowing you to maintain functionality and manage symptoms effectively. By integrating these exercises and techniques into your daily routine, you can potentially reduce pain and improve the quality of life despite the challenges posed by thumb arthritis.
Pain Management
Paracetamol, anti-inflammatory medications (such as aspirin and ibuprofen), or anti-inflammatory gels may help relieve your pain and reduce inflammation. Always consult your doctor or pharmacist for suitable advice.
Joint Injections
If pain management methods are insufficient and daily pain persists, a steroid injection might offer temporary relief. However, the effectiveness of these injections can vary significantly from patient to patient. While some may experience notable pain relief, others might find little to no benefit. It is important to be aware of the potential risks associated with steroid injections, which include infection, increased pain, and skin changes. These injections typically take 2-3 weeks to take effect. Your consultant will discuss your suitability for this treatment, as some medications may interact with steroid injections, making them unsuitable for certain individuals.
Surgery
Surgery is generally considered for you if you have severe arthritis and have not found relief through non-surgical treatments.
The procedure can significantly improve your thumb function and mobility, allowing you to perform daily activities with greater ease and less discomfort. By replacing your damaged joint with an artificial one, the surgery helps to reduce pain and enhance your overall quality of life. Additionally, it can restore grip strength and improve hand function, enabling you to return to your regular routines confidently. Joint replacement surgery also helps prevent further joint damage and reduces the risk of complications associated with untreated thumb arthritis, making it a valuable option for those with significant pain and mobility issues.
Like any surgical procedure, thumb joint replacement carries certain risks. You should thoroughly discuss the procedure’s risks and benefits with your surgeon before deciding.
During surgery
On the day of surgery, anaesthesia will be administered to manage your pain and ensure comfort. Your consultant will discuss anaesthesia options, such as general anaesthesia and/or regional block anaesthesia, to determine the best choice for your needs.
The surgery involves making an incision in your skin to access the affected joint. Your surgeon will remove damaged cartilage and bone, reshaping the bones to fit the artificial joint. This joint, made of metal and plastic, is secured in place. This procedure typically takes about 60-80 minutes and is usually performed as a day case, meaning you can go home the same day. After the surgery, a dressing will be applied to your thumb, and a splint will be worn for several weeks to immobilise the joint and aid healing.
After surgery
Recovery time varies, but you can expect some discomfort and swelling in your hand for the first few weeks post-surgery. Specialist hand therapy is often recommended to strengthen your hand and improve movement. Following thumb joint replacement surgery, you may need to wear a splint or thumb cast for several weeks to protect the new joint and support the healing process.
Recovery from thumb joint replacement typically spans several months to a year, with a gradual return to your normal activities and optimal hand function. The recovery timeline is influenced by individual factors and commitment to rehabilitation.
Appointment and Treatment Plan
Appointment
Based on your previous consultation with a doctor, an appointment will be arranged between you and a hand & wrist surgeon.
Treatment plan
During this appointment, you will review your medical history, discuss the treatment options and collaboratively decide on next steps.
Conservative treatment
Based on the treatment plan you will be booked in for treatment at the hospital, which might include hand therapy or pain injections.
Pre-op assessment
If conservative treatment options have failed and surgery is an option, then the surgeon and their team will thoroughly assess whether you’re right for the surgery. They’ll consider your current health, any previous issues, and other external matters.
Surgery
Prior to going through the surgery, our team will ensure that you’re prepped once again. If everything is confirmed, you’ll undergo the surgery and then we’ll explain the aftercare instructions.
Aftercare
If necessary, you’ll stay in a ward for a few hours to ensure that you’re ready to go home after the surgery. However, this may depend on the surgery outcome and whether you need moderate or light assistance.
Follow-Up
You’ll come in a few weeks later and we’ll give you one final check-over to ensure that you’re on track for recovery.
Experts
We are proud to provide patients with access to a wide range of clinicians, chosen specifically for their knowledge and reputation in their area of expertise. Our experts align with our values: putting you at the centre of your care and educating you on your options at each step of the journey. We encourage you to learn more about our clinicians and how they can help you below. As always, please contact our patient services team if you require any additional information.
We offer 3 ways to pay for your treatment
We exist to take the stress out of private healthcare.
Our payment options are designed to offer you easy access to our treatments and services. You can choose to pay on the day, spread the cost, or use your private medical insurance.
Our patient services team will guide you through the process, providing clear costs and support throughout your course of treatment so you can focus on the thing that matters most – your health.
Whether you pay in advance, spread the cost, or use your private medical insurance, rest assured you will be receiving exceptional care 365 days a year.
Pay in Advance
Even if you do not have medical insurance, you can still get quick and comprehensive access to private medical care.
We provide transparent pricing from your initial consultation to the completion of your treatment so you know where your stand, every step of the way.
We accept all major debit and credit cards, as well as Apple Pay for UK residents. Please note that we do not accept cash or cheques.
Pay monthly
Paying for your treatment at OSD Healthcare doesn’t need to mean settling the full cost in one go.
Many of our treatments have a pay monthly option that allows you to spread the cost of your treatment over 12 months with no credit checks required.
A minimum spend of £300 does apply. We’ll take your first payment upfront and then arrange a direct debit for your monthly payments thereafter. It’s that simple.
Pay using PMI
We are recognised by all major health insurance companies and with our extensive range of services, there are lots of benefits to using your insurance with us. Our patient services team is here to answer any questions you may have about using your private health insurance with us.
Please bring along your policy details including your scheme details, membership or policy number, expiry date and confirmation of eligibility to claim (i.e. your authorisation number). If you do not have these details with you, we will require payment from you on the day. Patients are liable for any amounts not settled by their insurer.