Thumb or First CMC Joint Osteoarthritis

First carpometacarpal (CMC) joint arthritis, also known as thumb arthritis or basal joint arthritis, is a common form of osteoarthritis that affects the base of the thumb. The first CMC joint, located at the base of the thumb, is a saddle joint that allows the thumb its wide range of movement. Over time, the cartilage that cushions this joint can wear down, causing the bones to rub against each other and leading to pain, inflammation and a visible deformity. This can impair the ability to grip, pinch, and perform other movements with the thumb.

Treatment options for first CMC arthritis typically follow a progression from less to more invasive options, and can include:

1. Non-Surgical Treatments:

  • a. Activity modifications: Avoiding activities that cause pain and trying different ways to carry out tasks to put less stress on the thumb.
  • b. Splinting: Wearing a splint or brace can help support the thumb, reduce pain, and rest the joint at the base of the thumb. The splint is designed to be worn during activity and does not limit the motion of the wrist or tip of the thumb.
  • c. Physical and occupational therapy: Therapists can provide exercises to improve thumb strength and flexibility, and suggest adaptive devices to help with daily activities.
  • d. Medications: Over-the-counter pain relievers, such as acetaminophen (Tylenol) or nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, can help reduce pain and inflammation. In some cases, prescription medications may be used.
  • e. Corticosteroid injections: If other treatments are ineffective, your doctor may recommend corticosteroid injections into the thumb joint to reduce pain and inflammation.

2. Surgical Options

If non-surgical treatments do not provide sufficient relief, several surgical options can be considered:

  • a. Trapeziectomy: This is the most common procedure performed and involves the removal of one of the bones in the joint, sometimes with a tendon graft or with the placement of a small implant to maintain the space and function. 
  • b. Joint fusion (arthrodesis): This procedure involves fusing the bones of the joint together, which can provide pain relief but also limits movement.

The choice of treatment for first CMC arthritis depends on several factors, including the severity of the condition, the patient’s overall health, their lifestyle and daily needs, and their personal preferences. Each treatment option has its own potential risks and benefits, which should be discussed thoroughly with a healthcare provider.  At Total Orthopedics and Sports Medicine, we have Hand Surgery Specialists who can evaluate your condition and devise a treatment plan specific to your condition. 

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