When you meet with us for your consultation about thumb pain or thumb arthritis treatment, the first consideration is a proper diagnosis. We will ask about your symptoms, prior injuries, pain patterns, or activities that aggravate the condition. The examination may show tenderness or swelling at the base of the thumb. An x-ray may show the diseased joint. Sometimes, patients have problems in addition to arthritis that are diagnosed at the same time, which need treatment as well.

Many arthritis patients also complain of numbness and tingling of the fingers, which is a sign of carpal tunnel syndrome. In fact, the two are known to be somewhat related. Read more about carpal tunnel syndrome.

If you are found to have thumb base arthritis, we then determine your category (see the section about categories below) and devise a treatment plan based on that assessment.

We will have an honest discussion with you about your expectations and concerns, as well as the limits and risks of the treatments we recommend. We will give you thorough written information for your diagnosis and treatment options. If surgery is to be performed, we will provide you with instructions to prepare for your surgery, how to take care of yourself after the surgery, and answer any questions you have.

At Summit Medical Group, the patient experience is of primary importance to us. We customize every single procedure we do so that it is tailored to what is best for you.

Just like orthopedic surgeons, all plastic surgeons train in the surgery of the hand. In fact, historically, the origins of hand surgery involved more plastic surgeons than orthopedic surgeons, but over time, orthopedic surgeons have surpassed plastic surgeons in number in the USA. Some plastic surgeons and some orthopedic surgeons choose to specialize and focus on hand surgery. Not all plastic surgeons and not all orthopedic surgeons specialize in hand surgery. In our practice, Drs. Momeni and Schmid specialize in hand surgery across multiple offices.

Patients fall into 3 categories:

• Category 1: Patients with MILD pain. They do not need a hand doctor, as they can manage their discomfort with non-surgical treatments, such as over-the-counter oral medication (Motrin or Advil) and topical anti-inflammatory medication (Aspercreme or BenGay), and a soft neoprene thumb brace.
• ​Category 2: Patients with MODERATE pain. In these cases, oral and topical anti-inflammatory medications, as well as a thumb brace, have not worked well enough. We then recommend physical therapy and cortisone injections in the thumb joint, and we prescribe stronger versions of the over-the-counter medications.
• Category 3: Patients with SEVERE pain. In these cases, none of the other interventions work any longer, and the patient feels he/she can no longer live with the pain. Surgery is indicated to help patients in this category.

For category 1 and 2 patients, the following can be done at home:

• Icing of the joint for 5 to 15 minutes several times a day. There is no great science about this. If it feels good to ice it, you can go for it. If it does not, don’t waste your time on it.
• Wearing a supportive splint (thumb brace) to limit the movement of the thumb and allow the joint to rest. It may be worn overnight or intermittently during the day. We recommend soft neoprene braces, which are available at many local drug stores. Once again, you should try this and continue it if it helps. If it doesn’t, stop wearing the brace.
• Oral anti-inflammatory medications to help reduce inflammation and swelling.
• Topical anti-inflammatory medication such as Aspercreme or BenGay.
• Injections of an anti-inflammatory (cortisone). These injections bring significant relief for about 6 months and are much more effective than the above treatments.
• Physical therapy, which helps patients learn behaviors that might reduce strain on the arthritic joint. However, it is important to understand that physical therapy will not cure the wear and tear that leads to arthritis.

If surgery is indicated in your case, it can be performed on an outpatient basis, and two different procedures can be used:

• Removal of the diseased part of the joint and reconstruction of the ligaments so that the bones no longer rub against each other. This method is somewhat similar to a knee or hip replacement and is the preferred technique, but no implants are used – just your own tissues – to reconstruct the joint.
• Fusing the bones of the joint together. This will limit movement, but usually treat the pain very well and leave a steady thumb. This is a good method for patients who perform heavy physical activity with their thumbs (a manual laborer, for example).

After surgery, you will have to wear a cast for 6-8 weeks at first. Then, you will need hand therapy for 2-3 months with a certified hand therapist to gradually regain movement and strength. For this reason, most patients plan ahead for their surgery so that they can put the recovery time aside.  The initial recovery can take 3-6 months, and the joint takes 10-12 months before it reaches its final state.

Even though post-surgical thumb arthritis recovery is lengthy, the satisfaction rate from the surgery is high, because the source of the arthritis pain is gone. The thumb may never be as good as new, but most patients are able to resume normal activities, with far less pain than before surgery. Most patients do not have to have the surgery again, although arthritis recurs or happens in surrounding joints in about 10% of patients who have severe osteoarthritis.