Pathophysiology

The thumb joint articulates with the trapezium which is one of the small carpal bones in the hand. This is the most commonly affected joint in the hand with osteoarthritis. More common in women than men with 30% of women aged over 40 years showing arthritic changes on x-ray. May exist as a localised (single joint) or type of inflammatory arthritis e.g rheumatoid arthritis/gout and previous injuries may increase risk.

Symptoms

• Pain with repetitive movements e.g pinching, turning and clicking of finger to thumb

• Swelling and tenderness at the base of thumb

• Loss of strength when gripping or pinching

• Reduced range of movement of the thumb

• Development of a bony prominence over the thumb

Management

• Activity modification

• Ice or heat

• Pain relief

• Physiotherapy including range of movement, strengthening exercises and splinting

• Orthopaedic options includes steroid injection and surgery if symptoms are not settling with 3 months conservative measures

Investigations

X-ray can assess the level of osteoarthritis