Thumb OA
This guideline applies to adults aged 18 and over.
Introduction
First carpometacarpal (CMCJ) joint osteoarthritis has a female:male ratio of 6:1. Previous ligament laxity is associated with CMCJ osteoarthritis.
Red Flag Features
Trauma
Septic joint
Inflammatory causes
Key Features of Assessment
-
Nature and location of pain
-
Function, work and leisure activities affected
-
Exclude red flags and alternative causes, i.e. gout, RA, tendonitis, fracture etc.
- In advanced cases there may be a prominence at the base of the thumb and hyperextension of the MCPJ
Investigations
Consider Xray if there are:
- Severe symptoms or deformity
- Alternative causes suspected
Request Xray within 6 months if:
- Referring for consideration for surgery
Management
Adopt a shared decision making approach with the patient.
Provide written information on Thumb Osteoarthritis
Basal thumb arthritis | The British Society for Surgery of the Hand (bssh.ac.uk)
Avoid activities that cause pain.
Trial of an over-the-counter thumb splint. Hand therapy are able to provide specialised thumb splints as needed.
Analgesia
- Topical NSAIDs
- Oral paracetamol
- Oral NSAIDs if tolerated and no contra-indications, consider concomitant proton pump inhibitor protection where appropriate
Consider a steroid injection into the CMCJ. Explain that the injection may improve pain in many cases, improvement may occur within a few days but often takes several weeks to be effective, although the effect may wear off over time. The risks of injection include infection, skin thinning or colour change at the site of injection. Patients can have a repeat injection or more if effective and required.
Referral
Trauma
Direct to Minor Injuries Unit/Emergency Department as needed
Septic joint
Discuss with Orthopaedic SHO on call
Inflammatory causes
Work up and refer to Rheumatology if needed
Refer to Orthopaedics if conservative measures have failed and the patient wishes to consider surgery
Refer to Hand therapy if specialised thumb splint required.
Advice and Guidance
No formal advice and guidance service is available.
Supporting Information
For professionals:
For patients:
Basal thumb arthritis | The British Society for Surgery of the Hand (bssh.ac.uk)
References
http://www.bssh.ac.uk/patients/conditions/24/basal_thumb_arthritis
Page Review Information
Review date |
11/03/2024 |
Next review date |
11/03/2026 |
Clinical editor |
Dr Rebecca Hopkins |
Contributors |
Dr Rebecca Hopkins, GP Guidelines Lead Referral Management Service, Cornwall and IoS ICB Mr Rob Poulter, Orthopaedic Surgeon, Royal Cornwall Hospitals NHS Trust |