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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