Rarely do we think about all that we accomplish with our hands, until we begin to lose this ability. As an orthopedic surgeon specializing in the small bones and joints of the hand, wrist and elbow, I see first-hand how debilitating it can be for patients, particularly in a population staying active and living longer than generations past.
A form of osteoarthritis, Basilar joint arthritis, also referred to as Basal Joint and arthritis of the thumb, affects women more commonly than men and generally occurs after 40 years of age. It is unclear why this type of arthritis affects women more than men.
It is prompted by the same joint conditions predisposing any other joint in the body to arthritis, joint instability — possibly caused by the improper healing of an injury or repeated injury to the joint — cartilage deterioration, and general wear and tear.
Patients suffering from rheumatoid arthritis are also more susceptible to osteoarthritis. Arthritis affecting the basilar joint of the thumb, or the first carpometacarpal joint located near the wrist bone, is called Basilar joint arthritis.
How Basilar Joint Arthritis Happens
The unique shapes of the small bones of the thumb permit its movement in and out of the plane of the palm to oppose the other fingers. The stability of the carpometacarpal joint of the thumb depends on several small ligaments, which allow movement but remain close to the joint surfaces.
If the ligaments loosen and permit too much sliding of the joint surfaces, increased wear on the joint cartilage may occur leading to arthritis. A fracture or injury can also lead to joint dysfunction and deterioration, ultimately leading to arthritis as well.
Inflammation may occur as joint degeneration progresses. Pain is prominent when pressure is applied to the joint in pinching and grasping activities. If left untreated, joint surfaces are eventually destroyed and bony spurs may develop around the joint. In severe cases, there may be complete joint destruction, an inward collapse of the metacarpal, and deterioration around the trapezium. Other joints may also become affected as they react to these changes.
Basilar joint arthritis will produce pain that progresses gradually over time. Symptoms may include:
- Pain and tenderness at the base of the thumb that worsens when snapping, turning a key or door knob.
- An overall enlarged appearance of the thumb.
- Improper alignment of the joint.
Eventually, the pain discourages use of the thumb, resulting in joint weakness and muscle loss.
After assessing a patient’s history and an examination of the thumb, an X-ray may help show the degree of joint damage. A series of X-rays can help determine the rate of progression.
Treatment is determined based on the affect that the arthritis has had on a patient’s joint at the time of diagnosis. It may involve conservative therapies, such as anti-inflammatory medications, rest from certain irritating activities, corticosteroid injections, rehabilitation and occupational therapy, as well as splinting of the thumb to provide support, reducing pain and preventing deformity.
In more severe cases, advanced arthroplasty procedures and refined joint implants are proving successful. During the procedure the damaged joint surfaces are removed and replaced with a substitute joint, eliminating pain, and improving strength and range of motion.
Dr. Evan Collins is a board-certified, fellowship-trained orthopedic surgeon who specializes in injuries and conditions affecting the hand, wrist and elbow. He is a published author and continues to participate in research focused on repetitive stress injuries and degenerative joint conditions. Formerly the Chief of the Hand Section and Director of the Hand Fellowship at Baylor College of Medicine, he serves today as Director of The Houston Methodist Hand & Upper Extremity Center and is a member of the faculty of Weill Cornell Medical College. Dr. Collins is located 6560 Fannin, Suite 410 in Houston TX 77030, and he can be reached at 713.441.3535.