Degenerative joint disease of the thumb can affect the ability to grip and grasp, so even the most routine activities, such as picking up coins or grasping a coffee cup, can be painful and troublesome. Several treatment options are available for degenerative joint disease of the thumb, to be chosen depending upon the severity of the arthritis.
Over-the-Counter Medications
Several types of over-the-counter (OTC) medications can be taken for relief of pain and inflammation. In the early, mild forms of joint degeneration, symptoms may present as a mild ache or soreness. Non-steroidal anti-inflammatory drugs, or NSAIDs, in OTC dosages may provide sufficient relief of pain-causing inflammation. These drugs are typically taken on an as-needed basis.
Prescription Medications
As the degenerative condition continues to worsen, the need increases for stronger medication to relieve pain and inflammation. Use of prescription, usually narcotic, medication may be warranted. Examples of medications at this level of treatment can include codeine, oxycodone and hydrocodone.
Narcotic pain medications exert their actions on the pain receptor centers in the brain, rather than at the site(s) of injury or inflammation that cause the pain. In essence, they numb the brain's interpretation of the pain impulses received, thus reducing the overall perception of pain.
Cortisone Injection
Another treatment option for degenerative joint disease of the thumb is the use of intra-articular (meaning "into the joint") steroid injections, also known as cortisone injections. These injections can be used in addition to, or in place of, oral medications depending on the severity of the symptoms.
Corticosteroids are substances that occur naturally in the body and are produced within the adrenal glands. They are powerful anti-inflammatory substances. When injectable cortisone is used to treat degenerative arthritis, it is injected directly into the joint. It is usually mixed with some form of local anesthetic to bring about some immediate pain relief. Relief can last for weeks to months.
Bracing/Splinting
There are many different types of braces and splints that can be used to treat degenerative joint disease of the thumb. The main purpose of using braces or splints is to minimize the movement of the arthritic thumb joint, thus reducing pain. Some brace types can be quite restrictive, while others allow more functionality.
Braces and splints that cross the wrist joint and onto the forearm in addition to the thumb are the most restrictive. Other braces can allow more movement of the hand while keeping the thumb still. The choice will depend on the severity of the symptoms.
Surgery
In severe cases of degenerative joint disease of the thumb, surgery may be the only successful treatment option. There are essentially three procedures that can be performed; fusion surgery (which makes the thumb permanently stiff), joint replacement and anchovy arthroplasty.
Fusion surgery involves surgically scraping off the cartilage joint surfaces of the base of the thumb metacarpal bone and the cartilage of the small carpal bone called the trapezium bone. The two surfaces are fixed together using screws and/or pins and held in place until they have healed solid.
Anchovy arthroplasty involves the complete removal of the entire carpal bone, harvesting a small tendon from the forearm and inserting it into the space left behind. This wad of tendon, which resembles an anchovy, provides a soft tissue buttress against the thumb bone, preventing the thumb from from becoming shortened. It also eliminates the pain of the arthritic surfaces rubbing together.
Joint replacement involves insertion of a prosthetic spacer, typically made of polished metal or silastic, a type of silicone, into a hollowed out portion of the canal at the base of the thumb. The spacer replaces the removed carpal bone to provide support to the thumb and to reduce friction and pain.
