What are fingertip and thumb arthritis?

As joints wears away, often due to aging, the loss of cartilage can lead to osteoarthritis. In the hand, the fingertips and the base of the thumb are among the common sites for osteoarthritis, leading to terminal finger joint arthritis and arthritis at the base of the thumb, respectively. It is common to have “good days” and “bad days” with any osteoarthritis.

Ms Anna Moon, highly experienced consultant orthopaedic hand surgeon, provides a comprehensive overview of these two conditions, including symptoms and treatment.

What is terminal finger joint arthritis?

Terminal finger joint arthritis is a type of osteoarthritis that affects the distal interphalangeal joint (DIP), the terminal joint of the finger. These joints are often affected by the loss of the smooth cartilage surface that covers the ends of the bones in the joints, a condition known as osteoarthritis. The cartilage then becomes thin and rough, causing the bone ends to rub together.

Although it can develop at any age, osteoarthritis usually appears after the age of 45 and may run in families, but it can also develop due to a fracture of the joints that happened years earlier.

Osteoarthritis can also affect the joint at the base of the thumb, leading to another type of osteoarthritis known as basal thumb arthritis.

What are the symptoms of terminal joint arthritis?

Some common symptoms include pain, deformity, swelling, stiffness and loss of function.

In most cases, people will notice small bony bumps on the back of the joint called osteophytes, which are bony swellings that form next to an osteoarthritic joint. They are called Heberdon’s Nodes when they appear in the hand.

Although pain is a symptom, many patients with terminal finger joint osteoarthritis will experience very little pain. The hands will usually continue to function well, even if the joints become lumpy and bent. We cannot get rid or cure osteoarthritis. The aim is to give patients as many “good days” as possible.

What is the treatment for terminal joint arthritis?

Patients can manage their episodes of pain, redness and swelling by avoiding painful activities (if and wherever possible) as well as taking simple painkillers, anti-inflammatory gels or anti-inflammatory medication. Sometimes, steroid injections may be administered. Frequently, episodes will settle on their own in a few weeks or months’ time.

By permanently stiffening (fusing) the joint in a straight or slightly bent position, surgery can be used to treat a joint that is persistently painful. However, the potential benefit of the procedure needs to be balanced against the loss of movement. There is also an option to have a joint replacement of DIP joint. 

The surgeon will explain the technique they plan to use for each individual case, given that there are several surgical techniques available that are used to achieve the fusion of the joints. Patients may need to wear a splint to protect and support the joint for several weeks after the surgery.

What is arthritis at the base of the thumb?

As people age, the basal joint at the base of the thumb (between the metacarpal and trapezium bones) is often affected by osteoarthritis. Common in women, X-rays show that 25 per cent of women over the age of 55, have arthritis of this joint. Arthritis at the base of the thumb is less frequent in men. Not every arthritis visible or present on X-rays is painful or causing any symptoms. In other words, X-ray findings do not correspond with clinical symptoms.

What are the symptoms of arthritis at the base of the thumb?

Most patients with arthritis of the basal joint of the thumb have no significant pain, but they could experience some pain at the base of the thumb, aggravated by thumb use. Patients may also feel tenderness if they press on the base of the thumb.

Other symptoms may include difficulty with tasks, such as opening of jars or turning a key in the lock, as well as stiffness of the thumb and a partial loss of ability to open the thumb away from the hand.

A bump at the base of the thumb and a hyperextended (with a zigzag appearance) middle thumb joint, may present in advanced cases.

What is the treatment for arthritis at the base of the thumb?

There are a number of treatment options available.

The first one is avoiding activities that cause pain, if and wherever this is possible.

The second one includes the use of analgesics and/or anti-inflammatory medication, on the advice of a pharmacist or a doctor.

The third option is the use of a splint to support the thumb and wrist. Whilst rigid splints (made of metal or plastic) are effective, they make thumb use difficult. Rather, a flexible neoprene rubber support is more practicable.

The fourth option comprises steroid injections that can improve pain in many cases, although the effect may wear off over time. Occasionally, it may cause some thinning or a change of colour in the skin at the site of injection, but in general, injections have few risks.

Often, symptoms stabilise over time and are controlled by non-surgical treatments alone. Surgery is a last resort and there are several procedures that can be performed to treat this condition.

The first operation requires an orthopaedic surgeon to cut and realign the metacarpal bone next to the arthritic bone, in a procedure called osteotomy.

Another option which is sometimes combined with the reconstruction of the ligaments involves the removal of the trapezium (the bone at the bottom of the thumb) which forms one surface of the arthritic joint. This is the most common surgical procedure to treat arthritis at the base of the thumb.

The fusion of the joint to prevent it from moving and joint replacement (similarly to hip replacement), are other surgery options available. The other surgical option is denervation, a procedure that cuts small nerve branches that transmit pain from the arthritic joint.

The last surgical option is CMC (carpometacarpal) joint replacement.

Depending on each individual case, the orthopaedic surgeon will advise on the best option to treat arthritis at the base of the thumb.

Ms Anna Moon is a highly experienced consultant orthopaedic hand surgeon who specialises in several hand, wrist and elbow conditions. If you have terminal finger joint arthritis or arthritis at the base of the thumb and would like to consider your options, make sure to visit Ms Moon’s Top Doctors profile today.