Thumb base arthritis

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Patient Information

A progressive degenerative disorder of the thumb carpometacarpal joint.
Patients typically complain of pain at the base of the thumb, with difficulty pinching and grasping objects.
Examination may reveal deformity of the joint with a positive grind test.

Blood tests and radiography are not usually indicated as part of a primary care assessment of suspected small joint osteoarthritis and are not required prior to commencing treatment or for referral.

Utilise a shared decision-making approach.
NICE core treatments are safe, low cost and widely accepted. Provide information and advice through leaflets and alternative sources.
Initial treatment includes exercise, paracetamol (regular better than ‘as required’) and NSAIDs (standard NSAID precautions).
When symptoms affect activities of daily life refer to Physiotherapy or Occupational therapy for joint protection training, protective splints, and assistive devices.
Steroid injections have limited efficacy but may provide temporary relief. Image guided injections are recommended rather than ‘blind’.
Surgical interventions include fusion, joint excision, and joint replacement.
Referral indications: Diagnostic uncertainty, Referral for physical therapy, Referral for intra-articular steroid injection, A fit patient willing to undergo surgery with pain/stiffness/loss of function significantly impacting quality of life and refractory to non-surgical treatment.