Managing Arthritis-Related Hand Pain: A Practical Solution

While arthritis is often associated with the knee and hip joints, these aren't the only areas that can be affected. The knees and hips are crucial for walking, and more than a third of adults over the age of 65 develop osteoarthritis in these areas. This leads to over a million joint replacements in the US annually.

However, despite its significance, the first carpometacarpal joint, which links the thumb to the wrist, is frequently overlooked. Most individuals may not be familiar with this joint and only become conscious of its importance when arthritis strikes. Recent research has revealed that a widely practiced, medication-free therapy can effectively alleviate the discomfort caused by this form of arthritis.

The Incredible Opposable Thumb

The first CMC joint is pivotal in granting our thumbs remarkable dexterity and functionality. The incredible opposable thumb can be attributed to this often-overlooked joint. It enables us to perform many daily tasks, from gripping objects and opening jars to turning doorknobs, writing, clenching a fist, using a key, and many other essential actions.

This is why the first CMC joint deserves greater recognition and appreciation as one of the most important joints in the human body.

Identifying First-CMC Arthritis: Key Symptoms

To determine if you have first-CMC arthritis, watch for the following common indicators:

  1. Aching at the base of your thumb and wrist
  2. Pain that intensifies during activities such as using keys, writing, or opening jars
  3. Reduced functionality, including weakened grip
  4. A bony bump over the joint, often resulting from excessive bone growth
  5. Pain at rest or during the night, especially if the arthritis is severe

Your doctor may suspect osteoarthritis of the first CMC based on your symptoms and a physical examination. However, an x-ray can provide a definitive diagnosis.

Effective Treatments for First-CMC Osteoarthritis of the Hands

While treatment options for osteoarthritis in any joint, including the first CMC, can be limited and may not always yield optimal results, the most recent US guidelines for hand or thumb osteoarthritis strongly recommend the following:

  1. Wearing a brace or splint (referred to as an orthosis)
  2. Engaging in exercises specifically designed for the affected joint
  3. Participating in educational programs that promote self-management of troublesome symptoms
  4. Taking anti-inflammatory medications, such as ibuprofen

A brace, exercise regimen, and education are typically provided through occupational therapy, a specialized branch of physical therapy that focuses on enhancing hand and wrist functions essential for daily activities, like bathing or getting dressed. However, the efficacy of occupational therapy had not been thoroughly assessed until recently.

Occupational Therapy Proven Effective in New Study

A recent study involving 180 participants with first-CMC osteoarthritis, with an average age of 63 and 80% being women, aimed to evaluate the effectiveness of occupational therapy.

The participants were divided into two groups: half were randomly assigned to receive occupational therapy (including education, exercises, braces, and assistive devices), while the other half received only information about osteoarthritis.

The findings revealed that a three-month course of occupational therapy effectively reduced pain at rest and post-exercise, while also enhancing grip strength and overall function.

This study stands as one of the most comprehensive evaluations of occupational therapy for this condition. However, it does have some limitations. Treatment assignments were not blinded, meaning participants were aware if they received occupational therapy or not, which could have influenced expectations and the placebo effect on the results. Additionally, the study only spanned three months, leaving the long-term impact of occupational therapy unexplored.

Other Treatment Options

Surgical Treatment Options

If non-surgical treatments fail to alleviate pain or enhance hand mobility, it may be time to explore surgical alternatives. Our orthopedic surgery team will help you determine when surgery is the appropriate solution and which procedure best aligns with your needs and healthcare objectives. Common surgical procedures include:

Joint Replacements

For patients experiencing persistent pain due to damaged or abnormal joints, joint replacement may be a viable option. During this procedure, the problematic joint is removed and replaced with a joint implant. This implant can help maintain joint motion and functionality without pain. Our hand specialists will assist you in determining if this is the right choice for you.

Joint Fusions

Joint fusions involve stabilizing and creating a pain-free joint by fusing the bones together, rather than replacing the joint. Although joint fusions relieve pain, some motion may be lost. Our team will collaborate with you to decide if this treatment aligns with your healthcare goals.

Partial Joint Fusions

Partial joint fusions are specifically designed for patients with degenerative wrist arthritis. This procedure involves fusing the small bones of the wrist together, which alleviates pain while still preserving some wrist mobility. If you suffer from degenerative wrist arthritis, this treatment may be the ideal solution for your needs.

William H. McDaniel, MD

Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School.

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