Two of the most persistent myths regarding thumb arthritis are that you must live in pain or that lost dexterity cannot be regained.

While the condition typically progresses in severity, treatment focuses on two main goals: decreasing pain and restoring grip strength.

“People often underestimate the thumb’s vital role in hand dexterity,” said Dr. Patrick Johnston, an orthopedic hand surgeon in Steamboat Springs and member of the medical staff at UCHealth Yampa Valley Medical Center. “Our thumb is essential for pinching and gripping. When it becomes unstable and painful, activities of daily living become difficult, and quality of life suffers.”

Thumb arthritis is a common condition that affects up to 30% of people as they age, typically surfacing in their 50s and 60s. It occurs through the progressive loss of cartilage at the base of the thumb which is the carpometacarpal or CMC joint, commonly referred to as the “saddle” joint. Years of stretching the ligament that stabilizes this joint places an excessive load on the cartilage until it wears thin.

Recognizing thumb arthritis

The most common complaint is pain at the base of the thumb or decreased grip strength when opening jars or sealed bags. Causes include genetics, prior trauma, or repetitive occupational and recreational stress.

“It is important to know that when treating thumb arthritis, we focus on the symptoms the patient is experiencing, rather than jumping to surgery because of an arthritic x-ray,” said Johnston, who is also an assistant clinical professor with the University of Colorado School of Medicine. “We start with conservative treatment and treat the patient, not the x-ray. The patient’s level of pain and thumb function are our primary concerns.”

Treatment options

According to Johnston, physicians and therapists begin with the least invasive options, including:

• Anti-inflammatory medications, both oral and topical.
• Supplements. Turmeric (1,000 mg daily), for example, has shown research-backed benefits for pain.
• Splinting, as bracing the thumb can provide stability.
• Injections, such as steroid injections.

If pain persists or movement continues to decline, surgery is a highly effective next step.

The outpatient Ligament Reconstruction and Tendon Interposition, or LRTI, procedure accounts for about 90% of thumb arthritis surgeries. During the 45-minute procedure and under a regional nerve block, Johnston makes a small incision to remove the arthritic bone causing the pain, then uses a forearm tendon to reconstruct the worn-out ligament.

“It is the most reliable hand surgery,” he said. “The complication rate is extremely low, and patient satisfaction is exceptionally high.”

Research shows patients report a 15% increase in grip strength six months post-operation, rising to 30% at nine months. The surgery has been performed since the 1940s with only slight variations, so there is solid long-term data on the outcomes.

“It’s better than any other technique that exists for thumb arthritis,” he said.

Patients use a removable thumb splint for six weeks, but the fingers remain free for washing and light use.

“I’ve performed this on patients in their 40s and up to those in their 90s,” Johnston said. “Whether you are a rancher, a knitter, or just want to grip your ski poles and lift your grandbaby, you shouldn’t have to live in pain. Thumb arthritis is treatable, and low-risk options are available to help you live pain-free.”

Mary Gay Broderick writes for UCHealth. She can be reached at marygaybroderick@comcast.net.