Thumb Arthritis

ΠΕΡΙΕΧΟΜΕΝΑ

The thumb constitutes, without a doubt, the most important digit of the human hand, undertaking nearly 50% of its total functionality. Thanks to the evolutionary capability of “opposition” (the ability of the thumb to turn and touch the rest of the fingers), humans can execute from the most powerful grips (such as holding a heavy tool) to the most delicate and precise movements (such as writing, sewing, or buttoning a piece of clothing). When this fundamental joint becomes diseased, the impacts on daily life are immediate and debilitating.

Thumb arthritis (known in the medical community as rhizarthrosis or osteoarthritis of the trapeziometacarpal joint) is a chronic, degenerative condition that gradually wears down and destroys the basal joint of the thumb. Although various types of arthritis exist (such as rheumatoid or post-traumatic), the type that most frequently affects the joint at the base of the thumb is classic osteoarthritis, which is due to the mechanical wear and tear of time.

What is Thumb Arthritis and How Is It Created?

To understand the condition, it is necessary to look at the unique anatomy of the region. The joint at the base of the thumb is formed by the union of a small wrist bone, called the trapezium, and the first bone of the thumb (the first metacarpal). This joint has a characteristic shape resembling a horse saddle (saddle joint). This exact shape allows the thumb to move freely in all directions, to rotate, and to pinch with immense power, so that you can firmly grasp things in your hand.

In a healthy joint, the ends of these bones are covered by articular cartilage. The cartilage is an extremely smooth, white, and elastic tissue that functions as a biological “shock absorber”. It lubricates the area and allows the bones to glide easily and painlessly within the joint, absorbing vibrations.

Unfortunately, over time and with continuous use, this cartilage wears away. Osteoarthritis occurs when the cartilage begins to thin, dry out, and eventually become completely destroyed. Without this protective layer, the bare bone of the metacarpal begins to rub directly against the bare bone of the trapezium. This mechanical friction causes severe inflammation, excruciating pain, and gradual destruction of the joint. The body, in its attempt to stabilize the worn joint, creates new bone at the edges (so-called bone spurs or osteophytes), which cause further deformity and stiffness.

Ο μόνος Ορθοπαιδικός στην Ελλάδα στην χειρουργική ώμου και άνω άκρου με προϋπηρεσία μόνιμης διευθυντικής θέσης (substantive Consultant ) για 10 συναπτά έτη στην Μεγάλη Βρετανία

Who is most at risk for Thumb Arthritis?

Arthritis of the base of the thumb does not appear randomly. There are specific predisposing factors that dramatically increase the chances of developing the condition:

Gender: The condition is overwhelmingly more common in women than in men (the ratio reaches up to 6:1). This is mainly due to the physiological joint laxity that women present, which allows greater micro-instability in the joint and thus faster wear. Also, hormonal factors during menopause play a significant role.
Age: The incidence of appearance increases exponentially with age. Usually, the first symptoms manifest after the age of 40 to 50, when the regenerative capacity of tissues declines.
Previous Injuries: Previous fractures at the base of the thumb (such as a Bennett or Rolando fracture) or repetitive sprains of the ligaments (such as “skier’s thumb”), can alter the biomechanics of the joint. This increases the probability of developing post-traumatic osteoarthritis, even at much younger ages (e.g., at 30).
Occupation and Daily Activities: Individuals who execute repetitive gripping and pinching movements (e.g., hairdressers, seamstresses, manual laborers, musicians, as well as people who type intensively) place a daily burden on the joint, accelerating the wear of the cartilage.

Symptoms of Thumb Arthritis

The symptomatology of thumb arthritis is exceptionally characteristic and, if left unaddressed, tends to worsen gradually over time. The main symptoms include:

Pain during gripping (Pinch Grip Pain)

It is the first and most agonizing symptom. The patient experiences a sharp, piercing pain at the base of the thumb during activities that involve grasping, squeezing, or “pinching” objects. Turning a key in a lock, opening a door, opening a jam jar, writing with a pen, using a computer, and any kind of manual labor become painful.

Swelling and Tenderness

The area at the base of the thumb (where it joins the wrist) presents swelling (edema) and is extremely tender to palpation. Inflammation of the synovium makes the joint appear enlarged.

Intense Pain at Rest

After prolonged use of the hand, the pain does not stop immediately. The patient may feel a deep, persistent pain (like a throbbing sensation) even when the hand is resting, which frequently wakes them up during the night.

Weakness and Dropping Objects

Due to the pain and the destruction of the joint’s biomechanics, the strength in the hand decreases dramatically. Patients often complain that objects drop from their hands (e.g., plates or glasses) without them realizing it.

Limited Range of Motion and Stiffness

As the bone spurs grow, the joint “locks”. The patient is unable to fully open their thumb (to grasp a large object).

Bony Deformity

In advanced stages, the joint subluxates slightly outward. This gives the hand a characteristic, square appearance at the base of the thumb, while the next joint of the digit may hyperextend (swan-neck deformity), in an attempt by the body to compensate for the loss of motion.

How is the Diagnosis performed?

Early diagnosis is the key to avoiding the complete destruction of the joint. Mr. Polyzois will take a detailed and specialized medical history and will ask you, among other things, about the duration of your symptoms, any previous injury in the past, the characteristics of the pain (whether it is sharp or continuous), and any activities or hobbies that exacerbate the condition.

During the clinical examination, the doctor will carefully observe your thumb for swelling and deformity. One of the most reliable clinical tests used is called the Grind Test (Compression and Rotation Test). During this test, the doctor holds the wrist joint firmly, presses the metacarpal of the thumb downward, and simultaneously rotates (moves) it. If sharp pain arises or if an intense crepitus (a grinding sound like gravel) is heard and felt in the joint during movement, this means that the protective cartilage is absent, the bones are rubbing directly against each other, and the diagnosis is advanced osteoarthritis.

The clinical diagnosis is always confirmed with imaging examinations. A simple X-ray of the hand is usually more than enough and can clearly show:

The narrowing of the joint space (meaning the disappearance of the cartilage).
The deterioration and hardening of the underlying bone.
Any bone spurs (osteophytes) or calcium deposits that have developed.
The degree of subluxation of the joint.

It is important to note that some patients with arthritis at the base of the thumb simultaneously have symptoms of Carpal Tunnel Syndrome (numbness in the fingers) or De Quervain’s tenosynovitis. Mr. Polyzois will thoroughly check you for these accompanying conditions as well, so that the treatment is comprehensive.

Treatment of Thumb Arthritis

The goal of treatment is twofold: immediate relief from the debilitating pain and restoration of the functionality and strength of the hand. The approach depends strictly on the stage of the disease and the demands of the patient.

Non-Surgical (Conservative) Treatment

In its initial stages, arthritis at the base of the thumb can respond exceptionally well to non-surgical treatment. The protocol includes:

Activity Modification: Adapting the way you use your hands. Using special tools with thick handles (e.g., thick pens, special jar openers) that reduce pressure on the joint.
Medication: Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), either in the form of pills or in the form of a topical cream/gel, help temporarily and effectively in reducing inflammation, swelling, and pain.
Immobilization (Splint): The use of a functional, supportive splint (Thumb Spica Splint) is fundamental. This splint encompasses the thumb and wrist, restricting the movement of the joint and absorbing mechanical loads. It allows the joint to rest, the inflammation to calm down, and healing to take place. The splint can protect both the wrist and the thumb and can be worn all night or intermittently during the day, especially during heavy tasks.
Intra-articular Cortisone Injections: Because arthritis is a progressive, degenerative disease, the condition can worsen over time despite the use of a splint. The next phase of treatment involves the infiltration (injection) of a solution of powerful steroids (cortisone) combined with a local anesthetic, directly into the affected joint. This offers rapid containment of the inflammation and can usually provide impressive relief for a few weeks, a few months, or – in some cases – for over a year, depending on the severity of the disease.
Biological Treatments: In certain selected cases, injections with Platelet-Rich Plasma (PRP) or Hyaluronic Acid can offer additional protection and pain reduction.

Surgical Treatment

When the cartilage has been completely destroyed (bone rubs against bone) and non-surgical treatment (splints, injections) is no longer effective in controlling the pain, surgical operation constitutes the sole method that fully and definitively relieves the symptoms, returning functionality to the hand.

Mr. Polyzois is particularly experienced, officially certified, and specialized in modern upper limb surgeries, which include three different methods to rid the patient of arthritis and pain:

Arthrodesis (Joint Fusion)

In this technique, the damaged ends of the bones (the trapezium and the metacarpal) are “cleaned” of cartilage and permanently joined (“fused”) together using special osteosynthesis materials (small plates, screws, or special wires). As the bones fuse (weld) and become one, the joint ceases to exist, and consequently, the movement that was causing pain stops.

Advantage: It offers complete and permanent relief from the pain of arthritis and creates an exceptionally strong thumb.
Disadvantage: There is almost complete immobility and loss in the range of motion of this specific joint. It is indicated mainly for younger patients or for heavy manual laborers who require raw gripping power.

Thumb Arthroplasty (Joint Replacement)

Just as is done in the knee or the hip, the damaged joint is removed and replaced by an artificial joint (prosthesis) made of titanium and special polyethylene.

Advantage: It fully preserves movement and normal anatomy.
Disadvantage: Like all artificial materials, it can loosen or wear out over the passage of years.

Trapeziectomy and Ligament Reconstruction (LRTI)

This method constitutes the “gold standard” worldwide. It includes the complete surgical removal of the carpal bone (the trapezium), which suffers from arthritis. Once the bone is removed, the gap created is covered. Reconstruction of the remaining joint and ligaments takes place using a portion of an adjacent tendon from the patient’s own body (as a biological cushion – graft) and with the use of special sutures or suspension systems (anchors).

This method is increasingly gaining ground, as it rids the patient of pain, while preserving an excellent range of motion and does not utilize metal prostheses that can wear out. It is usually the method of choice in the hands of Mr. Polyzois, although the final choice is, of course, always personalized for each patient, depending on age, occupation, activities, as well as the exact condition of the basal thumb joint and the adjacent joints (stage of disease).

Surgical Procedure: Speed and Safety

In any case, the operation is designed to offer the least possible distress:

Anesthesia: The operation is bloodless and entirely painless. General anesthesia is not required, as specialized regional anesthesia is utilized (only the hand is numbed – Awake Surgery), depending naturally on the desires of each patient.
Minimal Invasiveness: The surgical technique is minimally invasive (MIS) and the incision does not exceed 4 to 5 centimeters, following the natural folds of the skin.
Excellent Aesthetic Result: Careful healing and the use of intradermal absorbable sutures (which do not require removal) make the aesthetic result excellent.
Immediate Return Home: The patient does not stay overnight. They are discharged (Day Clinic) a few hours after the surgery and usually wear a light, small functional splint for about two to four weeks, while they can and are encouraged to use the rest of their hand and other fingers normally from day one. Most importantly: The agonizing pain of arthritis is eliminated completely and immediately from the very first day after the surgery!

Rehabilitation of Thumb Arthritis

The success of the operation is completed with proper postoperative care. Once the protective splint is removed (at 2 to 4 weeks), a personalized and specific physiotherapy program is followed in every case. The physiotherapist will guide you through stretching and gradual strengthening exercises.

Through this process, the patient regains full mobility, stability, and gripping power in their thumb in a short amount of time. Full recovery usually lasts 3 to 6 months, yet the radical improvement in the quality of life is immediately noticeable. Patients are now able to return fully and safely to their normal activities, their favorite hobbies, as well as to demanding manual work and sports activities of all kinds, without any pain.

A Few Words About the Doctor (Dr. Polyzois)

Surgery of the hand and particularly the demanding operations for thumb arthritis presuppose top-level specialization and absolute knowledge of the micro-anatomy of the region.

Orthopedic Surgeon Mr. Ioannis Polyzois is the only Orthopedic surgeon in Greece in shoulder and upper limb surgery with certified prior service in a permanent directorial position (substantive Consultant) for 10 consecutive years in the National Health System (NHS) of Great Britain.

During his long and successful tenure in the most specialized hospitals of London, he has managed and operated on thousands of complex cases of upper limb conditions. His multi-year international experience guarantees the performance of the most modern, safe, and effective surgical techniques. Mr. Polyzois and his specialized team are the most suitable to listen carefully to your needs and offer you the right, definitive solution and treatment for your own problem, no matter how simple or complex it may be.

Cost and Prices for the Management of Thumb Arthritis

Our medical philosophy focuses on providing medical services of excellence, while ensuring that the financial cost remains transparent, fair, and completely affordable for every patient.

The final cost of the treatment is strictly shaped based on the medical plan that will be chosen after the clinical examination. Conservative methods, such as local cortisone injections or prescribing a functional splint, constitute in-office treatments with a particularly low and affordable cost.

In the event that surgical operation is deemed necessary (Trapeziectomy, Arthroplasty, or Arthrodesis), the cost is adjusted depending on the method and the specialized materials (such as suture micro-anchors or prostheses) that might be needed. Because the surgery is performed under local/regional anesthesia and the patient returns home on the same day (as a day surgery – Day Clinic), the stay and hospitalization expenses in the private clinic are drastically reduced.

Our clinic maintains excellent cooperation with all private insurance companies, while the option to use the state insurance body (EOPYY) is always provided to cover a large part of the clinical expenses (imaging examinations, surgery, materials). During your visit, a detailed discussion will take place and you will receive a clear, personalized financial brief, ensuring that there will be no hidden charges.

Movement is life! Contact the doctor for specialized orthopedic care, tailored to your needs.

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Συχνές ερωτήσεις

How does thumb arthritis affect gripping power?

Arthritis in the basal joint of the thumb literally destroys gripping power (Grip strength & Pinch strength). This happens for two reasons: First, mechanically. When the cartilage disappears, the joint becomes unstable and the bone “slips”, with the result that the muscles of the hand do not have a stable point (fulcrum) to exert force. Second, biologically. The sharp pain caused by the friction of the bones triggers a neurological reflex. As soon as you try to squeeze something tightly, the brain instantly “interrupts” the muscle contraction to protect the joint from further damage, resulting in objects falling uncontrollably from your hands. Successful surgical operation fully restores this lost strength.

Are there stages of progression in thumb arthritis?

Yes, the disease is progressive and the medical community usually classifies it into 4 stages (based on the Eaton-Littler radiological classification):

Stage 1: Initial inflammation. X-rays appear normal or present a slight widening of the space due to fluid.
Stage 2: Mild wear of the cartilage. A slight narrowing of the joint space begins to be observed and small bone spurs (osteophytes) smaller than 2 millimeters appear.
Stage 3: Advanced arthritis. The cartilage has been completely destroyed. Significant narrowing is present (bone touches bone), large bone spurs exist, and the joint begins to subluxate (come out of its position).
Stage 4: End stage. Complete destruction has extended to the adjacent joints of the wrist as well (scaphotrapeziotrapezoid joint), causing huge deformity and permanent stiffness in the hand.

Is there a genetic predisposition?

Certainly. Genetic predisposition plays a huge role, especially in cases where arthritis appears at younger ages without a prior acute injury (fracture) having occurred. Genes determine the quality and resistance of the articular cartilage, as well as the elasticity of the ligaments that hold the joint together. Women whose mothers or grandmothers suffered from severe arthritis of the hands (with characteristic nodules on the fingers), have multiple chances of developing osteoarthritis at the base of the thumb themselves.

Which daily movements should be avoided?

To protect the joint and delay the progression of wear, you must modify movements that exert immense mechanical pressure (pinch grip). The following should be avoided:

Tight pinching of the thumb with the index finger (e.g., during prolonged writing with a thin pen or during sewing).
Rotational movements under pressure, such as opening tight lids on jars, intense wringing of clothes or a mop, and turning stiff locks.
Holding heavy objects (such as large pans or pots) with only one hand.

Advice: Use tools with thick, soft handles and special opening aids for the kitchen.

Can thumb arthritis subside on its own?

Medically and anatomically speaking, the answer is no. Osteoarthritis is a chronic, degenerative disease. From the moment the cartilage begins to be destroyed, there is no natural mechanism in the human body that can regenerate it and restore it to its original, smooth form. Therefore, the anatomical damage is permanent.

However, the symptoms (the pain) can present remissions and flare-ups. It is a very common phenomenon for pain to subside significantly on its own after a period of rest or in end stages, where the joint fuses completely (self-arthrodesis) and friction stops, leaving the patient, however, with a permanently deformed and stiff hand. That is why medical intervention at the appropriate time saves the functionality of the limb.

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