Transcription:
Rule of Thumb, Arthritis

Joey Wahler (Host): It's a common form of arthritis affecting the part of the thumb right next to your wrist, so we're discussing basal thumb arthritis.

This is A Bone To Fix, a podcast from the Centers for Advanced Orthopaedics. I'm Joey Wahler, and I've got a bone to fix with you. Thanks for listening. Welcome to our series segment called Hands On, focusing on different parts of the hand from fingertip to wrist. Today, we are indeed talking thumbs. Our guest, Dr. Brian Janz, a hand and upper extremity surgeon with Orthopaedics Associates of Central Maryland division. Dr. Janz, thanks for joining us.

Brian Janz, MD: Oh, happy to be here to discuss arthritis with you.

Joey Wahler (Host): And happy to have you here to discuss it. So first, simply put, what is basal thumb arthritis?

Brian Janz, MD: So basal thumb arthritis is a very common arthritis that we see at the base of the thumb, more technically, the base of the metacarpal, which really affects individuals as we age, usually after 40 or 50 years of age, really limiting grip and weakness, and increasing weakness involving the hand.

Joey Wahler (Host): And so what causes this condition other than simply the age process?

Brian Janz, MD: The vast majority of time, if you're going to have arthritis at the base of the thumb, it's due to osteoarthritis or wear and tear arthritis of the bone.

Joey Wahler (Host): And so would anything we do in everyday life increase or decrease our chances of succumbing to this condition?

Brian Janz, MD: That's a tough one to answer. A lot of times, the arthritis is more due to wear and tear, and even sometimes genetics. Although there's no specific cause of the basal joint arthritis, repetitive activity, genetics, and, trauma can all add up to leading to decreased cartilage, which will lead to more bone-on-bone rubbing, leading to, you know, progression of the arthritic process.

Joey Wahler (Host): So, what are the basic symptoms of this basal thumb arthritis?

Brian Janz, MD: So the usual symptoms for basal arthritis of the thumb are weakness and pain and discomfort, especially with gripping.

Joey Wahler (Host): And would that tend to happen more in our dominant hand?

Brian Janz, MD: It's variable. Some patients, it'll show up in the dominant hand and some patients it'll show up in a nondominant hand. So there is a bit of variability to it.

Joey Wahler (Host): And I guess, like with many things in life, until this injury or condition occurs, we don't realize just quite how much we use those thumbs, right, doc?

Brian Janz, MD: Absolutely. And actually, in most situations, if we do an x-ray of a hand that's arthritic, we may see changes in the x-rays even prior to the thumb being symptomatic.

Joey Wahler (Host): So this is something that could be laying dormant for a while then before it's even officially diagnosed. Speaking of which, how do you diagnose it?

Brian Janz, MD: Diagnosis is usually performed with a clinical examination, very specific examination, especially to the thumb where we manipulate the base. And if there's discomfort and pain, that's considered to be a positive grind test and that's pretty indicative of inflammation or arthritic changes involving the base of the thumb. So at that point, we would do x-rays of the thumb and, in those situations, we usually see decreasing cartilage, decreasing space to the joints or increasing irregularities consistent with the osteoarthritis. So the x-ray is usually extremely important for the diagnosis of this condition.

Joey Wahler (Host): How does basal thumb arthritis, doctor, differ from carpal tunnel syndrome?

Brian Janz, MD: Basal joint arthritis is going to be aching and pain and weakness when gripping and the pain is almost very specifically to the base of the thumb right above where your radius is or the long bone. Now, carpal tunnel syndrome is going to be more numbness and tingling in the thumb index and middle finger, and then weakness over time if it gets more severe. Now, with carpal tunnel syndrome, you're going to see more symptoms at night when you're sleeping and also during the daytime with numbness, aching, and pain. Now, that's also involving usually the thumb, index and middle finger, and sometimes part of the ring finger. The basal joint arthritis is not going to be so much numbness, but more aching, very specifically to the base of the thumb.

Joey Wahler (Host): I'm almost afraid to ask this, do people ever get both of those?

Brian Janz, MD: Yes. Actually, they're pretty common to have them both at the same time. And we'll go ahead and treat them, especially if they're mild, with conservative management for both the carpal tunnel syndrome and the basal joint arthritis.

Joey Wahler (Host): So let's talk about treatment. What do you do for basal thumb arthritis?

Brian Janz, MD: So non-surgical treatments usually revolve around anti-inflammatories and settling down any inflammation. So, NSAIDs, aspirin, Naproxen all work well initially to decrease the inflammation. And then, immobilization, so we'll use a series of either small, medium, or large-sized thumb splints in order to decrease some of the discomfort. Now, you don't have to wear the splints all the time. But usually when you have a flare or discomfort, you have patients put the splint on to go ahead and settle down some of the discomfort that they're having.

Joey Wahler (Host): Yeah, splints are interesting I think in general, because I've had to use them a little bit myself in that I think a lot of people that haven't tend to associate splints more with recovering from an injury, but you're talking about, you used the term settle down, sometimes using a splint can simply keep a part of the body from moving and that in and of itself can allow it to heal, right?

Brian Janz, MD: Correct. Correct. If you're having inflammation of the joint, it's sort of in this situation, you want to hit a happy medium. You don't want to immobilize so long that the joint gets stiff and your arthritic process worsens. But you also don't want to keep on moving once it's inflamed. So you want to settle down the inflammation with the splint and then get back to a happy medium and then start using the joint again. And if the splinting and NSAIDs aren't working, or if you can't take the NSAIDs, then sometimes corticosteroids are a good option. And sometimes, we'll do a Medrol Dosepak to go ahead and decrease some of the swelling. Or another great option is to do steroid injections directly to the joint. Now, it doesn't reverse the arthritic process, but it does minimize the symptoms. You can get some fairly significant relief, especially with mild arthritis with steroid injections to the joint.

Joey Wahler (Host): And what if surgery is needed?

Brian Janz, MD: Now, surgery usually is an option if you're not responding to conservative management, or if you have really severe arthritis, where it doesn't look like you're going to improve with conservative management. And in those situations, then we will perform what's called a basal joint arthroplasty, which can be done in a couple different ways where we remove a bone and sometimes part of a second bone and we tighten up a ligament to go ahead and stabilize the thumb and the outcomes for those tend to be pretty good. Now, if you have arthritis and you're younger and you're a manual laborer, sometimes a joint arthroplasty is not your best option. In those situations, we'll fuse the joint with the metacarpal on some of the smaller bones in order to decrease the bone-on-bone rubbing.

Joey Wahler (Host): So it sounds like you're saying then that age and wear and tear that's already taken place is a factor in trying to determine the best course of action, yeah?

Brian Janz, MD: Correct? Yes. And also, what you do for a living. If you're going to be lifting 100, 200 pounds, then chances are a basal joint fusion may be a better option if you're younger, as opposed to a basal joint arthroplasty.

Joey Wahler (Host): Now, what's not commonly known is that a thumb, correct me if I'm wrong, doctor, is considered to be not technically a finger, but a digit whose opposable nature gives us an advantage over most other mammals, right?

Brian Janz, MD: Correct. Now, most hand surgeons will say that you have four fingers in one hand and a thumb. And the thumb basal joint is designed a little bit different, almost like a saddle joint. And I think that to some degree also predisposes you with opposition to a little bit more arthritic changes to that joint versus the other joint.

Joey Wahler (Host): And so when we say that the opposable nature makes us different from other animals, what does that mean exactly?

Brian Janz, MD: That means that our thumb actually is rotated in such a way that we can grip and use the thumb in a different plane, as opposed to the index, middle, ring and small finger. And that's largely due to the basal joint.

Joey Wahler (Host): And so that again is one of the things that makes us different from other mammals. I probably learned that in school somewhere along the way, but it's been so long that it's good to get a refresher from you here today, right?

Brian Janz, MD: Absolutely.

Joey Wahler (Host): Never too old to learn. Well, folks, we trust you're now more familiar with basal thumb arthritis. Dr. Brian Janz, thanks so much again.

Brian Janz, MD: Thanks for having me.

Joey Wahler (Host): And for more information or to make an appointment, please visit mdbonedocs.com. Again, that's M-D-B-O-N-E-D-O-C-S.com. And that was a bone that's fixed. If you found this podcast helpful, please do share it on your social media. Hoping your health is good health, I'm Joey Wahler.