Thumb pain can be debilitating, compromising one’s ability to perform the easiest of tasks. The pain can be unrelenting at times and compromise the competitive edge we all seek. Let’s review what the thumb joint is and treatment options.
Understanding Thumb Anatomy
There are five different types of bones in the hand, which is illustrated below. The carpals and metacarpals are the most important in reference to thumb pain.
The thumb joint is formed by the articulation of the trapezium (red [E] below) and the first metacarpal (gray [J] below). The joint is also referred to as the carpometacarpal (CMC) or the trapeziometacarpal joint as this references the two bones that create the joint. In the second group of images below, the thumb joint is identified by the dotted red circle.
Instability in the Thumb Joint
Instability is common in the thumb joint and can be responsible for the development of osteoarthritis. Stability of a given joint is dependent upon the muscle strength and ligament integrity. Below is a dynamic ultrasound of the thumb joint. The metacarpal is the bone to the far right, which is articulating with the trapezium, the middle bone. The thick white band above the joint is the critical thumb ligaments. Thus thumb joint is stable.
Signs and Symptoms of Thumb (CMC) Joint Injury
Signs and symptoms of an injury to the thumb joint include the following:
- Pain at the base of the thumb
- Loss of strength
- Difficulty grabbing or holding objects (buttoning a shirt can be next to impossible)
The first step in the traditional medicine model is conservative care, characterized by rest, splints, manual therapy, and NSAIDs. If patients fail conservative care, they are often referred for steroid injections. Are these effective?
The toxic effects of steroid injections have been previously discussed in depth. Steroid injections compromise joint cartilage, weaken ligaments, and kill mesenchymal stem cells, which are your repair cells. The dangerous side effects of NSAIDs have also been shared, including the risks of stroke, heart attack, GI bleed, male infertility, and much more.
PRP vs Steroid Injections for Thumb Arthritis
A recent study compared PRP to steroid injections in 33 patients with CMC joint arthritis. In the prospective, randomized, blind study, the patients were divided into two groups. The first group had two ultrasound-guided PRP injections over a two-week interval vs the second group, which had two steroid injections. After 12 months the PRP group demonstrated superior reduction in pain and increase in function when compared to the steroid group.
If you have ongoing thumb pain that has been refractory to conservative care, the Centeno-Schultz Clinic has extensive experience in the treatment of CMC joint arthritis. A board-certified physician will evaluate your current symptoms and perform a diagnostic ultrasound to determine ligament laxity. Treatment options include PRP or bone marrow-derived stem cells, both of which are injected under direct visualization. Click here to view our treatment options.
Life is too short to struggle with simple things, like gripping a pen or ski pole. An evaluation will provide you with valuable information and treatment options. Regain that competitive edge and thoroughly enjoy the upcoming holidays!