Getting a Grip

It's easy to take use of your thumbs for granted, but not so for those living with arthritis of the thumb. They experience pain even with the simple pinching and gripping tasks of daily living, such as opening doors, wringing out a wash cloth, turning a key --even holding a newspaper. But there are effective therapy remedies that can help.

The culprit in such cases is arthritis of the joint at the base of the thumb, called carpal metacarpal (CMC) joint arthritis. According to current research, the condition is more common among women than men.

"The thumb accounts for about 50 percent of functionality with your hands," explains Jennifer Chisar, M.S., P.T., C.H.T., hand therapy supervisor for John Muir Health. "If you don't have use of your thumbs, every aspect of life is impaired -- your job, recreational activities, meal preparation, housework -- the list goes on." Worse still, some patients attempt to avoid discomfort by pinching items between the fingers and avoiding the thumb. But these stop-gap measures are not effective and if left untreated can lead to loss of muscle strength.

What causes the pain?

Pain is often the first indicator that something may be wrong. For most, pain usually occurs when related to a particular activity. Later, as the condition worsens, pain may be present even at rest. The most noticeable problem is that it becomes difficult to grip or pinch anything, causing a sharp pain at the base of the thumb in the heel of the hand.

"Studies have shown that the joint structure of women is less congruent than that of men, meaning the joints may not fit together as well," notes Chisar.

"Also, the articular cartilage, the elastic tissue that covers the ends of bones in joints and enables the bones to move smoothly over one another, typically is thinner in women than in men, so there's greater risk of painful bone-on-bone contact. And hormonal changes, including pregnancy and menstrual cycles, make women more prone to joint laxity, which allows bones to slide a little more and decreases stability of the joint," explains Chisar.

"Such laxity can occur at any age, depending on activities," says Chisar. "Joint changes following trauma may also set you up for that type of arthritis, or if you just have lax ligaments in general."

Treatment Options

Effective therapy is available for people with CMC joint arthritis at four John Muir Health outpatient centers. These facilities are staffed by certified hand therapists with specialized training and credentialing. Patients must be referred by a physician and may undergo one or several various therapeutic treatments, including:

• Paraffin baths: The hand is immersed in wax melted by an electric heating device. The effect is soothing and penetrates to the joint.
• Contrast baths: Alternate dips in cold and hot water increase hand circulation and decrease inflammation. Heat or ice alone may be used as well.
• Splinting: Splints help position and stabilize the thumb, decreasing detrimental forces on the joint. Splints also help the joints rest, decreasing inflammation.
• Exercises: Exercise improves motion and strength. Learning to protect the joint where patients learn to use their hands in ways that don't overstress the joint, are also an important component.
• Use of assistive devices: Patients employ built-up grips for writing instruments and kitchen utensils, jar openers and more.

The course of treatment varies, depending on the intensity of pain and duration of the condition. Typically, therapy sessions are scheduled once or twice a week for three to four weeks— often in combination with prescription or over-the-counter anti-inflammatory medications. If all these remedies fail, cortisone injections or surgery may be an option.

"Often, we can make a noticeable change in just a few visits if the patient is compliant," emphasizes Chisar. "If you are having thumb pain, address it sooner rather than later. There a lot of things you can be taught that will help you get rid of the pain faster and avoid a chronic problem that has fewer options for treatment."

(Posted October 3, 2006)