Dr. Brian Tobias says arthritis affecting the base of the thumb is a common issue his patients experience. Arthritis treatment can begin with a splint and oral anti-inflammatories, possibly followed by steroid injections. Surgery using minimally invasive techniques can be performed if these solutions don't provide the desired results.View transcript
[00:00:07.280] So a common problem we see at the Hand to Shoulder Center [00:00:09.640] is arthritis at the base of the thumb. [00:00:11.160] And people will first complain of pain in this area, [00:00:13.840] especially with pinch, turning a key in the door, opening a jar. [00:00:17.400] So with thumb base and joint arthritis, [00:00:19.280] I think the first thing is for people to understand exactly what the problem is. [00:00:22.480] So we often describe this bone [00:00:24.280] as a rider sitting on a saddle on the horse. [00:00:26.320] And where the problem occurs is between the rider and the saddle. [00:00:29.400] And once arthritis sets in, [00:00:31.440] then, of course, you can have changes in the joint, [00:00:33.640] changes in the alignment of the thumb, and that can affect function. [00:00:37.400] Treatment options generally start out as nonsurgical. [00:00:40.400] That includes a splint that they'll wear [00:00:42.160] for periods of time during the day and night, [00:00:44.080] and oral anti-inflammatories. [00:00:46.080] If that does not take care of the problem, then the next step up [00:00:48.840] is to do a steroid injection into the joint, [00:00:50.720] which we do here in the office. [00:00:52.560] And then, of course, if steroid injections take care of it, [00:00:55.760] but only on a temporary basis, [00:00:57.480] then we start to talk about the surgical options, [00:00:59.600] which sometimes can include arthroscopy in this joint, [00:01:02.480] and/or reconstructions of the joint. [00:01:05.040] So what we like to do, obviously, after we meet the patient [00:01:08.840] is to listen to what their chief complaint is regarding that, [00:01:12.080] and if their description matches thumb base or joint arthritis, [00:01:15.880] then, of course, we'll get X-rays, show them the X-rays, [00:01:18.720] and use, obviously, internet pictures [00:01:20.600] to demonstrate the various treatment options. [00:01:23.000] So for arthroscopy, [00:01:25.080] generally the recovery is a post-operative dressing for a week [00:01:28.440] and then they go to the therapist, they're fitted with a splint. [00:01:32.440] There are only two one stitch incisions, so those stitches come out at two weeks. [00:01:36.600] And then at the two week to six week mark, people are put in a home therapy program, [00:01:41.280] graduate out of their split, return to their regular activities. [00:01:44.320] For the reconstructions, [00:01:45.600] the mobilization is slightly longer, usually about four weeks. [00:01:48.560] Stitches do come out in two weeks, [00:01:50.280] and then again it's a similar home therapy program [00:01:52.880] progressively graduating out of the splint, [00:01:54.680] returning to the regular activities. [00:01:56.800] For someone to decide whether surgery is appropriate for them [00:02:00.040] is generally based on the fact that their symptoms persist [00:02:03.080] despite nonsurgical management. [00:02:05.160] If they continue to have symptoms [00:02:06.800] despite being compliant with a nonsurgical management program, [00:02:09.800] and/or they've had an injection in this area and it's failed [00:02:12.760] or it just hasn't lasted that long, [00:02:14.680] then there's usually an opportunity [00:02:17.440] to talk about what the surgical options are to increase their function.