Author Topic: Arthritis in thumb  (Read 444 times)

Arthritis in thumb
« on: January 25, 2021, 07:38:23 pm »
I've just been diagnosed with this. Suggestion is to have an injection in the joint.

It's quite painful and came on fairly suddenly, about 6-8 weeks ago. I have had a couple of injuries to that thumb over the years which might have been a factor. The worst thing for it is trying to put on a tight glove, that's really painful.

It doesn't hurt when cycling so I don't think that's a cause.

I'm just doing research on it now. Anyone got it / had it? Any tips?

And if I have it in my thumb, I'd it likely to crop up in other places as well soon?

Re: Arthritis in thumb
« Reply #1 on: January 25, 2021, 08:20:55 pm »
Frank
where in the thumb is the pain? where the thumb meets the wrist or further upto the nail?

Did you have an injury at the time of onset of the pain

Have you had an x-ray

seen a physio, etc

What painkillers are you taking

How bad is the pain on a 0-10 scale where 10 is the worst possible pain imaginable

Is the pain constant or intermittent. Is it precipitated by certain activities? Could you change how you do those activities to help the pain

how old are you

Is it being aggravated by the cold and would some deep heat or similar help.

Have you tried paracetamol, ibuprofen gel or tablets

Have you seen an OT or physio specialising in hands and had appropriate advice and even a little splint?

If we assume you are over 50, and the pain is where the thumb joins the wrist then it is likely that you have CMC joint arthritis related to wear and tear (although a small fracture or ligament injury is a possibility as a cause)

The primary treatment is conservative and many patients will have worse symptoms in cold weather and better in the warm (hence the deep heat)

cycling gloves can exacerbate the pain if they are the wrong shape or size and alter the thumb movement.

Changing how you do things to stop getting the pain is my first choice treatment with a support strap perhaps for things like mountain biking, weights, etc

then paracetamol before painful activities and if you still have pain which is greater than 5/10 perhaps a steroid injection.

But steroid injections themselves damage the joint cartilage so you are starting on a slippery slope with injections.  They are also often short lasting for a condition which usually waxes and wanes.

If you are under 50 then a lot more investigation is required before an injection.

Good luck

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Re: Arthritis in thumb
« Reply #2 on: January 25, 2021, 09:48:43 pm »
Depends on whether it is osteoarthritis which is caused by wear and tear on specific joints or rheumatoid arthritis which is an autoimmune disorder. 

On the assumption it is osteoarthritis it could just be restricted to a specific joint.  I've had problems in my big toes as a legacy of playing cricket and wearing shoes that don't fit (I have very narrow heels so find it very hard to get a shoe that fits snugly).  After a company medical I was referred to a consultant who suggested rather unhelpfully that I stop running, then, when problems flared up again, went to  a podiatrist who made some custom inserts to get my feet into a more comfortable place (since when I've been able to restart running).  The long and short of the advice I have been given is avoid surgery if you can - it is hit and miss - they might have got good at artificial hips and knees but thumbs and toes not so good.  If they do flare up (I stubbed a toe running recently) then using ibuprofen cream rubbed hard in every day for 10 days reduces the inflammation. 

So, a mix of physio and TLC might be able to help.  chrisbainbridge's suggestions are all very good
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Re: Arthritis in thumb
« Reply #3 on: January 26, 2021, 08:12:15 am »
  chrisbainbridge's suggestions are all very good

Can I say "I would hope so!"

Re: Arthritis in thumb
« Reply #4 on: January 26, 2021, 11:30:23 am »
Hi Chris,

Thanks for the input.  This is the full story.

History is that I have had de Quervains for the last couple of years, which I put down to lifting my daughter when she was little with my thumbs in the wrong position.  Initially I saw a physio but he suggested that I see a consultant with a view to having a steroid injection.  So I had one in summer 2019.  It was then fine until October when it just went, so I had another injection at the end of 2020. 

It was then fine for a year, but, about 6-8 weeks ago I, quite suddenly, started to get pains at and around the base of my thumb.  I felt it was different from de Quervains but in the same area.  It's fine if I do nothing but certain movements hurt and it is sensitive if I touch the right spot.  One thing that particularly hurts is putting on a tight glove, and someone said 'that sounds like tendons' so I went back to the consultant, who thought it might be de Q again, and suggested a third steroid injection for it.  I had that and, as I expected, it made no difference. 

I've now had an MRI scan, which has identified the suspected osteoarthritis - my doctor has said the joint between Trapezium and scaphoid is where he sees an issue

I'm not using painkillers regularly, as it doesn't hurt if I avoid it doing the wrong things.  I have tried paracetemol and inbuprofen gel, which didn't do any harm, but didn't settle it down.   I wore a thumb splint for a while (which I had from de Quervains) but have stopped as I can generally protect it without one. 

If I squeeze it, it gets sore, up to 7 or 8, until I back off. 

I'm 53 

Not sure if temperature makes a difference to it.  It is not a problem for cycling, and it doesn't bother me riding in the cold, even if my fingers are starting to go numb.

I have injured this thumb a few times over the years.  At school I damaged it (x-ray was negative, but ever since that thumb has been very slightly rotated inwards compared to the other one.  I got a cricket ball on the end of it and, in 2018, I had a mallet injury to it after falling off my bike.

Sounds like maybe hold off before the injection...?  I agreed to the injection as it is pretty sore and I'd like to do something, and that was what was on offer.

Re: Arthritis in thumb
« Reply #5 on: January 26, 2021, 11:34:41 am »
Depends on whether it is osteoarthritis which is caused by wear and tear on specific joints or rheumatoid arthritis which is an autoimmune disorder. 

On the assumption it is osteoarthritis it could just be restricted to a specific joint.  I've had problems in my big toes as a legacy of playing cricket and wearing shoes that don't fit (I have very narrow heels so find it very hard to get a shoe that fits snugly).  After a company medical I was referred to a consultant who suggested rather unhelpfully that I stop running, then, when problems flared up again, went to  a podiatrist who made some custom inserts to get my feet into a more comfortable place (since when I've been able to restart running).  The long and short of the advice I have been given is avoid surgery if you can - it is hit and miss - they might have got good at artificial hips and knees but thumbs and toes not so good.  If they do flare up (I stubbed a toe running recently) then using ibuprofen cream rubbed hard in every day for 10 days reduces the inflammation. 

So, a mix of physio and TLC might be able to help.  chrisbainbridge's suggestions are all very good

Thanks Colin, that's interesting.  Yes, it is suspected osteoarthritis.

Re: Arthritis in thumb
« Reply #6 on: January 26, 2021, 11:43:50 am »
Thank you.  This all comes with the usual caveats about taking medical advice from self aggrandizing idiots with a claimed medical knowledge on the internet

De Quervains is relatively common and certainly does seem to occur with lifting small children although rarely in men. Why on earth an MRI scan was ordered when a plain X-ray is an order of magnitude cheaper is beyond me but that is modern medicine, sigh.

if the arthritis is between the scaphoid and trapezium then you have scapho-trapezial arthritis which is a degenerative condition possibly related to previous injury.

Many of my colleagues forget that patients want advice primarily and information and resort to surgery because it is easier and quicker in the clinic.  However no surgeon that I knowof would have a steroid injection when you say
Quote
I'm not using painkillers regularly, as it doesn't hurt if I avoid it doing the wrong things.
.

Steroid injections are painful, dangerous and time limited in their efficacy.  Especially at the moment they are not a good idea.  Whilst we do not think they increase the risk of serious COVID, they may increase the risk of asymptomatic becoming symptomatic and cannot be given for at least 3 weeks and probably 6-8 weeks either side of a vaccine injection.

53 would be a common age to start getting such problems and will probably be a bit of a nuisance for the next 10 years.  By then my new artificial trapezium may be available!

Happy to discuss in more detail by message if you wish

Re: Arthritis in thumb
« Reply #7 on: January 26, 2021, 01:34:44 pm »
Both thumbs damaged in, I think, the exact same spot.
Chronic pain for years, particularly if the thumbs are bent "inwards"
Old rugby injuries. Back row player, hands being forcefully prized off the ball and stood on because they were where they shouldn't have been etc.
I played for too long and used to go through rolls of tape to bind them up in the final few years of playing.
The arthritis gets in and particularly on damp days or first thing in the morning.  I found myself obsessively massaging the injuries.
You are not going to like it as I know you tend veggie etc, but following a LCHF diet my symptoms have largely disappeared. I assume inflamation Its a total revelation TBH.
Its not just me either. My other half (who didn't play rugby) had issues with "crunchy thumbs" and it has massively abated since dietary change for her too.
Pain in knuckles and fingers that have been similarly abused has also pretty much vanished.
IFYP with the putting on of gloves. Then there is the "catching the thumb and bending it forward in the cuff of a jumper."  :sick:
often lost.

Re: Arthritis in thumb
« Reply #8 on: January 26, 2021, 02:34:58 pm »
Both thumbs damaged in, I think, the exact same spot.
Chronic pain for years, particularly if the thumbs are bent "inwards"
Old rugby injuries. Back row player, hands being forcefully prized off the ball and stood on because they were where they shouldn't have been etc.
I played for too long and used to go through rolls of tape to bind them up in the final few years of playing.
The arthritis gets in and particularly on damp days or first thing in the morning.  I found myself obsessively massaging the injuries.
You are not going to like it as I know you tend veggie etc, but following a LCHF diet my symptoms have largely disappeared. I assume inflamation Its a total revelation TBH.
Its not just me either. My other half (who didn't play rugby) had issues with "crunchy thumbs" and it has massively abated since dietary change for her too.
Pain in knuckles and fingers that have been similarly abused has also pretty much vanished.
IFYP with the putting on of gloves. Then there is the "catching the thumb and bending it forward in the cuff of a jumper."  :sick:

Ouch! Mine sounds very mild compared to yours.  Good to hear that you have found something that has worked.

I can identify with the jumper cuff problem as well - I have a cycling jacket that I can't wear at the moment as the cuff is tight and it presses my thumb in.