This page was last reviewed 13-08-20
Joint inflammation is indicated by pain, swelling, stiffness and loss of
function, that can result from degenerative osteoarthritis (OA) or systemic,
autoimmune arthritis. The former commonly affects the thumb base CMC joints and
the DIP joints (Heberden’s nodes) or PIP joints (Bouchard’s nodes) of the
fingers. Middle age and older adults are predominantly affected although other
risk factors include previous major or repetitive joint trauma or joint
instability. Management is primarily conservative, making use of rest,
anti-inflammatory medications and splints for use at night and during specific
activities. Physiotherapy is often helpful.
What we will see
- Diagnostic difficulties
- Thumb base arthritis
- Digital arthritis
- Pain unresponsive to simple non-interventional measures
What we won’t see
- Straightforward diagnosis with no functional deficit
- Early intermittent pain not requiring any intervention
Specific tests
- Clinical examination of joint – palpation, range of movement
- X-ray of affected part (be specific about digit and joint on request)
Trial of therapy pre-referral
- If no functional deficit then no treatment required
- Trial of oral analgesia or topical NSAID gel
- Activity modification
- Consider appropriate splintage
Whom to direct referral to
After using an XRAY to confirm diagnosis, and intial early management as per primary care management tab, refer to:
- Thumb base arthritis clinic for CMC joint arthritis
- Run by Allied Health Professional under supervision of consultant hand surgeon
- Any hand surgeon
Advise the patient on analgesia, activity modification, and using a thumb base splint for at least 3-6 months.
- Plastic Surg – PIL BSSH CARPAL TUNNEL Aug18opens a new window
- Plastic Surg – PIL BSSH GANGLIA Aug18opens a new window
- Plastic Surg – PIL BSSH OA THUMB Aug18opens a new window
- Plastic Surg – PIL BSSH TRIGGER FINGERAug18opens a new window
- National Institute for Health and Care Excellence (NICE)opens a new window
- Scottish Intercollegiate Guidelines Network (SIGN)opens a new window
- Wrist Pain Algorithm of Differential Diagnoses
- BSSH OA THUMB
- Plastic Surg – PIL BSSH OA THUMB Aug18
