Treatment of arthritis begins with a non-surgical program that includes a therapist working on gentle range of motion exercises, thermal modalities, splinting during the inflammatory period in rheumatoid arthritis or for protection and strengthening once motion is achieved. Oral anti-inflammatory medication and cortisone injections in the joint helpcontrol the inflammation and resultant pain. Activity modifications take pressure off the joint and ergonomic adaptations are also helpful. For basilar thumb arthritis, a supportive splint can be worn to help perform more powerful activities.
When conservative nonoperative measures fail, surgical treatment is considered. If the arthritis is located at the base of the thumb four procedures have been described:
- LRTI which is the removal of the arthritic carpal bonecalled the trapezium and reconstructing the space with a tendon transfer used as a stabilizer and spacer.
- Putting a spacer in the joint when only the CMC bone is affected.
- Replacing the articular surface with a joint implant or
- Fusing the joint. Option number 1 has the longest track record and is the first choice at ROC when all four articular surfaces of the trapezium is affected.
the DIPJ and the arthritis is mild to moderate with painful cysts or spurs, simple excision of the ”arthritic spurs or cysts” is performed. In the DIPJ, the smallest joint of the finger, if the arthritis is severe with associated deformity, the joint is fused. Function is good after a fusion of that joint. In the proximal interphalangeal joints which are the middle joint of the fingers, a joint replacement with the use of an implant. Choosing the correct surgical procedure that best fits the patient is based on the patient’s activity demands. All of these procedures are performed on an outpatient basis. A splint is usually used after surgery to help support the operated hand initially. When the time is right, hand therapists get involved to help the recovery process. Patients are back to most activities by 3 months. Tasks that require more strength and power take slightly longer to return.