Management of Hand Deformity Caused by Thumb Osteoarthritis
For patients with hand deformity caused by thumb osteoarthritis, a comprehensive treatment approach should begin with non-surgical interventions including orthoses (splints), exercises, and topical NSAIDs, with surgery (specifically trapeziectomy) reserved for cases with severe symptoms that fail to respond to conservative management.
Non-Surgical Management Options
Orthoses (Splints)
- Orthoses should be considered first-line treatment for symptom relief in patients with thumb base OA 1
- Long-term use (minimum 3 months) is strongly advocated for optimal outcomes 1, 2
- Custom-made orthoses are preferred over prefabricated ones to improve patient compliance 2
- Evidence shows orthoses effectively reduce pain without negative effects on function, strength, or dexterity 3
Exercise Therapy
- Exercises to improve function and muscle strength should be considered for every patient 1
- Focus should include:
- Range of motion exercises
- Strengthening exercises for intrinsic and extrinsic finger muscles
- Joint mobilization techniques 2
- Manual therapy combined with therapeutic exercise has shown moderate quality evidence for improving pain in thumb CMC OA at short- and intermediate-term follow-up 4
Pharmacological Management
- Topical treatments are preferred over systemic treatments due to safety considerations 1
- Treatment algorithm:
Intra-articular Injections
- Intra-articular corticosteroid injections may provide short-term pain relief for painful flares of thumb base OA 1
- However, current guidelines suggest these should not generally be used in hand OA except in specific cases of painful interphalangeal joints 1
- Evidence suggests hyaluronate injections may be more effective than steroid injections, though follow-up studies are generally short-term (maximum 12 months) 3
Surgical Management
- Surgery should be considered only when other treatment modalities have not been sufficiently effective in relieving pain 1
- Trapeziectomy is the recommended surgical procedure for patients with thumb base OA 1
- Simpler surgical procedures (like trapeziectomy alone) are preferable to combination procedures, as they have similar efficacy with fewer complications 1
- The Cochrane Musculoskeletal Group review found that combination surgical procedures (e.g., trapeziectomy + ligament reconstruction) offered no advantage over single procedures but had higher complication rates 1
Monitoring and Follow-up
- Regular assessment of treatment response should be conducted, with evaluation of:
- Range of motion
- Pain levels
- Functional improvement
- Ability to perform activities of daily living 2
- Consider discussing surgical options if no clinically relevant improvement is seen after 6 weeks of therapy, as 73-83% of patients who don't improve by 6 weeks also show no improvement at 3 months 5
Important Considerations
- Patients with either high pain or low function may benefit most from conservative treatment, so it's recommended to always start with non-surgical approaches regardless of symptom severity 5
- Education on joint protection principles, ergonomics, and pacing of activity should be offered to every patient 1
- A dynamic stability model approach (including proprioceptive exercises and neuromuscular re-education) shows promising results for thumb CMC OA management 6
- Disease-modifying OA drugs (DMOADs) for hand OA are currently not available 7
By following this structured approach to managing thumb OA-related hand deformity, clinicians can optimize outcomes while minimizing risks, with the ultimate goal of controlling symptoms and maximizing hand function, activity, participation, and quality of life.