From the Guidelines
For thumb pain, the next step is to try conservative management first, focusing on education, exercises, and orthoses, as recommended by the most recent and highest quality study 1. The management of thumb pain should prioritize a patient-centered approach, considering the biopsychosocial factors that influence pain perception, as emphasized in recent guidelines 1. Key aspects of conservative management include:
- Education on joint protection and ergonomic principles to avoid adverse mechanical factors 1
- Exercises to improve function and muscle strength, as well as to reduce pain, which should be considered for every patient 1
- Orthoses, such as thumb splints, which should be considered for symptom relief in patients with thumb base OA, with long-term use advocated 1
- Topical treatments, with topical NSAIDs being the first pharmacological topical treatment of choice, preferred over systemic treatments due to safety reasons 1 If pain persists or is severe, oral analgesics, particularly NSAIDs, may be considered for a limited duration, with the patient’s requirements and response to treatment being re-evaluated periodically 1. It is essential to assess the patient's individual needs, preferences, and priorities, as well as pain characteristics, previous and ongoing pain treatments, inflammation, and joint damage, to guide treatment decisions 1. By following these recommendations and prioritizing conservative management, patients with thumb pain can potentially achieve significant improvements in pain relief and functional ability, thereby enhancing their quality of life.
From the Research
Thumb Pain Treatment Options
- The mainstay of initial treatment for basal thumb arthritis is activity modifications, rest, nonsteroidal anti-inflammatory drugs, exercises, and splinting 2
- Injection-based therapies, such as hyaluronic acid and corticosteroid injections, may provide pain relief, but the available evidence does not suggest that any of these therapies are superior to placebo or one another 3
- Conservative treatments, including medication, procedures, and exercise, can be used to control chronic pain, but the effectiveness of these treatments for thumb pain specifically is not well established 4
Conservative Treatment
- Hand therapy may possibly reduce pain, but the lack of good-quality trials with sufficient follow-up time makes it difficult to draw conclusions 5
- Orthoses can reduce pain, but do not affect function, strength, or dexterity, and the type of orthosis and follow-up time can vary 5
- Intra-articular injections of hyaluronic acid or steroids can provide pain relief, but the evidence is limited by heterogeneity of study design and outcome parameters 5
Surgical Treatment
- Numerous options and controversies exist for surgical treatment of carpometacarpal joint arthritis, while fewer options exist for metacarpophalangeal joint arthritis, and surgical treatment for interphalangeal arthritis is mainly arthrodesis 6