- Pain at base of thumb on movement of 1st CMC joint, aggravated by use, usually over 45 years old
- Can run in families, more common in women.
- May be post-fracture
- Reduced range of movement thumb (abduction and extension)
- Pain on grinding 1st CMC joint
- Thumb may have zig zag appearance
- Joint burn out and pain settle within 2-5 years.
OA Base of Thumb
Symptoms and signs
Initial management
- Non-steroidal anti-inflammatory drugs/analgesia
- Modify activity
- Splint – (wrap around 1st CMC support thumb splint) can be bought from Boots/Allardyce/online
- Corticosteroid injection by appropriately trained healthcare professional
- Refer to MSK Physiotherapy to aid with pain relief/ROM or steroid injection if unable to do in GP Practice. Onward referral iof required can be organised by Physiotherapy.
Useful resources
Primary Care diagnostics
- XR wrist and thumb if considering referral
Who to refer
Referral for surgery should be considered as a last resort as symptoms often stabilise with conservative treatment. Consider referring to hand service for opinion on surgery only if:
- Severe OA changes on XR and symptoms increase despite conservative treatment
- Significant problem with function
How to refer
- SCI Gateway/Hand Surgery. Patient may be appointed to Advance Practice Physiotherapist initially.
Include the following information:
- Duration of symptoms
- Conservative management tried (e.g. any relief through activity avoidance/ splintage/ physiotherapy/ steroid injection?)
- Movement loss
- Functional limitations/dominance
- Pain severity (constant/ intermittent/ waking at night)
- XR findings