EP 29: Thumb pain demystified: Understanding Osteoarthritis and Practical Solutions for Arthritis

Osteoarthritis at the base of the thumb is one of the most common forms of arthritis, affecting a specialized saddle joint that allows extensive movement but is prone to wear and tear. We explore what happens anatomically when the joint begins to degenerate, including the formation of a visible "shoulder sign" bump and how bone spurs develop as the body attempts to stabilize the damaged joint.

In this episode we will go over:

• The thumb's saddle joint allows movement in multiple directions but this mobility makes it vulnerable to arthritis
• As arthritis progresses, the thumb joint may begin to sublux (partially dislocate) creating a visible bump
• Arthritis doesn't always appear on X-rays despite physical symptoms being present
• Bone spurs form as the body attempts to fuse the joint but constant hand movement prevents fusion
• Kinesio tape can provide effective support by creating a sling around the base of the thumb
• Neoprene thumb braces without metal stays offer excellent support for heavy activities
• Support devices should be used selectively - "like a crutch" - only when needed for demanding tasks
• Early assessment by hand specialists is crucial for proper diagnosis and treatment

Chapters

• 0:00 Understanding Thumb Osteoarthritis
• 1:55 Signs and Symptoms of Arthritis
• 3:29 Kinesio Tape Support Technique
• 4:45 Recommended Braces and Support Options
• 6:44 Importance of Professional Assessment

Transcript

Speaker 1: 0:00

Welcome back to the Hand-to-Shoulder Solution Giving Pain the Middle Finger. I'm your host, carl Petito, occupational Therapist and Board-Certified Hand Therapist. I want to talk to you today about osteoarthritis and the base of the thumb, one of the most common places to have arthritis affecting the body. Of course we have arthritis affecting the weight-bearing hips, the ankles, knees and hips, the weight-bearing joints. Now, when we're talking about the hand, the base of the thumb is a saddle joint. It's called a saddle joint because it's like two horses saddles moves this way and it moves this way. So when you look at on the skeleton, if you follow this bone right here down to the base of the thumb at the wrist, it meets up with one of the carpal bones called the trapezium and you can see it's curved this way and it's also curved this way. Now that allows us to have all that movement, but the price we pay for all that movement is more wear and tear. When the joint gets worn it starts to sublux or come out of joint a little bit. So where the bone comes and meets out, that little bone in the wrist, it starts to slide off toward the thumb side of the wrist. So it'll it'll slide down and pop up and it'll pull the skin up a little bit. So if you look at the base of your thumb there'll be a little hump right there. We call that a shoulder sign because it actually looks like a shoulder right there. And going back to the skeleton, when you look at the base of your thumb you follow that down. It tends to slide off upward at the base and that causes that shoulder appearance. If you're seeing that you have arthritis and it's just the wear and tear of the joint and because the joint surface is worn and bone spurs start to form, it just starts to degenerate. It slides out of socket a little bit Arthritis in general.

Speaker 1: 2:00

A lot of times it's not going to show on the x-ray and patients will come in with big round bulbous areas and some outcroppings of bony material, some calcifications on the middle knuckle and on the end knuckle they're called Bouchard's and Heberden's nodes and they'll have stiffness and some discomfort. But that's not always going to show on the x-ray. So you know your doctor might say, oh, there's no arthritis that doesn't show on the x-ray. So you know your doctor might say, oh, there's no arthritis, that doesn't show on the x-ray. But when we're seeing that on the surface and we're seeing all the signs of the arthritis.

Speaker 1: 2:31

Itis just means inflammation, whether it's tendonitis or arthritis. Tendonitis is inflammation of the tendon. Tendons connect muscles to bone. We've all heard of tendonitis, arthritis, arthritis arthro means joint, so itis means inflammation, so arthritis is inflammation of the joints. And then beyond that you get, you start getting the wear and tear and and the reason bone spurs form is it's very this is very interesting the body is trying to fuse the joint together, so it's sending out these bone spurs because the body knows it's rubbing bone on bone and said, oh, you know, we don't like that, so let's fuse it together. Let's sending out these bone spurs because the body knows it's rubbing bone on bone and said, oh, you know, we don't like that, so let's fuse it together. Let's send out some bone spurs. However, because we use our hands all the time and it gets movement frequently, the bone spurs don't have a chance to meet each other and mesh up, so instead they go out to the side and they start causing these other outcroppings, and that why you have the the big bulbousness in the joints if you're experiencing that.

Speaker 1: 3:29

Now back to the base of the thumb, here's a. Here's a couple of nice tips and tricks. One is the use of kinesio tape and this is the athletic tape that you see on athletes on tv. You know, most often you'll see on the shoulders and on on the back different colors of tape. Now this just happens to be black and at the base of the thumb on that joint, especially when it starts to come out of joint a little bit, it starts to sublux. You can attach it to the back of your hand and then I usually have people pull about 50 to 60 percent and then pull it right around the base where that you can feel it. You can feel that bone when when you slide off the end of the bone there it is on me, right there. That's, that's the joint. So I'm going to go right around the base of that joint and and make a little sling and that really supports that nicely.

Speaker 1: 4:21

I have people who work in schools, in the kitchen and other places in kitchens and they're cleaning pots and pans a lot of heavy scrubbing and they can wear this underneath dishwashing gloves. This is waterproof. If somebody needs some heavier support, there's one over-the-counter brace that I really like a lot needs some heavier support. There's one over-the-counter brace that I really like a lot and I'm going to put the link of that in the description below so you can link on that. Go right to amazon. Uh, they're. They're not very costly and there's no stiffener bar that causes problems. You probably saw my other videos on very problematic over-the-counter braces.

Speaker 1: 4:58

This is this is one of the only over-the-counter braces I use because it's made out of nice neoprene or wetsuit material. So you just slide your thumb into it, guide it over the back of your wrist, connect it and then. Same idea as a Kinesio tape that I just showed you. This is a sling that goes around the base of your thumb, really supports that joint. So when I'm doing heavy work, like stacking wood or a bunch of shoveling to do or something, I'll put this on just when I'm, just when I'm using my hand for those heavy things, and then I'll take it off when I'm done. But that gives it nice support, removes any any discomfort, prevents excessive wear and tear on the joint and then when I'm done I just take it off.

Speaker 1: 5:45

I have some people wear this. Hey, you know what? Keep it in your purse, put it on when you go get groceries and take it off when you get home after you're done, putting away your groceries and and I just tell uh, ladies and gentlemen, to put this on only as needed use it like a crutch to support the joint when you need the support. Sometimes people will especially initially when they're having a lot of discomfort they'll make this sling with the tape, then they'll apply the splint right over the top of it, then they take the splint off and they still have the tape on and they'll slowly wean away from using both as they get better. But you know, over the weeks folks learn how to use it optimally for their needs.

Speaker 1: 6:22

Everybody's different and that's why we ask everybody to be seen by your hand therapist, be seen by a doctor. Don't watch anything online, including this, and just run with that. And only do that because there are other conditions that could be causing pain at the base of your thumb and then on the thumb side of the wrist. It can get quite complicated and, as with anything else, the earlier you catch it the better, always. And if you're treating it wrong, nobody should treat themselves. If you're treating it wrong, then it's going to just prolong the problem and the problem will get worse and the problem will be more difficult to correct. So get it looked at, more difficult to correct, so get it looked at. Things we talk about here are more first aid and some tips and tricks that you can do at home. Thank you for watching.