Osteoarthritis (OA) thumb

OA at the base of the thumb or the 1st carpometacarpal joint occurs as a result of degenerative changes in the trapeziometacarpal joint. Its prevalence increases with age, studies showing it can affect 15% of the population, and is more common in postmenopausal women. Patients often present with radial sided wrist pain, weakness and grating or crepitus at the base of the thumb. Symptoms are worsened by activities involving the thumb such as pinching and gripping.

• Mechanism of onset, location of pain, severity and longevity of symptoms, limitation to function.

1. Active ROM & thumb opposition
2. Grind test CMC Grind Test-Thumb (youtube.com)
3. Pain with pinch or grasp.

X-ray (when no improvement and considering referral into secondary care)

De Quervain’s

• Self-management – link to MSK work book/leaflet
• Self-management for 2-3/12
• Pain relief in line with agreed formularies/ guidance
• Elastic thumb spica (Promedics example)

• Push CMC (Promedics example)

• Corticosteroid injection if thought appropriate and available.

• Diagnostically uncertain
• Symptoms persist beyond 2-3/12 and/or interfere with ADLs
• Exceptionally severe.