Treatments for Thumb Base, Finger Joint and Wrist Arthritis

To help us understand the treatment options, we spoke to Rupert Wharton – Consultant Trauma and Orthopaedic Hand and Wrist Surgeon at King Edward VII’s Hospital. Here, he explains the causes, symptoms and personalised treatment options available for each type of arthritis, describing the most effective ways to reduce pain and preserve hand mobility.

Get in touch if you want to find out more about treatments for your wrist pain.

• 1. Thumb-Base Arthritis Treatment
• 2. Finger Joint Arthritis Treatment
• 3. Wrist Arthritis Treatment

Thumb-Base Arthritis Treatment

An introduction to thumb-base arthritis

The joint at the base of the thumb (the carpometacarpal joint), experiences extremely high pressure – especially when pinching, which can create forces several times greater than body weight. The forces acting on thumb joints are some of the highest, leading to cartilage wear.

Symptoms of thumb-base arthritis include pain, swelling and stiffness and the thumb joint may change shape (known as ‘shouldering’). 

Thumb-base arthritis treatments range from non-surgical options – like splints, anti-inflammatory medications, injections and physical therapy – to surgical procedures, including joint fusion, joint replacement and ligament reconstruction, depending on the severity of symptoms and pain levels.

Thumb-base arthritis is notably more common in women, especially after menopause, which suggests a link to oestrogen levels. Research shows that around 25% of postmenopausal women develop arthritis in the thumb base, although only a quarter of those with the condition experience pain.

 

Non-Surgical Management Options

Splints

There are two common brands: Push and Jura. They mould with exposure to body heat and patients usually find them comfortable. These splints allow people to carry on with daily life and can really help with pain. Some people never need anything more than a good splint.

These splints are fitted to your hand and become more snug over time. This allows movement while also supporting the thumb.

Steroid injections

Steroid injections are often recommended for managing thumb-base arthritis when initial treatments, such as splinting, do not provide adequate relief. These injections deliver anti-inflammatory medication directly into the affected area, helping reduce pain and inflammation.

In many cases, arthritis affects not only the carpometacarpal joint but also the adjacent STT (scaphoid-trapezium-trapezoid) joint, about a centimetre below. When both joints are involved, an ultrasound-guided steroid injection is typically recommended to ensure accuracy. At King Edward VII’s Hospital, ultrasound-guided injections are readily available through collaboration with radiology specialists, making same-day treatment possible.

Benefits and Limitations

Steroid injections can be highly effective, particularly in the early stages of arthritis, though the relief they provide is usually temporary and repeat treatments may be needed over time.

Frequency and Risks

Patients often ask how many steroid injections they can receive. While the standard recommendation for other joints is a maximum of three injections at one site, thumb arthritis allows for a more flexible approach due to the recovery time required for surgical options. Injections can continue as long as they are effective and the patient’s skin and tendons remain healthy.

One potential side effect is skin thinning, which may lead to ulcers if injections are continued excessively. As long as the skin and tendons remain unaffected, there is generally no hard limit on the number of injections for thumb arthritis, making it a viable long-term option to manage pain without immediate surgery.

Hand Therapy

Hand therapy can be helpful during all of the treatments above. We normally recommend strengthening exercises, especially for the first dorsal interosseus. The vector of that muscle is such that if you keep it strong, patients can usually reduce the joint reaction force a little bit in the carpal metacarpal joint. 

Simple things like putting a rubber band around your fingers and then pushing them in and out can be really helpful for keeping that muscle as strong as possible. Patients can do this while watching TV and we’d recommend that to everybody.

Surgical Treatment Options

Once people get to a point where the steroid is no longer helping them, we talk to patients about operations. 

Realignment Osteotomy 

Various operations exist for thumb-base arthritis. In rare cases involving young patients, a realignment osteotomy may be performed, where the bone is recut and repositioned with a plate to adjust the metacarpal’s angle against the trapezium.

Joint Fusion (Arthrodesis)

For working-age individuals in manual jobs, a durable solution like joint fusion is often recommended. This procedure removes cartilage in the carpometacarpal joint and uses metal to hold it in place until new bone forms, preventing movement – and thus pain. This stable, single-operation approach is ideal for manual workers, often eliminating the need for further treatment.

Trapeziectomy

In this operation, the trapezium bone is removed to eliminate the painful joint and a tendon is used to reconstruct the ligament, preserving thumb length. This approach suits more sedentary individuals, who require less joint stability for lifting. Recovery involves initial soreness (2-6 weeks) with a cast and splint and full improvement often takes up to six months, with highly effective pain relief.

Joint Replacement (aka arthroplasty)

One newer technique, thumb carpometacarpal arthroplasty (joint replacement), has improved significantly over earlier designs, which often led to dislocation issues and a poor reputation. The latest implants resemble miniature, upside-down hip replacements, using durable materials like cobalt chrome and cross-linked polyethylene, making them much more reliable.

While still within a 10-year follow-up period, recent results are very encouraging. They validate this approach as safe and effective when arthritis is limited to the carpometacarpal joint and there is sufficient bone in the trapezium.

Recovery is quick, with patients moving their thumb after two weeks in a cast and resuming nearly all activities by six weeks, offering faster pain relief. However, the success of the procedure depends on adjacent joints being unaffected, as arthritis in nearby joints could lead to persistent pain.

 

Finger Joint Arthritis Treatment

Finger joint arthritis affects hand function similarly to thumb-based arthritis, though it typically impacts different demographics. Thumb arthritis is common, especially among postmenopausal women, while finger arthritis may arise from old injuries, often only causing pain in the 70s or 80s and typically involves isolated joints like knuckles or proximal interphalangeal joints.

A separate group includes those with inflammatory arthritis, such as rheumatoid arthritis, systemic lupus and psoriatic arthritis, which often affects multiple small joints in the hand.

Non-Surgical Management Options

The main issues for finger joint arthritis are pain and stiffness. Management follows a similar approach to thumb arthritis: splints, provided by hand therapists, are often the first step. If splints don’t help we’d consider steroid injections and if those are ineffective, we might discuss surgery (joint fusion or replacement).

• Hand therapy: Exercises targeting finger joints to improve flexibility and reduce stiffness.
• Splints: Provide support and relieve pain in affected finger joints.
• Steroid injections: Offer temporary symptom relief for finger joint arthritis.

See section 1 for more details on these.

Surgical Treatment Options

Joint Fusion

Fusion is typically recommended for the distal interphalangeal joint, where limited movement is normal, making it an effective option. However, for the proximal interphalangeal joint, fusion would significantly reduce motion and impact hand function, so joint replacement is usually preferred if the joint is still flexible.

Joint Replacement

Joint replacement for finger arthritis can relieve pain but is less effective at restoring movement. Generally, the range of motion before surgery remains unchanged after surgery. If a joint is fully stiff, fusion may be preferred as a single, permanent solution since motion is already limited.

Finger joint replacements are available as single- or two-piece components. Single-piece Silastic (silicon) implants are stable and can’t dislocate, though they may require revision after 7-10 years if they wear out or snap.

Unlike hip replacements, finger joint replacements are not typically transformative. Pain relief is the primary benefit, while restored movement is limited. Given these modest outcomes, steroid injections often play a greater role in managing finger joint arthritis than surgery.

 

Wrist Arthritis Treatment

Wrist arthritis often affects people who were very active in sports during their youth. Two common patterns of arthritis stem from untreated sports injuries: one involves rupture of the ligament between the scaphoid and lunate bones, often mistaken for a minor sprain or tendon irritation. If left untreated, this ligament injury alters wrist mechanics, leading to abnormal cartilage wear and arthritis. Similarly, an unrecognised and untreated scaphoid fracture can cause a predictable arthritis pattern as well.

Wrist arthritis can also develop from rheumatoid arthritis or primary idiopathic osteoarthritis, which occurs naturally with age. However, many cases are due to seemingly minor sports injuries that later lead to significant issues.

For sportspeople experiencing wrist pain and swelling after a fall, even if it subsides, it’s recommended to consult a hand surgeon. An MRI scan can confirm ligament health and help prevent arthritis from developing in the future.

Non-surgical management options for wrist arthritis

If wrist arthritis develops, several non-surgical options can help manage pain and preserve function:

• Splinting: Wearing a wrist splint, particularly at night, can provide stability and allow the joint to rest, reducing strain and alleviating pain.
• Hand therapy: Specific exercises prescribed by a hand therapist can help maintain wrist mobility and strength, preventing stiffness and supporting daily activities.
• Steroid injections: Steroid injections offer temporary relief by reducing inflammation within the joint. They can be repeated as needed for pain management, as long as they remain effective and side effects are minimal.

See section 1 for more details on these.

Surgical treatment options

Several surgical options are available for wrist arthritis, depending on the severity and pattern of the condition:

Denervation

This involves making a small incision on the back of the wrist to cut sensory nerve branches that supply the wrist joint (without affecting finger sensation or movement). This can relieve pain in about half of patients without restricting wrist movement or precluding future treatments if pain returns.

Partial fusion

Suitable for cases where arthritis is limited to specific areas, partial fusion stabilises the affected joint portions while preserving some wrist movement, which is typically adequate for daily activities. This option can reduce pain without completely stiffening the wrist.

Total fusion

If arthritis is more widespread, total fusion may be necessary. This involves positioning the wrist in a slight backward tilt to support grip strength, then securing it with a metal plate to permanently stabilise the joint. This option is ideal for those who are physically active, as it provides long-term stability.

Joint replacement

For less active or more sedentary patients, or those with a stiff wrist on the opposite side, joint replacement may be an option. However, wrist replacements have limitations – they can only support light weights (1-2 kg), making this less suitable for active individuals.

Don’t forget, you can get in touch if you want to find out more about treatments for your wrist pain.