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Treatments and drugs
By Mayo Clinic staffTreatment focuses on helping to:
- Reduce pain
- Maintain or improve joint movement
- Minimize disability
Your doctor may recommend a combination of treatments, including self-care measures, activity modification, splints, medications and physical therapy. In early stages, nonsurgical treatments are usually effective. In severe cases, surgery may be necessary.
Splints
Your doctor may recommend the use of a splint to support your joint and limit the movement of your thumb and wrist. Splints help decrease pain, encourage proper positioning and give your joint some much-needed rest. Depending on your needs, you may wear a splint overnight or throughout the day.
Several types of splints are available. Some are prefabricated, and you can find them in medical supply stores or drugstores. Others can be custom-made to fit your hand. They may be soft and cloth-like or made of plastic. Your doctor or an occupational or physical therapist with special training in treating hand disorders (hand therapist) can help you decide which kind of splint is right for you.
Medications
Your doctor may recommend that you take acetaminophen (Tylenol, others) on a regular basis to relieve your joint pain. Acetaminophen may have fewer side effects than do other pain relievers. Nonsteroidal anti-inflammatory drugs (NSAIDs) decrease the inflammation and relieve the pain in your thumb and wrists. NSAIDs include such over-the-counter (OTC) medications as ibuprofen (Advil, Motrin, others) and naproxen (Aleve, others). Prescription-strength NSAIDs include diclofenac (Cataflam, Voltaren), nabumetone (Relafen) and ketoprofen.
NSAIDs have risks of side effects that increase when used at high dosages for long-term treatment. Side effects may include ringing in your ears, gastric ulcers, cardiovascular problems, gastrointestinal bleeding, and liver and kidney damage.
Injections
If a combination of analgesics and splint use isn't effective, your doctor may recommend injecting a long-acting corticosteroid into your basal joint. Corticosteroid injections can offer some pain relief and reduce inflammation. Corticosteroid injections are only a temporary solution. This is because frequent use of corticosteroid injections may cause further joint damage.
When surgery is necessary
If you don't respond to other treatments or if your ability to use your thumb is significantly compromised, your doctor may recommend a surgical procedure called arthroscopy.
During arthroscopy, your surgeon makes a tiny incision in the area around your joint and inserts a tubular instrument called an arthroscope. The arthroscope contains a light and a small camera, which projects an enlarged image of the interior of your joint onto a video monitor so that your surgeon can view it. If your joint needs repairing, the surgeon can insert surgical instruments into the joint through the arthroscope or through additional small incisions.
Based on what your doctor discovers during arthroscopy, or based on your history, physical exam and imaging studies, he or she may recommend the following treatments:
- Joint fusion (arthrodesis). In arthrodesis, surgeons permanently fuse bones in a joint to increase stability and reduce pain. The fused joint can then bear weight without pain, but has no flexibility.
- Osteotomy. In this procedure, sometimes called bone cutting, surgeons reposition your bones to help correct deformities.
- Trapeziectomy. In this procedure, the surgeon removes the trapezium bone that sits adjacent to the joint.
- Joint replacement (arthroplasty). In this procedure, surgeons remove part or all of the joint and replace it with a graft from one of your tendons. New plastic or metal devices called prostheses also are being developed to replace the joint. Currently, however, doctors prefer soft-tissue (tendon) arthroplasty.
Each of these surgical procedures can be done on an outpatient basis. After surgery, your thumb and wrist is placed in a cast or splint for up to six weeks. Once the cast is removed, you may work with a physical therapist to help regain hand strength and movement. Although recovery is slow, you should be able to resume your normal activities within six months of surgery.
