Base of Thumb Arthritis – Reducing Pain and Enhancing Function
'Pain used to be the name of my game before I met Robyn Midgley. My journey started with the diagnosis of Hypermobility Syndrome, which mostly affected my hands. I lived with it my whole life and had to have numerous surgeries including partial bone fusions and carpal tunnel releases in order to maintain hand function. Recently, after having a ganglion removed, I was diagnosed with base of thumb arthritis. Being a keen guitar player, and mother of twins, this was devastating news, since the two greatest joys of my life caused me a lot of physical pain. And then I met Robyn, who made me splints for both hands, which, miraculously, took away the pain. Since wearing the splints I am able to play guitar and pick up my kids, pain free. I believe that if I had met Robyn before the operation to remove the ganglions, it wouldn’t have been necessary, and the after effects of any operation could have been avoided. Be that as it may, Robyn and the splints changed my life. All I can say is, thank you, oh, and, wait before you operate…. There might be another option.'
Retha Buys, June 2015
Arthritis at the base of the thumb (CMC Joint) can be very disabling as a result of the pain that is experienced during functional use of the hand.
Therapists and surgeons frequently recommend splinting as part of conservative treatment. Early stabilization of the thumb CMC joint with a small CMC immobilization splint prevents further degeneration of the joint and the subsequent need for surgery.
Patient compliance with splinting will be poor if too many joints are immobilised, if hand function is limited and if pain is not reduced.
An effective splint must:
- Prevent motion of the thumb metacarpal in relation to the finger metacarpals.
- Prevent tilting of the first metacarpal during pinch
- Permit unrestricted thumb metacarpal and wrist joint motion.
Attention to detail during construction is required for the splint to be successful in controlling thumb CMC pain. The splint must not impair pinching or the handling of objects. When the splint is correctly designed and moulded, patients report an immediate elimination or reduction of thumb CMC pain with pinch.
Unlike most splints applied to joints, this CMC splint cannot be worn too long or too much. The problem at the thumb CMC joint is one of excessive motion. It is believed that the splint can be worn long enough for the joint to "stiffen" and subsequently have greater stability.
Reference: Colditz J, The Biomechanics of a Thumb Carpometacarpal Immobilization Splint: Design and Fitting J HAND THER. 2000, 13:228-235.