It is estimated that around 53.2 million adults in the United States have been diagnosed with arthritis by a doctor or healthcare professional. From 2019 to 2021 around 25.7 million adults in the US aged 65 and older have been diagnosed with arthritis while adults aged 18 to 44 years accounted for 6.2 million cases. The states with the highest rates of arthritis are West Virginia, Alabama, and Arkansas. In West Virginia, around 44 percent of all adults have arthritis.
Understanding Thumb Osteoarthritis
Thumb arthritis is a very common form of osteoarthritis. Some experts consider it the most common area of arthritis. Thumb arthritis is extremely common. X-rays of people starting at the age of 50 and beyond have evidence of arthritic changes.
The Anatomy of the Thumb and CMC Joint
The base of the thumb is the area most affected by arthritis. The carpometacarpal joints (CMC) are the five joints in the wrist that articulate with the distal row of carpal bones in the wrist. The CMC joint of the thumb or the first CMC joint is also known as the trapeziometacarpal joint and differs significantly from the other four similar joints at the base of the wrist area.
The carpometacarpal joint of the thumb connects the trapezium (carpal bone of the wrist) to the first metacarpal bone of the thumb. The first metacarpal bone of the thumb plays an irreplaceable role in the functioning of the thumb because of the motion of opposition and other ranges of motion.
Importance of Thumb Mobility and Function
The thumb via this joint can oppose, flex and extend, abduct and adduct, and rotate. The most important motion is opposition where the tip of the thumb is brought into contact with the slightly flexed fingers. This movement has evolved from primitive primates approximately 70 million years ago and the current shape of the human TMC joint dates back to about 5 million years ago. As a result of evolution, the range of motion of this joint allows for the “Pinch motion” which is an important function of the hand.
Since the range of motion of this joint is diverse and utilized in common daily living activities, osteoarthritis is common. The cartilage wears away from the ends of the bones, making the joint predisposed to instability and degenerative changes. This type of arthritis is extremely common in post-menopausal women and older adults.
Causes of Thumb Osteoarthritis
- Age due to repeated wear and tear cumulative degeneration.
- Gender – Women are much more common than men due to hormonal changes and ligament laxity.
- Repetitive Use due to occupational exposure.
- Genetics – Family members who have arthritic conditions increase susceptibility.
- Trauma – Previous fractures, dislocations, or ligamentous injuries predispose to CMC arthritic changes.
Trapeziometacarpal joint arthritis is a prevalent orthopedic condition particularly affecting up to a third of all postmenopausal women. This degenerative disease involves wear and destruction of the articular cartilage within this joint. As the cartilage deteriorates, the bone-on-bone causes friction leading to pain, inflammation, and the formation of osteophytes and bone spurs. These contribute to reduced mobility, instability, and decreased grip strength.
Symptoms of Carpometacarpal Arthritis
- Pain and tenderness at the base of the thumb
- Swelling and stiffness of the joint
- Difficulty doing fine motor tasks such as sewing or opening a jar
- Reduced grip and pinch (hallmark of CMC joint OA)
- Bony deformity at the base of the thumb
Treatment Options for Thumb Osteoarthritis
Non-Pharmacological Treatments
- Splinting to support and immobilize the thumb (Thumb Spica Splint).
- Physical and occupational therapy to improve joint mobility and strengthen surrounding and supporting musculature.
- Activity modification to reduce stress on the joint.
Pharmacological Treatments
- Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) are the most commonly prescribed medication for this arthritis. These are used to reduce pain and inflammation.
- Corticosteroid Injections to reduce inflammation and pain. The use of steroid injections is controversial since steroids can further degrade the tissues and the joint itself. Many clinicians avoid steroids at all costs.
Surgical Interventions
- Ligament reconstruction and/or tendon interposition
- Joint fusion or arthroplasty (results in severe limitation of motion)
Alternative and Regenerative Therapies
- Extracorporeal Shockwave Therapy to reduce pain and inflammation.
- Electroporation and Iontophoresis to deliver drugs to the site and stimulate regeneration.
Platelet-Rich Plasma (PRP) for Thumb Osteoarthritis
Platelet Rich Plasma is a treatment that harnesses the healing power of the body. It is an autologous blood-derived concentrate, rich in growth factors, cytokines, and bioactive proteins. These factors promote the repair of damaged tissues while reducing pain and inflammation.
Mechanism of Action of PRP
- Stimulates the repair and regeneration of lost cartilage in the joint.
- Reduces inflammatory cytokines.
- Promotes the replacement of synovial fluid to lubricate and cushion the joint space.
Since platelet-rich plasma is autologous, the side effects are insignificant and repair can continue to evolve over weeks to months, especially if platelet-rich fibrin is added to the treatment cascade.
Scientific Studies on PRP for Thumb Osteoarthritis
Effectiveness of Arthroscopic Debridement, Trapeziectomy and Joint Replacement for Trapeziometacarpal Joint Osteoarthritis: A Meta-Analysis of Pre and Postoperative Pain Scores
Cureus 2024 Feb 18:16(2):e54409 PMID 38510875
Purpose: To compare the effectiveness of three surgical options for CMC OA.
Conclusion: The fundamental goal behind these surgeries is to alleviate pain and restore function. Pain was improved but movement was not addressed.
Authors note: On review of this analysis, there was little improvement in pain while function was not addressed. Factors associated with longevity, functional change and long-term complications were not addressed to mitigate the variability in conclusions. It appears that while surgery is an option for the most severe cases of this disease, the results are not appreciated by this author.
Nonoperative Management of Trapeziometacarpal Joint Arthritis: A Systematic Review of the Clinical Trials
Cureus 2024 Aug 13:16(8): e66801 PMID 39268317
Abstract: A Randomized controlled trials assessing pain outcomes with nonoperative outcomes over at least a six month follow up were assessed using the visual analog scale. Moderate quality of evidence was found to corticosteroids and hyaluronic acid both exhibiting comparable mean scores at six months. After 12 months, Platelet Rich Plasma surpassed both of the above with PRP achieving higher scores demonstrating long term effectiveness.
Note: Shockwave treatments were shown to be beneficial in pain reduction
High Concentrated Platelet Rich Plasma versus Placebo in Osteoarthritis in the Thumb Base: Study Protocol for an Assessor Blinded Randomized Controlled Trial
Trials 2024 Nov 26;25(1):797 PMID 39587622
Background: Osteoarthritis in the thumb base is prevalent, particularly among middle aged and elderly women, causing significant disability. Conservative treatments, including steroid injections, have been questioned for their efficacy, prompting exploration into alternative therapies such as platelet rich plasma injections. This randomized, double blinded controlled trial aims to evaluate the effectiveness of high concentration PRP injection compared to placebo (saline) in reducing pain and disability in patients with thumb base osteoarthritis.
Discussion: This study will assess pain and movement at 3,6- and 12-month intervals including rom studies, pinch testing, grip strength and abduction.
Authors note: As this study has not yet been completed, it was included here to demonstrate the lack of effectiveness and the questioning by experts in the use of steroids for this disease.
Juventix Regenerative Medical: Leading in PRP Innovation
Juventix Regenerative Medical is an industry leader in the regenerative medical field. Our Platelet Rich Plasma Kits are FDA cleared and designed for safety, sterility and effectiveness. Our Kits are scientifically manufactured to produce a platelet concentrate, devoid of red blood cells with a minimum number of leukocytes that are critical for the regenerative process.
Juventix Regenerative Medical offers a LED Activator to activate the platelets and begin the regenerative process. This activation is a critical step in the release of growth factors, cytokines and bioactive proteins from the alpha granules on the platelets and is accomplished with LED light. This negates the use of chemical additives such as Calcium Chloride, Thrombin and Collagen. This mode of activation by LED light provides sustained growth factor release versus older methods of activation while adhering to the minimal manipulation standards of the FDA. This activation should be accomplished after the swirl of the centrifuged product to maximize the number of captured platelets.
Juventix Regenerative Medical supplies a patented Bio-Incubator to transform the Platelet Rich Plasma into an Injectable Platelet Rich Fibrin. The Platelet Rich Fibrin, commonly called the “second generation of platelet products” has different growth factory and cytokines than the original PRP. These different cytokines provide an anti-inflammatory microenvironment and can be used confidently in inflammatory conditions.
Juventix Regenerative Medical has a vast array of products, devices and services for the regenerative professional. From the Physio-Pro Radial Shockwave Device to the Apollo Duet Facial Skincare System, Juventix Regenerative Medical offers the newest “cutting edge” products for our regenerative clients. The regenerative marketplace is evolving and transforming daily. With our premier line and experienced support staff, Juventix will aid any regenerative professional to provide enhance outcomes and increased patient satisfaction.
RESTORE, REVIVE, REGENERATE- JUVENTIX REGENERATIVE MEDICAL
Regenerative Regards,
Dr. Robert McGrath
