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• Posted November 7, 2023

Nonsurgical Treatment Works Well for Arthritic Thumbs

Patients with osteoarthritis in their thumbs can get good long-term outcomes with orthotics and exercise therapy, and avoid surgery at the same time, new research shows.

"Our findings support nonsurgical treatment as the first treatment choice and suggest that treatment effects are sustainable" in patients with problems in the thumb carpometacarpal joint, said study author Lisa Esteban Lopez, of University Medical Center Rotterdam in the Netherlands.

Osteoarthritis in this area is common in older adults. It causes pain and stiffness at the base of the thumb.

Current guidelines call for initial nonsurgical treatments, including orthoses, steroid injections, analgesics and exercise therapy. Surgery can be considered if these don't work, but it costs a lot, requires lengthy rehabilitation and outcomes vary.

While other studies have looked at short-term outcomes, this one looked at a longer timeframe.

The investigators analyzed long-term follow-up data for patients with thumb arthritis treated at eight specialized hand clinics between 2011 and 2015.

Nonsurgical treatment focused on the use of orthotics, physical therapy sessions focused on exercises, achieving more stable thumb opposition and daily home exercise.

The researchers analyzed pain, activities of daily living (ADL) and other outcomes for more than five years, using standardized questions.

In an initial analysis of 134 patients who did not have surgery, most improvements happened in the first three months. But from 12 months to over five years, there was "clinically relevant" improvement in standardized scores, as well as in scores for overall hand function and workability.

About 16% of patients rated the outcomes of nonsurgical treatment as excellent, 39% said they were good, 26% answered fair and 14% said moderate. Only 5% reported poor outcomes.

About 71% of patients said they would be willing to undergo the same treatment again under similar circumstances.

The authors also evaluated rates of subsequent surgery in a larger sample of 217 patients. At a median follow-up of seven years, 22% decided to get surgical treatment.

About 70% of patients who had surgery did so within the first year after initial treatment.

The findings, published online Oct. 30 in The Journal of Bone & Joint Surgery, support current recommendations for initial nonsurgical treatment.

Adding to previous evidence of short-term benefits, the new study shows "no worsening of pain or limitations in ADL after 12 months in patients undergoing nonsurgical treatment," the researchers said in a journal news release.

More information

The U.S. National Institutes of Health has more on osteoarthritis.

SOURCE: The Journal of Bone and Joint Surgery, news release, Oct. 30, 2023