Basal Joint (Thumb) Arthritis Often Misdiagnosed as Carpal Tunnel Syndrome, Notes Cleveland-area Hand Surgeon John Krebs, MD

Sheffield Village, Ohio November 1, 2010 — According to U.S. government statistics, carpal tunnel syndrome affects more than 8 million Americans who undergo repetitive use of their hands and wrists in daily living.

"But many patients with arthritis in the basal joint of the thumb are misdiagnosed as having carpal tunnel syndrome," says board-certified hand surgeon John Krebs, MD, of the Center for Orthopedics in Sheffield Village, Ohio. "If patients come in complaining of pain in the hand or wrist, it's probably tendinitis or arthritis."

Nearly one in five U.S. adults—46 million people—has arthritis, according to a study published in the journal Arthritis and Rheumatism. "Basal joint arthritis, affecting the carpo-metacarpal (CMC) joint of the thumb, is probably the most common form of arthritis in the upper extremities," Dr. Krebs explains. "Symptoms of CMC arthritis include pain and weakness in the lower part of the thumb near the wrist.

"With carpal tunnel syndrome, the main complaint is numbness that wakes the patient up at night or that gets worse with certain activities," says Dr. Krebs. "It's not necessarily pain in the thumb. If you're going to have pain, it's going to be in the whole hand, and there could be numbness involving the thumb, index finger and middle finger.

"CMC arthritis is usually related to repetitive strain from activities involving a lot of pinching or gripping motions," Dr. Krebs explains. "When pain relievers, cortisone injections and physical therapy fail, CMC arthroplasty can replace the basal joint, relieve the pain and restore normal strength and function.

"We often see basal joint arthritis in women who do handwork that involves fine, intricate detail, such as sewing, knitting, crocheting, needlepoint and embroidery," says Dr. Krebs.

"Plumbers and mechanics often develop CMC arthritis through repetitive use of wrenches," he adds. "It's common among people who work with tools that require grip strength and pinch strength."

Usually, CMC arthritis occurs in people in their early 40s and up. But a recent phenomenon—texter's thumb—caused by the repetitive strain of text messaging, is affecting younger people as well.

"Every pound of pressure caused by pushing a keypad with the thumb is magnified at the base of the thumb," Dr. Krebs explains. "Multiply this by hundreds of keystrokes a day and the risk of thumb arthritis increases." A recent British study by Virgin Mobile, a U.K. mobile phone provider, showed that 38% of mobile phone users suffer from sore wrists and thumbs from texting.

CMC arthritis can develop gradually, as in the case of Tim Haywood, a 61-year-old jeweler from Elyria, Ohio. "The pain in my thumbs started about 2000," he recalls. "At first, it was just slight pain caused by my work."

Haywood's work involves a lot of pinching motions. "I've sat at the jeweler's bench for almost 30 years," he explains. "I work a lot with small diamonds, doing setting work. And I also work with a buffing machine that runs at 3,500 rpm. When you buff a ring, the machine draws your hands downward and puts pressure on the joint at the base of the thumb."

Dr. Krebs diagnosed Haywood with CMC arthritis in 2004. "I had cortisone shots for about six months," he recalls. "Dr. Krebs told me that when the pain got bad enough, I'd know when I was ready for joint replacement surgery.

"After the 2004 Christmas season, I couldn't stand the pain anymore," says Haywood. "I remember my business partner walking in one day when I was buffing rings and seeing I had tears running down my face."

"Mr. Haywood had all the right indications for surgery," says Dr. Krebs. "Conservative treatments had failed. The beauty of this surgery is that we're literally taking out the arthritis and we don't have to put in any kind of metal or plastic joint. We're using the patient's own tissue to reestablish the joint motion and relieve the pain."

In January 2005, Haywood had CMC arthroplasty to replace the basal joint in his right thumb. He had the left basal joint replaced a year later.

"After surgery, my pain relief was almost immediate," says Haywood. "Today, I'm pain-free in both hands. It's incredible!"

For details on CMC arthroplasty, visit: www.center4orthopedics.com/hand-wrist-surgery. To schedule a consultation with Dr. Krebs, call Northeast Ohio's Center for Orthopedics at 440.329.2800.

Northeast Ohio's Center for Orthopedics, with offices in Sheffield Village, Oberlin and Westlake, Ohio, offers complete bone and joint care by five advance-trained, board-certified orthopedic surgeons. Call 440-329-2800 or visit www.center4orthopedics.com for more information.