Ultrasound-Guided Cortisone and Hyaluronic Acid Injections for Thumb Arthritis

 Thumb arthritis, or carpometacarpal (CMC) joint arthritis, is a common condition that affects the base of the thumb. It can significantly impact daily activities such as gripping, pinching, or writing. At Alton Pain Clinic, we aim to provide insights into this condition, exploring its anatomy, pathology, and treatment options, with a focus on ultrasound-guided cortisone and hyaluronic acid injections.

Introduction to Thumb Arthritis

Thumb arthritis, particularly osteoarthritis, typically affects the CMC joint where the thumb meets the wrist. Over time, the protective cartilage in the joint wears away, leading to pain, stiffness, and functional limitations.

While thumb arthritis often develops due to wear and tear, other factors such as trauma or inflammatory conditions can contribute to its onset.

Anatomy of the Thumb Joint

The thumb’s base joint, also known as the trapeziometacarpal (TMC) joint, connects the thumb’s metacarpal bone to the trapezium, a small wrist bone. This joint is a saddle joint, allowing a wide range of motion including flexion, extension, abduction, and opposition.

The joint’s structure, while highly mobile, makes it susceptible to stress and wear. Supporting ligaments provide stability, while cartilage cushions the joint during movement.

Pathology of Thumb Arthritis

Degeneration of Cartilage:
Thumb arthritis is primarily characterised by the deterioration of articular cartilage, the smooth tissue covering the bone ends. The absence of cartilage leads to bone-on-bone contact, causing pain and inflammation.

Joint Changes:
Over time, the joint may develop osteophytes (bone spurs), further limiting mobility and exacerbating discomfort. Subchondral sclerosis, or the hardening of bone under the cartilage, is another hallmark of advanced arthritis.

Inflammation:
Chronic inflammation in the joint may result in synovitis, where the joint’s synovial lining becomes thickened and swollen, causing additional pain and stiffness.

Causes of Thumb Arthritis

  • Ageing: Natural wear and tear with age is a leading cause.
  • Repetitive Movements: Activities that place stress on the thumb joint can accelerate cartilage breakdown.
  • Genetic Predisposition: A family history of osteoarthritis increases the likelihood of developing thumb arthritis.
  • Previous Injuries: Trauma or fractures involving the thumb joint may predispose individuals to arthritis.
  • Inflammatory Conditions: Diseases such as rheumatoid arthritis can contribute to thumb joint degeneration.

Symptoms of Thumb Arthritis

  • Pain at the base of the thumb, especially during gripping or pinching.
  • Swelling and tenderness around the joint.
  • Decreased range of motion or stiffness.
  • A noticeable bump or deformity at the thumb base.
  • Weakness or reduced hand strength.

Diagnosis of Thumb Arthritis

Clinical Evaluation:
Doctors assess symptoms, joint deformity, and mobility. Patients may also be asked to perform specific tasks to determine functional limitations.

Imaging Studies:

  • X-rays: Useful for identifying joint space narrowing, osteophytes, and bone changes.
  • Ultrasound: Provides a detailed view of soft tissues, synovitis, and inflammation.

Management of Thumb Arthritis

Conservative Treatments:

  • Rest and activity modification.
  • Use of splints or braces to support the thumb joint.
  • Over-the-counter pain relievers and anti-inflammatory medications.

Advanced Treatments:
When conservative measures are insufficient, injection therapies like cortisone and hyaluronic acid can help manage symptoms.

Ultrasound-Guided Injections

Ultrasound guidance ensures precise delivery of therapeutic agents directly into the affected joint. This approach improves the efficacy of treatment while minimising risks.

Cortisone Injections

Overview:
Cortisone is a corticosteroid that reduces inflammation in the joint, providing pain relief and improving mobility.

Mechanism of Action:

  • Cortisone suppresses inflammatory mediators such as prostaglandins and cytokines.
  • It stabilises cell membranes and reduces leukocyte infiltration, thereby decreasing swelling and pain.

Benefits:

  • Rapid onset of pain relief.
  • Reduction in inflammation, improving joint function.

Considerations:
While cortisone injections are effective, their benefits are typically temporary, requiring repeated treatments under medical supervision.

Hyaluronic Acid Injections

Overview:
Hyaluronic acid (HA) is a natural component of joint fluid, providing lubrication and cushioning. Injecting HA into the thumb joint can restore joint function and reduce pain.

Mechanism of Action:

  • HA supplements the natural joint fluid, improving lubrication and shock absorption.
  • It reduces inflammatory responses and protects cartilage from further damage.
  • HA may stimulate the production of endogenous hyaluronic acid within the joint.

Benefits:

  • Improves joint mobility and reduces stiffness.
  • Slower, more sustained pain relief compared to cortisone.
  • Protects remaining cartilage from wear.

Why Choose Alton Pain Clinic?

At Alton Pain Clinic, we specialise in providing personalised, evidence-based care for conditions like thumb arthritis. Our expertise in ultrasound-guided injection techniques ensures precision and comfort.

Conclusion

Thumb arthritis is a common yet debilitating condition that can significantly impact daily life. While conservative measures provide initial relief, advanced treatments like ultrasound-guided cortisone and hyaluronic acid injections offer targeted symptom management. At Alton Pain Clinic, we are dedicated to helping you regain function and improve your quality of life.

Contact us today to learn more about how we can support your journey to pain relief and better hand health.

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