Ultrasound-Guided Cortisone and Hyaluronic Acid Injections for Osteoarthritis of the Thumb

 

Introduction

Osteoarthritis (OA) of the thumb, also known as thumb basal joint arthritis or carpometacarpal (CMC) joint osteoarthritis, is a degenerative condition that affects the joint at the base of the thumb. It is one of the most common forms of hand osteoarthritis, particularly in individuals over the age of 50. This condition develops due to the gradual breakdown of cartilage within the CMC joint, leading to pain, stiffness, reduced grip strength, and difficulty in performing daily activities such as writing, opening jars, or holding objects.

At Alton Pain Clinic, we provide ultrasound-guided cortisone and hyaluronic acid injections to help manage symptoms of thumb osteoarthritis. These minimally invasive treatments aim to reduce inflammation, improve joint function, and provide relief from discomfort.

This blog will explore the anatomy of the thumb joint, the pathology of osteoarthritis, symptoms, causes, and available treatment options. Additionally, it will discuss the mechanism of action of cortisone and hyaluronic acid injections and how they may help individuals with this condition.

Anatomy of the Thumb Joint

The thumb's basal joint, also called the carpometacarpal (CMC) joint, is where the first metacarpal bone meets the trapezium bone in the wrist. This joint allows for a wide range of movements, including pinching, gripping, and rotation, making the thumb one of the most functional and mobile parts of the hand.

The CMC joint is lined with cartilage, a smooth, cushioning tissue that prevents bones from rubbing against each other. Additionally, synovial fluid within the joint ensures smooth motion and reduces friction.

Over time, with repetitive movements and ageing, this cartilage can wear down, leading to increased bone-on-bone contact, resulting in osteoarthritis.



Pathology of Osteoarthritis of the Thumb

Osteoarthritis is a chronic degenerative condition that affects the integrity of joint cartilage. In the thumb, the condition progresses through gradual cartilage loss, leading to joint space narrowing, inflammation, and the formation of osteophytes (bone spurs).

Key pathological changes in thumb osteoarthritis include:

  • Cartilage Degeneration: The protective cartilage covering the bones gradually breaks down, reducing cushioning between bones.
  • Inflammation: The synovial lining of the joint may become inflamed, leading to pain and swelling.
  • Bone Spurs (Osteophytes): The body responds to cartilage loss by forming extra bony growths, which can cause further stiffness and discomfort.
  • Joint Space Narrowing: As cartilage disappears, the space between bones reduces, leading to bone-on-bone contact.
  • Weakening of Ligaments and Tendons: The supporting structures of the thumb joint may weaken, reducing stability and grip strength.

Causes of Thumb Osteoarthritis

Several factors contribute to the development of CMC joint osteoarthritis, including:

  • Ageing: The natural ageing process leads to wear and tear of joint cartilage.
  • Repetitive Use: Activities that involve frequent thumb movement, such as writing, typing, or knitting, can contribute to joint degeneration.
  • Genetics: A family history of osteoarthritis increases the risk of developing the condition.
  • Previous Injury: Past fractures, dislocations, or trauma to the thumb joint can accelerate cartilage breakdown.
  • Joint Misalignment: Structural imbalances in the hand may lead to abnormal pressure on the CMC joint.
  • Inflammatory Conditions: Conditions like rheumatoid arthritis may predispose individuals to thumb osteoarthritis.

Symptoms of Thumb Osteoarthritis

Symptoms of CMC joint osteoarthritis typically develop gradually and worsen over time. Common symptoms include:

  • Pain at the Base of the Thumb: Especially noticeable when gripping or pinching objects.
  • Swelling and Stiffness: The joint may appear swollen and feel stiff, particularly in the morning or after prolonged use.
  • Weak Grip Strength: Difficulty holding objects due to reduced joint stability.
  • Clicking or Grinding Sensation: The joint may produce clicking sounds due to irregular bone movement.
  • Loss of Motion: Reduced ability to move the thumb in different directions.

Diagnosis of Thumb Osteoarthritis

Diagnosis is typically based on a clinical assessment and imaging studies.

  • Physical Examination: The doctor evaluates pain levels, grip strength, range of motion, and joint stability.
  • Ultrasound: Used to assess soft tissue structures, inflammation, and fluid buildup within the joint.

Management of Thumb Osteoarthritis

Treatment for thumb osteoarthritis focuses on pain management and improving function. Non-surgical interventions include:

Conservative Treatment Options

  • Activity Modification: Reducing repetitive thumb movements can help prevent further cartilage deterioration.
  • Splinting or Bracing: Supports the thumb joint to reduce strain and improve stability.
  • Pain Medication: Non-steroidal anti-inflammatory drugs (NSAIDs) may help manage pain and inflammation.
  • Physical Therapy: Strengthening and stretching exercises improve thumb function and reduce stiffness.

Minimally Invasive Treatments

If conservative measures do not provide sufficient relief, ultrasound-guided injections may be considered.

Ultrasound-Guided Cortisone and Hyaluronic Acid Injections

Cortisone Injections

Corticosteroid (cortisone) injections are used to reduce inflammation and alleviate pain in thumb osteoarthritis. These injections are administered under ultrasound guidance, ensuring precise placement within the CMC joint.

Mechanism of Action of Cortisone

  • Cortisone is a potent anti-inflammatory medication that helps reduce swelling and pain in the affected joint.
  • It works by inhibiting inflammatory mediators, reducing joint inflammation.
  • By suppressing inflammation, cortisone lowers pain levels and improves thumb mobility.

Cortisone injections provide temporary relief and may be used in combination with other therapies.

Hyaluronic Acid Injections

Hyaluronic acid (HA) is a lubricating substance found naturally in joint fluid. HA injections aim to restore joint lubrication and cushioning, improving thumb function.

Mechanism of Action of Hyaluronic Acid

  • HA injections act as a viscosupplement, improving joint lubrication.
  • They help reduce joint friction, potentially slowing cartilage degeneration.
  • HA injections may enhance the shock-absorbing properties of joint fluid, reducing pain and stiffness.

Benefits of Ultrasound-Guided Injections at Alton Pain Clinic

At Alton Pain Clinic, we offer ultrasound-guided cortisone and hyaluronic acid injections for thumb osteoarthritis. The benefits of ultrasound guidance include:

  • Precision: Accurate placement of medication into the affected joint.
  • Improved Efficacy: Enhances the effectiveness of the injection by targeting the precise area of inflammation.
  • Reduced Discomfort: Minimises unnecessary tissue trauma.
  • Real-Time Visualisation: Ensures the medication is delivered to the intended location.

Conclusion

Osteoarthritis of the thumb is a degenerative condition that can impact daily activities and overall hand function. At Alton Pain Clinic, ultrasound-guided cortisone and hyaluronic acid injections are available to help manage symptoms and improve quality of life. These minimally invasive treatments aim to reduce inflammation, improve lubrication, and enhance joint function.

For individuals seeking relief from thumb osteoarthritis, Alton Pain Clinic provides a comprehensive and tailored approach to treatment.

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