1st Carpometacarpal Joint Arthritis Treatment London | Private Ultrasound Diagnosis & Injections

1st Carpometacarpal Joint Osteoarthritis Explained

What is a 1st Carpometacarpal Joint Osteoarthritis?

The 1st carpometacarpal joint is the name given to the base of the thumb joint. 

This joint is required during almost every hand task including gripping, twisting and lifting activities and to accommodate these wide variety of tasks, the joint has significant mobility into all planes of movement as well as tendons and muscles which allow it a significant degree of dexterity.

Due to the substantial use of this joint throughout our lives it is susceptible to injuries and degenerative changes (1st carpometacarpal joint osteoarthritis).

1st Carpometacarpal Joint Osteoarthritis Symptoms

The most common complaint with 1st carpometacarpal joint osteoarthritis is pain around the outer aspect of the base of the thumb.

Additional symptoms may include:

• Creaking or crepitus in the joint

• Stiffness in the range of motion of the joint

• Problems during gripping and weight-bearing activities involving the thumb

What Causes 1st Carpometacarpal Joint Osteoarthritis?

Due to the significant load placed through the thumbs during gripping and oppositional movements, combined with the fact that the 1st carpometacarpal joint has a complex range of motion — requiring extension, flexion, tilt, and rotation — this joint commonly develops age-related degenerative changes over time.

How is 1st Carpometacarpal Joint Osteoarthritis Diagnosed?

Due to the superficial location of the 1st carpometacarpal joint, ultrasound scanning provides an excellent gold-standard method of imaging the joint, both statically and dynamically.

Ultrasound can assess:

• The extent of bony changes associated with osteoarthritis

• The presence of joint inflammation

• Capsular distension or swelling of the soft tissue joint capsule

Furthermore, ultrasound provides excellent differential diagnosis capability, helping to:

• Exclude other causes of base of thumb pain, including STT (scapho-trapezio-trapezoid) joint osteoarthritis, which may coexist with 1st CMC joint osteoarthritis

• Identify tenosynovitis affecting the first dorsal compartment (known as De Quervain’s tenosynovitis)

Thumb Arthritis Ultrasound Guided Injections

How is a 1st Carpometacarpal Joint injection administered?

If symptoms persist, an ultrasound-guided injection is a useful way of managing 1st carpometacarpal joint osteoarthritis.

The injection is performed by placing the ultrasound probe in a longitudinal orientation over the joint — with one end of the probe pointing towards the tip of the thumb, and the other towards the wrist.

Ultrasound gel is applied beneath the probe at the wrist end to help create some standoff for better visualisation. The needle is then introduced and visualised at approximately a 45° angle from the wrist-end of the probe, advancing towards the 1st carpometacarpal joint. The injectate can be clearly seen flowing into the joint using this technique.

What to Do After Your 1st Carpometacarpal Joint Injection

Needle Path & Post-Injection Pain
The needle approach to the 1st CMC joint is via the dorsal/ top of the joint but due to significant bony changes and tendons in the region the needle path may be painful for two to three days following an injection.

In some cases it may lead to better outcomes to inject a higher volume into the joint and in these cases this may also lead to some post injections soreness in the joint. 

A post injection flare due to the corticosteroid reacting with the inflamed tissues within the joint may also occur.
However, in some cases of steroid or hyaluronic acid injections, the joint may become painful due to a post-injection flare. This is believed to occur because the medication and injectate react with the synovial fluid in your joint.
If this occurs, over-the-counter painkillers (as directed on the patient information leaflet) can be taken.

Wound Care & Infection Risk
Avoid exposing the needle site to public or dirty water (e.g., swimming pools, hot tubs, lakes) for 2–3 days after any ultrasound-guided injection, due to the small infection risk.

Activity Guidance
After a thumb arthritis injection, it is advisable to avoid any significant increase in activity for 10 days.
This allows the anti-inflammatory properties of the steroid to work optimally.
Following this period, you should engage in a progressive program of physical therapy exercises but should not push the wrist and hand into pain.

Follow-Up
Following a thumb arthritis injection, please contact me immediately if you experience any difficulties.

Other Treatments for 1st Carpometacarpal Joint Osteoarthritis

1st Carpometacarpal Joint Osteoarthritis Bracing

1st Carpometacarpal Joint Osteoarthritis Mobility Exercises

1st Carpometacarpal Joint Osteoarthritis Mobility Strengthening Exercises

1st Carpometacarpal Joint Osteoarthritis | Evidence base

First carpometacarpal joint osteoarthritis is a common degenerative condition causing pain at the base of the thumb, reduced grip and pinch strength, and functional limitation. Symptoms often fluctuate, with inflammatory flares superimposed on chronic joint degeneration. Evidence supports a stepwise conservative approach, with education, splinting, activity modification, and strengthening as the foundation of care. Intra-articular corticosteroid injection has moderate to strong evidence for short-term pain relief and functional improvement, particularly during symptomatic flares or when pain limits participation in rehabilitation. Due to the small joint size and variable anatomy, ultrasound guidance significantly improves injection accuracy compared with landmark techniques and reduces the risk of extra-articular injection. While long-term outcomes are similar regardless of technique, studies suggest US-guided injections may provide more reliable early symptom relief, especially in patients with advanced joint changes, prior failed landmark injections, or significant osteophyte formation. Repeat injections may offer diminishing benefit and should be used judiciously. Surgical options, including trapeziectomy or ligament reconstruction, are reserved for patients with persistent pain and disability despite well-executed conservative management. Overall, ultrasound-guided intra-articular corticosteroid injection is a well-supported option for short-term symptom control in first CMC joint osteoarthritis and can facilitate improved hand function and engagement in therapy.

Questions about your thumb pain?