Questionnaire/history: 45+ years? Activity-related joint pain, which has developed over months or years? No morning joint-related stiffness or morning stiffness lasting no longer than 30 min? Stiffness? Pain history: - Location? ------ 1st carpometacarpal (CMC) joint at the base of the thumb? ------ Distal interphalangeal (DIP) joint? ------ Proximal interphalangeal (PIP) joint? - Radiation distally towards the thumb or proximally to the wrist and distal forearm? - Exacerbation by pinching actions or strong grip? - Onset? - Duration? ------ At rest? ------ Disturbing sleep? - Progression? - Pattern? - Severity of symptoms? - Exacerbation by pinching actions or strong grip? Risk factor for osteoarthritis? Trauma? Systemic symptoms? Functional impairment? Psychosocial impact? Tried self-help strategies and treatments? Fall risk? Past medical history (eg chronic pain syndrome, obesity)? Family history (eg osteoarthritis or joint problems)? Current medication? Drug allergies? Social support? Examination: Height? Weight? BMI? Bony swelling and joint deformity? - Fixed flexion deformity of the CMC joint with hyperextension of the distal joints? - Squaring at the joint caused by subluxation, formation of osteophytes and remodelling of the bones? - Ulnar or radial deviation? Joint warmth and/or tenderness (there may be synovitis)? Muscle wasting and weakness? - Thenar muscle at the base of the thumb? Restricted and painful range of joint movement? Crepitus (a grating sound or sensation produced by friction between bone and\cartilage)? Joint instability? Mucoid cysts? Heberden’s nodes on the dorsum of the fingers next to the DIP joints? Bouchard’s nodes on the dorsum of the fingers next to the PIP joints? Management: Advised: - Paracetamol and/or topical ibuprofen and if ineffective oral ibuprofen +/- codeine - Capsaicin prn - Local heat or cold packs - Local muscle strengthening exercise and aerobic fitness training - To avoid repetitive grasp, pinch or twisting motions - To lose weight if overweight or obese - Psychological support options - Adjustments to home and/or work if needed - Sources of information and support: ----- Versus Arthritis ----- Arthritis and Musculoskeletal Alliance (ARMA) ----- NHS Health A to Z: Osteoarthritis ----- Patient UK: Osteoarthritis ----- British Society for Surgery of the Hand (BSSH): Arthritis at the base of the thumb - Review prn Reference(s): NICE CKS: Osteoarthritis Information for parents/carers: British Society for Surgery of the Hand (BSSH): Arthritis at the base of the thumb NHS Health A to Z: Osteoarthritis Patient UK: Osteoarthritis British Society for Surgery of the Hand (BSSH): Arthritis at the base of the thumb Versus Arthritis