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Can I get injections called hyaluronate for the arthritis in my hand?

Q: I had a special series of injections called hyaluronate to my knee that worked like a charm for my arthritis. Do you think I could get this for my thumb? It's been acting up for ages.

A: You may be experiencing basal thumb arthritis if by acting up you mean there is pain, stiffness, and decreased pinch strength. These are symptoms often associated with degenerative changes of the trapeziometacarpal (TM) joint.

The trapeziometacarpal (TM) joint is at the base of the thumb where the metacarpal bone of the thumb connects to the trapezium of the wrist. This joint is also referred to as the CMC joint (an abbreviation for carpometacarpal joint) of the thumb.

This is the joint that allows you to move your thumb into your palm, a motion called opposition. The TM or CMC joint is sometimes referred to as a universal joint because of the wide range of movements possible.

Treatment usually begins with conservative (nonoperative) care. This could include splinting, exercise, antiinflammatory medications, and steroid or hyaluronate injections. A recent survey of active surgeons from the American Society for Surgery of the Hand showed only a small number of surgeons (four per cent) used the more recent treatment of hyaluronate injections.

The use of hyaluronate for the thumb has not yet received approval from the FDA. Insurance doesn't always cover this procedure and it costs more than steroid injections. Studies haven't really shown a benefit of hyaluronate injection over steroid injection. These factors may explain why this treatment is not more popular.

Patients who fail conservative care as described may benefit from surgery. The simplest procedure is a trapeziectomy (removal of the trapezium bone). More advanced procedures include trapeziectomy with ligament reconstruction, arthrodesis (fusion), or arthroplasty (joint replacement).

But the first step for you is to get an accurate diagnosis. Your orthopedic surgeon can evaluate you and make recommendations based on clinical findings. X-rays may help identify the severity of changes in the joint. Your symptoms along with the objective clinical results will guide treatment.

Reference: Jennifer Moriatis Wolf, MD, and Steven Delaronde, MPH, MSW. Current Trends in Nonoperative and Operative Treatment of Trapeziometacarpal Osteoarthritis: A Survey.