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Tomasz Poboży

Kategoria: Patient Knowledge (EN)

Evidence-informed orthopaedic information for patients in English: symptoms, injuries, diagnostics, treatment, surgery and recovery.

  • Inhaled siRNA Silences an Inflammatory Signal in the Lung: First-in-Human Trial

    General Medical Discoveries · Human study — phase 1/2a

    Researchers tested ARO-RAGE, an experimental inhaled siRNA designed to silence RAGE in lung cells, a protein involved in sustaining inflammatory signalling. In this first-in-human study, the treatment was given to healthy volunteers and people with asthma; it reached its pulmonary target and produced marked reductions in soluble RAGE (sRAGE) in the airways and blood. ARO-RAGE was well tolerated in these early cohorts, with no clinically relevant deterioration in chest X-ray findings, pulmonary function tests or systemic inflammatory markers. The delivery approach is of interest because inhaled siRNA may eventually be explored for other inflammatory lung diseases as well. An orthopaedic surgeon reading early research on inflammatory pathways should note that this was a small early-phase study and it was not designed to show improvement in asthma symptoms or fewer exacerbations, so clinical efficacy remains unproven.

    Source: O’Carroll M et al. Inhaled siRNA therapy targeting RAGE for pulmonary inflammation: a first-in-human randomized trial. Nature Medicine. Published online 9 September 2026. DOI: 10.1038/s41591-026-04607-z. PMID 42717034. Checked 15 September 2026. Access: full article on the publisher’s website and PubMed record; no published correction or retraction was identified in the checked records.

    ← More General Medical Discoveries

    Polish version

    Content prepared by: Tomasz Poboży - orthopaedic surgeon.

  • Teclistamab Before Symptomatic Myeloma: Promising Phase 2 Results

    General Medical Discoveries · Human study — phase 2

    Researchers tested teclistamab in people with high-risk smoldering multiple myeloma, a precursor condition that has not yet caused the typical organ damage of active multiple myeloma but carries a substantial risk of progression. In this randomized phase 2 study, teclistamab produced much deeper responses than lenalidomide plus dexamethasone; at two years, progression-free survival was estimated at 92% with teclistamab and 49% with the comparison treatment. The result is important because it explores whether disease can be intercepted before symptomatic myeloma develops. An orthopaedic surgeon interpreting this haematology study should note that it was still small—59 people were treated—and that longer follow-up is needed to establish durability, overall-survival effects and longer-term safety. Teclistamab remains experimental in this setting, and these findings do not mean that every person with smoldering myeloma should receive treatment.

    Source: Nadeem O, Cordas dos Santos DM, Magidson S, et al. Teclistamab versus lenalidomide-dexamethasone in high-risk smoldering multiple myeloma: a randomized phase 2 trial. Nature Medicine. Published online 11 September 2026. DOI: 10.1038/s41591-026-04642-w. ClinicalTrials.gov: NCT05469893. Verified 15 September 2026 against the open-access full article and PubMed record.

    Polish version · More General Medical Discoveries

    Content prepared by: Tomasz Poboży - orthopaedic surgeon.

  • One CRISPR Infusion, Effects Still Seen at One Year: Early Lipid-Lowering Data

    General Medical Discoveries · Human study — phase 1a

    Researchers followed participants in an early phase 1a study who received a one-time infusion of CTX310, an experimental CRISPR-Cas9 therapy designed to edit the ANGPTL3 gene in the liver. At one year, reductions in ANGPTL3 protein and atherogenic lipids were still present, and the published report described no treatment-related dose-limiting toxic effects. This is an interesting signal for people with difficult-to-treat lipid disorders, but the research remains at a very early stage. An orthopaedic surgeon following developments in gene editing should distinguish a biomarker change from a patient benefit: it is not yet known whether permanent gene editing will reduce the risk of heart attack or stroke, or what its safety profile will look like over many years. CTX310 remains an experimental treatment.

    Source: Laffin LJ, Nicholls SJ, Scott RS, et al. Durability of CRISPR-Cas9 Gene Editing Targeting ANGPTL3 with CTX310. New England Journal of Medicine. Published online 28 August 2026. DOI: 10.1056/NEJMc2609825. Verified 15 September 2026 against the NEJM article page and PubMed record. The public abstract and article page were reviewed; the full letter was not analysed.

    Polish version · More General Medical Discoveries

    Content prepared by: Tomasz Poboży - orthopaedic surgeon.

  • Why Does an Orthopaedic Surgeon Ask About Your Work and Daily Activities?

    A job title says surprisingly little about the actual load placed on the musculoskeletal system. For diagnosis and treatment planning, the useful details are the tasks themselves: how long you sit or stand, what you lift, how often you kneel or climb, whether you work overhead, and whether your hands perform repetitive or precise movements.

    A job title is not a workload description

    Two people with the same job title may have very different physical demands. “Office work” can mean eight hours at a computer, frequent movement between rooms, or regular handling of equipment. “Manual work” can involve heavy lifting, repeated gripping, walking on uneven ground, or holding the same posture for long periods.

    That is why a short description of a typical day is more informative during a consultation than the job title alone. What matters is what you do, for how long, how often, with how much force, and after which activity symptoms begin or worsen.

    How can this help with diagnosis?

    The pattern of loading can help identify which movements should be reproduced safely during examination and which structures deserve closer assessment. Shoulder pain that appears only after prolonged overhead work raises different questions from pain when fastening clothing. Hand tingling that increases with forceful gripping needs a different diagnostic approach from similar symptoms that occur mainly at night.

    A relationship between symptoms and work does not prove that work is their sole cause. It is one part of the clinical picture and should be interpreted together with the examination, the course of symptoms and, when needed, appropriately chosen imaging. It also helps to reconstruct the timeline of symptoms.

    Function helps define the goal of treatment

    The same range-of-motion limitation or similar pain intensity can have very different consequences for different people. Reduced knee flexion may be a minor inconvenience for someone working at a desk but a major limitation for a person who repeatedly climbs ladders or kneels. Reduced grip strength may have little effect on one occupation and make another one difficult or unsafe.

    Describing everyday tasks makes the goals more concrete: walking a certain distance, using stairs safely, lifting an object to shelf height, or completing a series of precise hand movements without increasing numbness. Progress can then be judged by recovered function rather than by an imaging result alone.

    Returning to work is not always a single date

    After an injury or operation, readiness to work depends on tissue healing, strength, movement, limb control, tolerance of load and the demands of the specific job. Sometimes an earlier return is possible with temporary modified duties, shorter exposure to a provoking task or gradually increasing workload. In other situations, those adaptations will not be safe.

    There is no universal return-to-work date that applies to everyone with the same diagnosis. Restrictions are more useful when they are specific and reviewed over time—for example, a lifting limit, a maximum period in one position, whether working at height is allowed, or whether driving is safe. Return-to-work guidance emphasises matching a person’s current abilities to the real demands of the job.

    How to describe your work before an appointment

    • List the 3–5 tasks you perform most often, rather than giving only your job title.
    • Estimate how long you sit, stand, walk or stay in a forced position at one time.
    • Note the approximate weight of objects you move and the height to which you need to lift them.
    • Record which movement triggers symptoms and how long it takes for them to appear.
    • Notice whether symptoms settle quickly after a break or remain until the following day.
    • If lighter duties are available, describe what they would actually involve.

    The same approach is useful for household duties, caring responsibilities, commuting and sport. Conservative treatment is most useful when it has a clear goal, an appropriate dose of activity and a planned point for reassessment; see Conservative Treatment Is Not the Same as Waiting.

    When should you seek assessment sooner?

    Regardless of whether symptoms seem work-related, urgent assessment is warranted for a new deformity after injury, rapidly increasing pain or swelling, loss of strength, progressive sensory disturbance, a cold or pale limb, fever with marked redness, or inability to bear weight safely. A description of job demands can help with treatment planning, but it does not replace assessment of warning signs.

    Sources

    • Daley D, Pettet Payne L, Galper J, et al. Clinical Guidance to Optimize Work Participation After Injury or Illness: The Role of Physical Therapists. J Orthop Sports Phys Ther. 2021;51(8):CPG1–CPG102. DOI: 10.2519/jospt.2021.0303.
    • National Institute for Occupational Safety and Health. Promote Worker Recovery. Last reviewed 6 March 2024.
    • World Health Organization. Musculoskeletal health. 14 July 2022.

    Polish version · Patient Blog

    Content prepared by: Tomasz Poboży - orthopaedic surgeon.

  • Hip Arthroscopy After 40 — What Does the New Review Show?

    A new systematic review suggests that carefully selected patients aged 40 or older can have durable improvement after hip arthroscopy for femoroacetabular impingement syndrome (FAIS). This does not mean that age no longer matters, or that surgery is better than non-operative treatment for every patient.

    What was studied?

    The review, published online on 14 September 2026, included nine studies with 451 patients and 467 hips. Follow-up ranged from 60 to 167 months — five years to almost fourteen years. The studies evaluated people aged at least 40 who underwent hip arthroscopy for FAIS.

    What did the review find?

    Across the included studies, pain and functional outcome scores generally improved and the gains were often maintained at longer follow-up. When comparisons with younger groups were available, age-related differences were not consistent. Some patients nevertheless later underwent total hip arthroplasty; reported conversion rates ranged from 2.9% to 13.2%.

    What should a patient discuss with an orthopaedic surgeon?

    Being over 40 should not, by itself, determine whether hip arthroscopy is appropriate. Symptoms, clinical examination, the condition of the cartilage and labrum, radiographic findings and whether the presentation is actually consistent with FAIS all matter.

    The review did not provide a randomised comparison of arthroscopy with a well-delivered rehabilitation programme. It therefore cannot establish that surgery is the best first option. Rather, it shows that improvement after arthroscopy can be durable in selected patients over 40, while the risk of later joint replacement is not zero.

    Important limitations

    The review combined studies of differing quality and was classified as Level IV evidence. Patient groups, procedures and outcome reporting varied, so the numerical ranges are not a prediction for an individual patient. This summary was prepared from the public abstract and bibliographic record; the full text was not used. The PubMed record showed no correction or retraction when checked on 15 September 2026.

    Source

    Lehman AC, Lee S, Berzolla E, Lezak BA, Youm T. Hip Arthroscopy for Femoroacetabular Impingement Syndrome in Patients Aged ≥40 Years Produces Durable Functional Improvement With Moderate Survivorship Compared With Younger Cohorts: A Systematic Review. Arthroscopy. Published online 14 September 2026. PubMed PMID 42734296.

    More Orthopaedic Updates · Polish version

    This material is for general information and does not replace individual assessment for treatment.

    Content prepared by: Tomasz Poboży - orthopaedic surgeon.

  • Symptom Timeline — Why Does the Order Matter?

    In orthopaedic assessment, it matters not only what hurts, but also what happened first, what appeared later and how the symptoms changed over time. Two people may currently report similar pain and swelling, yet a different sequence of events can lead to different questions, a different examination and different choices of imaging.

    A list of symptoms is not enough

    Saying that an area “hurts, swells and sometimes clicks” describes the current situation but not how it developed. It matters whether pain began during one specific movement or gradually increased over several weeks. It also matters whether swelling followed an injury or was already present before a later episode of overload.

    Chronology helps organise the possible causes. It does not replace examination and is not a diagnosis by itself, but it can help distinguish the original symptom from effects caused by avoiding movement, changing the way you walk or overloading another structure later.

    What can the sequence of symptoms suggest?

    A sudden event or gradual onset

    A clear moment of injury draws attention to the mechanism and the force acting on the limb. A gradual onset more often prompts questions about changes in training, work, footwear, activity volume or recovery. This is still only the beginning of the differential diagnosis: sudden pain does not automatically mean a rupture, and slowly increasing symptoms can have more than one cause.

    Pain, swelling and loss of function

    It is useful to know whether pain or restricted movement came first, whether swelling developed immediately or only after further activity, and whether the limb stopped working normally because of pain or despite relatively little pain. That sequence can help decide what should be assessed first: bone, joint stability, tendon, muscle, nerve or blood supply.

    Numbness or weakness

    If altered sensation or loss of strength appeared before the pain, that conveys different information from brief tingling after prolonged pressure or swelling. It is particularly important to note whether these symptoms are progressing, spreading to additional fingers or toes, or are accompanied by a change in limb colour or temperature.

    How does an orthopaedic surgeon use the symptom timeline?

    An ordered history helps establish how urgently the problem should be assessed and which test, if any, answers the clinical question. After a recent injury, X-ray and assessment of stability may take priority. When snapping or clicking depends on movement, dynamic examination may be useful; with persistent nerve symptoms, careful assessment of sensation, strength and the course of the nerve becomes important. None of this means that every symptom automatically requires a particular test.

    A timeline also helps judge response to treatment. If pain improves over several days but weakness becomes more pronounced or new numbness appears, this should not simply be described as “partial improvement”. A new symptom may change the priorities and justify reassessment.

    Chronology is not a diagnosis

    Memory for the sequence of events can be imperfect, especially after severe pain, stress or several injuries occurring together. Symptoms can overlap, and pain medication, immobilisation and reduced activity may alter how they appear. Even a very detailed history therefore needs to be combined with clinical examination, with imaging selected to answer questions that remain unresolved.

    Diagnostic uncertainty does not always mean that an error has been made. In some musculoskeletal problems, observing the direction of change, the response to appropriately selected management or a repeat examination is what allows the diagnosis to be narrowed. What matters then is agreeing clearly on what to observe and when reassessment is needed.

    How to prepare a short symptom timeline

    1. Write down the date or approximate time when the problem began.
    2. Record the first thing you noticed: pain, a pop, swelling, locking, numbness or loss of strength.
    3. Add the next symptoms in order and whether they changed over hours, days or weeks.
    4. Note what changed after rest, medication, a brace, exercises or return to activity.
    5. Include new symptoms even if the original pain has improved.

    You do not need a detailed diary. A few dates and short sentences are usually enough to preserve the most important sequence of events for the consultation.

    When should you not wait and keep observing?

    Urgent assessment is needed for rapidly increasing weakness or numbness, a cold, pale or blue limb, visible deformity, inability to bear weight after an injury, very severe pain that is worsening, fever with a red and swollen joint, or shortness of breath. In those situations, creating a perfect timeline is less important than obtaining prompt medical assessment.

    Related materials

    Sources

    More from the Patient Blog · Polish version

    This educational material does not replace examination or individual medical advice.

    Content prepared by: Tomasz Poboży - orthopaedic surgeon.

  • CAR-T Cells Made Directly in the Body? Early Results in Autoimmune Neurologic Disease

    General Medical Discoveries · Early human study

    Researchers have reported early results from a method designed to generate CD19 CAR-T cells directly inside the patient using a lentiviral vector, rather than first collecting and modifying cells in a laboratory. Among 16 people with treatment-refractory neurologic autoimmune disorders, the study reported complete B-cell depletion, manageable side effects and preliminary clinical improvement across disease groups. The approach is interesting because it could eventually simplify CAR-T treatment, which is best known from oncology. An orthopaedic surgeon following developments in cell therapy should note that, for now, this is a small early report rather than evidence from a large controlled trial, so larger controlled studies are needed before it can be considered established treatment.

    Source: Cheng Y-H, et al. Lentiviral In Vivo CD19 CAR T-Cell Therapy in Neurologic Autoimmune Disorders. New England Journal of Medicine. Published online 2 September 2026;395:926–929. DOI: 10.1056/NEJMc2603114 · PubMed. Access used for this summary: article page and abstract; bibliographic metadata checked in PubMed on 15 September 2026.

    More General Medical Discoveries · Polish version

    Content prepared by: Tomasz Poboży - orthopaedic surgeon.

  • Lab-Grown Heart Cells: A Step Toward Repairing the Heart After a Heart Attack

    General Medical Discoveries · Animal study

    Researchers produced aggregates of heart muscle cells from human induced pluripotent stem cells and transplanted them into the hearts of monkeys after myocardial infarction. Three months later, substantial, organised human graft tissue was present in the animals’ hearts, and recovery of heart function appeared to vary with the properties of the cardiomyocytes used. Graft-related arrhythmias occurred, although they became less frequent over time. An orthopaedic surgeon following regenerative medicine should distinguish preclinical progress from clinical evidence: this is an important preclinical step toward repairing damaged heart muscle, but it does not yet show that this specific approach is safe or effective in people.

    Source: Gruh I, Martens A, et al. Human iPSC-cardiomyocyte-aggregate cell therapy in non-human primates and correlation of heart recovery with contractile and electrophysiological cardiomyocyte properties. Nature Communications. Published 26 August 2026;17:9066. Source publication · PubMed. Prepared from the public abstract and bibliographic record; full text was not used. Source details checked 15 September 2026.

    More General Medical Discoveries · Polish version

    Content prepared by: Tomasz Poboży - orthopaedic surgeon.

  • Distal Biceps Tendon Rupture at the Elbow — When Is Surgery Needed?

    Polish version: Zerwanie ścięgna bicepsa przy łokciu — kiedy potrzebna jest operacja?

    Sudden pain at the front of the elbow after a forceful pull or while lifting, a noticeable “pop,” rapidly developing bruising and a clear loss of strength when turning the palm upward may indicate a distal biceps tendon rupture. A complete rupture in an active person is often treated surgically, but not every injury requires an operation. The extent of the tear, age, activity level, functional demands and coexisting medical conditions all matter.

    What actually tears?

    The biceps brachii ends near the elbow in a strong tendon that attaches to the radius. This tendon contributes not only to elbow flexion but especially to forearm supination—the movement that turns the palm upward.

    Rupture most often occurs when a large sudden load is applied to an extended or extending elbow, for example while trying to catch or hold a falling weight. The injury may be complete or partial.

    What symptoms are typical?

    • sudden pain at the front of the elbow, often during heavy loading,
    • a popping sensation or sound,
    • swelling and bruising in the elbow crease or forearm,
    • a change in the contour of the biceps, with the muscle belly sometimes retracting slightly upward,
    • reduced elbow-flexion strength,
    • particularly noticeable weakness when turning the forearm palm-up, such as when using a screwdriver or loosening a tightly fastened object.

    Pain may improve considerably after several days, but less pain does not mean that the tendon has reattached. With a complete rupture, a persistent loss of strength—especially in supination—may remain.

    Does every rupture look dramatic?

    No. A partial tear may present mainly as pain at the front of the elbow during exertion, without extensive bruising or an obvious change in muscle contour. Persistent pain in this area should therefore not automatically be labelled as tennis elbow or golfer’s elbow.

    Tennis elbow usually causes pain on the lateral side of the elbow, while golfer’s elbow is typically medial. Pain directly at the back of the elbow has a different differential diagnosis again. The location and mechanism of symptoms are therefore important.

    How is a distal biceps tendon rupture diagnosed?

    The starting point is the history and clinical examination. The clinician assesses the contour of the muscle, bruising, elbow-flexion and supination strength, and uses tests aimed at tendon continuity, including the Hook test.

    Ultrasound

    Ultrasound can rapidly assess tendon continuity, the site of injury, retraction of the torn end and some partial tears. The distal biceps tendon is technically demanding to examine because of its deep position and twisted course, so operator experience matters.

    MRI

    MRI is particularly useful when the clinical picture or ultrasound findings are inconclusive, when a partial tear is suspected, or when the degree of retraction and other structures around the elbow need more detailed assessment. A patient with a clinically typical complete rupture does not necessarily need MRI as the first diagnostic test.

    When can non-operative treatment be reasonable?

    Non-operative treatment can be appropriate for some partial tears, for people with relatively low strength demands, or when the risks of surgery are greater than the expected benefit. Initial management includes reducing load and controlling pain, followed by gradual restoration of movement and strengthening.

    The possibility of persistent weakness should be understood. Meta-analyses of complete ruptures have found that operative treatment provides greater average flexion strength and, in particular, greater supination strength than non-operative care. Most of this evidence is observational, however, and the non-operative groups were much smaller, so the decision should not be reduced to a single percentage from a pooled analysis.

    When does an orthopaedic surgeon consider surgery?

    Tendon repair is most often considered for a complete rupture in an active patient who wants to recover as much elbow-flexion and forearm-supination strength as possible. This is especially relevant for people who perform physical work, strength training or sports that place substantial demands on the upper limb.

    Assessment should not be postponed for many weeks simply because the pain has improved. Over time, the torn tendon may retract and scar, making primary repair more difficult. Chronic cases may occasionally require a more complex reconstruction using a graft.

    Surgery also carries risks, including temporary sensory disturbance from irritation of cutaneous nerves and, less commonly, motor nerve injury, heterotopic ossification or loss of motion. The expected gain in strength therefore needs to be weighed against the risks of the procedure.

    What does return to activity look like?

    After tendon repair, the reattachment is initially protected while movement is restored gradually. Strengthening is introduced later according to the surgeon’s protocol and progress of healing. Return to heavy loading is usually measured in months rather than weeks.

    In a systematic review of 42 studies involving more than 1,000 patients after surgical repair, about 91% returned to sport, with a mean time to return of approximately 6 months. These are pooled figures from very different patient groups and should not be treated as a fixed deadline for an individual patient.

    When is urgent assessment needed?

    After a recent injury suspicious for tendon rupture, orthopaedic assessment should be arranged without unnecessary delay, particularly after a characteristic pop, extensive bruising or a clear loss of strength. More urgent medical attention is warranted if there is increasing numbness or weakness of the hand, a cold or pale hand, abnormal pulses, very rapid severe swelling, an open wound, or an injury in which a fracture is also suspected.

    Key takeaways

    A distal biceps tendon rupture is different from the common overuse disorders that cause elbow pain. In an active patient with a complete rupture, surgery often offers a better chance of restoring strength, especially forearm supination. Non-operative treatment remains a reasonable option in selected cases. The key is to identify the type of injury promptly and match treatment to the patient’s actual functional needs.

    References

    1. Looney AM, Day J, Bodendorfer BM, et al. Operative vs. nonoperative treatment of distal biceps ruptures: a systematic review and meta-analysis. J Shoulder Elbow Surg. 2022;31(4):e169–e189. DOI: 10.1016/j.jse.2021.12.001.
    2. Deschrijver M, Hautekiet A, Steyaert A, De Muynck M, Luypaert E. Distal biceps tendon ruptures: more efficient diagnostics for a better outcome. Acta Orthop Belg. 2022;88(1):160–167. DOI: 10.52628/88.1.20.
    3. Cuzzolin M, Secco D, Guerra E, et al. Operative Versus Nonoperative Management for Distal Biceps Brachii Tendon Lesions: A Systematic Review and Meta-analysis. Orthop J Sports Med. 2021;9(10):23259671211037311. DOI: 10.1177/23259671211037311.
    4. Boufadel P, Daher M, Lopez R, et al. Return to Sport After Distal Biceps Tendon Repair: A Systematic Review. Am J Sports Med. 2025;53(7):1769–1778. DOI: 10.1177/03635465241295618.

    ← Injuries and fractures: patient guide

    Content prepared by: Tomasz Poboży - orthopaedic surgeon.

  • Pain at the Base of the Thumb — Is It Thumb CMC Osteoarthritis?

    Pain at the base of the thumb that becomes worse when opening a jar, turning a key, pinching, squeezing or using a strong grip is commonly caused by osteoarthritis of the thumb carpometacarpal joint. This is the first CMC joint, between the first metacarpal and the trapezium. Pain location alone is not enough to make the diagnosis, however: de Quervain tenosynovitis, scaphoid injury, disease in adjacent joints and nerve irritation can produce similar symptoms. Most patients start with non-operative treatment.

    Polish version: Ból u podstawy kciuka — czy to zwyrodnienie stawu siodełkowego?

    What is the thumb CMC joint?

    The joint at the base of the thumb has a saddle-shaped geometry that allows a large range of motion. It lets the thumb move away from the palm, oppose the fingers and perform precise pinch. That mobility comes at the cost of substantial loading across a relatively small articular surface.

    Over time, cartilage may deteriorate and the joint can become less stable. Imaging may show joint-space narrowing, osteophytes, subchondral sclerosis and sometimes subluxation of the base of the first metacarpal. An important point is that radiographic severity does not always match pain or functional limitation. Treatment decisions should be based on the patient and the symptoms, not on the X-ray alone.

    What symptoms are typical?

    • pain around the base of the thumb, usually on the palmar or radial side,
    • pain when opening jars, turning keys, fastening buttons, opening packaging or using tools that require pinch,
    • reduced grip and pinch strength,
    • tenderness directly over the joint,
    • sometimes crepitus or clicking with movement,
    • in more advanced cases, visible widening or deformity at the base of the thumb.

    Symptoms often develop gradually. Activities requiring forceful grip or loaded pinch typically provoke more pain than moving the hand freely without resistance.

    How is this different from de Quervain tenosynovitis?

    Both problems may be described simply as “pain on the thumb side,” but the area of greatest tenderness is usually different. With first CMC osteoarthritis, pain is centred at the base of the thumb around the joint. With de Quervain tenosynovitis, pain is typically higher at the radial styloid on the wrist and relates to the tendons of the first extensor compartment.

    After a fall onto the hand, the diagnostic situation is different again. New pain on the radial side can result from a scaphoid fracture and should not automatically be attributed to osteoarthritis.

    How is thumb CMC osteoarthritis diagnosed?

    History and examination

    The pattern of symptoms and the clinical examination are central. Assessment includes the exact pain location, range of motion, thumb stability, grip and pinch strength, and neighbouring joints and tendons. The grind test — axial loading with rotation of the first metacarpal — can support the diagnosis, but it is not a perfect test. A negative result does not exclude thumb-base osteoarthritis.

    X-ray

    Radiographs are useful when bony changes need confirmation, their extent matters, adjacent-joint disease must be considered or surgery is being planned. An X-ray is not necessarily required for every first mild episode with a typical presentation. Even marked radiographic osteoarthritis can coexist with limited symptoms, and the reverse can also occur.

    Ultrasound

    Ultrasound can demonstrate osteophytes, joint fluid and synovial changes while also assessing the soft tissues around the painful region. It can be particularly useful when differentiating joint disease from de Quervain tenosynovitis or another tendon problem. It can also guide a planned injection accurately. Ultrasound is not mandatory in every patient with a typical clinical presentation.

    MRI

    MRI is rarely the first-line test for typical first CMC osteoarthritis. It is more useful when symptoms are atypical, previous tests do not explain the pain, or another bone, ligament or cartilage abnormality is suspected.

    How is thumb-base osteoarthritis treated without surgery?

    Current British Society for Surgery of the Hand guidance supports a stepwise approach. Initial management is multimodal and non-operative, with additional options introduced if symptoms continue to cause meaningful functional limitation.

    Load modification and exercise

    The aim is not to stop using the thumb completely, but to reduce the most provocative loads and improve how everyday tasks are performed. Wider handles, jar-opening aids, using two hands instead of one and limiting prolonged forceful pinch can be helpful.

    Exercises directed at thumb stability, range of motion and hand strength may reduce pain and improve function. Their intensity should be adjusted so that they do not provoke a prolonged flare of symptoms.

    Brace

    A brace that stabilises the base of the thumb can reduce pain during gripping activities. It does not necessarily need to be worn continuously. Some people benefit most during demanding tasks, while others use it for selected periods at rest as well. The type and schedule should match the symptoms and the functional demands on the hand.

    Pain and anti-inflammatory medication

    Medication can reduce pain temporarily but does not restore cartilage. Topical anti-inflammatory preparations are often considered for local symptoms. Oral medication needs individual assessment, particularly in people with gastrointestinal, kidney or cardiovascular disease or those taking anticoagulants.

    Joint injection

    If non-invasive treatment has not provided enough relief, an intra-articular corticosteroid injection may be considered. BSSH guidance places injection at this stage in the pathway. The goal should be realistic: an injection may reduce pain for a period, but it does not regenerate cartilage or remove the mechanical cause of osteoarthritis.

    The evidence for injection efficacy is less consistent than its widespread use might suggest. Systematic reviews have found heterogeneous results, so the decision should take symptom severity, previous treatment and alternatives into account.

    When does an orthopaedic surgeon consider surgery?

    Surgery is considered when pain and functional limitation remain substantial despite appropriate non-operative treatment and continue to interfere with daily life, work or activity. A “bad X-ray” alone is not an indication for surgery.

    One of the most commonly used operations is trapeziectomy, which removes the trapezium. Numerous modifications add ligament reconstruction, suspension of the first metacarpal or tissue interposition. Current BSSH guidance notes that available evidence has not demonstrated an advantage of adding interposition or ligament reconstruction over trapeziectomy alone.

    This does not mean every patient should have the same operation. Procedure selection depends on age, deformity, neighbouring joints, functional demands and surgeon experience. More complex reconstruction should have a specific rationale rather than being performed automatically.

    When should thumb pain be assessed more urgently?

    • severe pain after a fall or other injury, especially with deformity, bruising or inability to use the thumb,
    • rapidly increasing swelling, redness and marked warmth, particularly with fever,
    • new or pronounced numbness or weakness in the hand,
    • a thumb that becomes blue, pale or cold, or other signs of impaired circulation,
    • rapidly progressive unexplained symptoms or involvement of several joints suggesting inflammatory disease.

    Common questions

    Can osteoarthritis be reversed?

    Structural changes in cartilage and bone cannot simply be reversed by exercise, a brace or an injection. Pain and function can nevertheless improve substantially, which is why imaging severity does not determine how well the hand can function.

    Do severe X-ray changes mean I need surgery?

    No. The relationship between radiographic severity and symptoms is limited. Surgical decisions are based mainly on pain, loss of function and failure of appropriate previous treatment, with imaging as one part of the decision.

    Is ultrasound always needed before an injection?

    Not in every straightforward case. Ultrasound guidance allows the operator to visualise the needle and adjacent structures and confirm that medication reaches the intended location. It may be particularly useful with atypical anatomy, previous unsuccessful injections or diagnostic uncertainty.

    References

    1. Gangopadhyay S, Jansen V, Khor WS, Gardiner MD, Burchette D, McKenna H. Guideline on managing thumb base osteoarthritis: The British Society for Surgery of the Hand Evidence for Surgical Treatment (BEST) findings and recommendations. J Hand Surg Eur Vol. 2025;50(5):576–586. DOI: 10.1177/17531934241313206.
    2. Hamasaki T, Laprise S, Harris PG, et al. Efficacy of Nonsurgical Interventions for Trapeziometacarpal (Thumb Base) Osteoarthritis: A Systematic Review. Arthritis Care Res (Hoboken). 2020;72(12):1719–1735. DOI: 10.1002/acr.24084.
    3. Merritt MM, Roddey TS, Costello C, Olson S. Diagnostic value of clinical grind test for carpometacarpal osteoarthritis of the thumb. J Hand Ther. 2010;23(3):261–267. PMID: 20452743.

    This article is educational and does not replace a medical examination or individual treatment assessment.

    ← Osteoarthritis

    Content prepared by: Tomasz Poboży - orthopaedic surgeon.