Thumb arthritis is the most common arthritis of the hand and wrist, affecting the joint at the base of the thumb — the carpometacarpal (CMC) joint. Many people ask about a cortisone injection in the thumb joint. So what is thumb arthritis, when should you have a CMC joint injection, and does a steroid injection for thumb arthritis work?
What are the symptoms of thumb arthritis?
Thumb arthritis usually causes pain, swelling, and stiffness at the base of the thumb. The pain is worse when gripping, pinching, or grasping, and people often find it difficult to open jars or turn doorknobs and keys. Other findings include restricted thumb movement, reduced strength, and a bony appearance at the base of the thumb. Sometimes, using a computer mouse reproduces the thumb pain.
Factors that increase the risk of thumb arthritis include being female, being over 50, previous injuries such as fractures or sprains, jobs that place high stress on the thumb, and obesity.
How do we diagnose thumb arthritis?
We diagnose thumb arthritis using a combination of clinical tests and X-rays. Clinical findings typically include tenderness at the base of the thumb, restricted thumb movement, and reduced thumb strength. An X-ray shows a narrowed joint space, spur formation, and a deformed joint.
It’s essential to assess every patient with thumb pain to exclude other causes, such as De Quervain’s tenosynovitis, trigger thumb, STT joint arthritis, or inflammatory arthritis.
What treatments are available for thumb arthritis?
Most people respond well to simple treatments supervised by a hand therapist. These include stretching and strengthening exercises for the thumb, wrist, and forearm, and manual therapy to improve thumb movement. A thumb spica splint reduces pain by limiting thumb movement while still allowing you to use the thumb. Pain-relieving creams or gels, such as ibuprofen gel or Flexiseq, help alongside exercise therapy.
Should you have a cortisone injection in the thumb joint?
In cases that don’t respond to simple treatment, a steroid injection for basal thumb arthritis is the next step. Consider a cortisone injection for the thumb when the pain is severe, or when thumb arthritis stops you doing simple activities such as dressing, cooking, or cleaning.
Recent evidence suggests ultrasound-guided injections for thumb arthritis are more accurate and effective than blind injections. For CMC joint injections specifically, ultrasound-guided injections are 94% accurate, compared with 80% for blind injections — and cortisone injections for the thumb provide good pain relief for up to six months.
What about gel (hyaluronic acid) injections for thumb arthritis?
Some doctors believe gel, or hyaluronic acid, injections help thumb arthritis, though we need more evidence to support this. A recent paper suggests no injection is clearly better than another for the first CMC joint.
What about a PRP injection for thumb arthritis?
PRP has a good effect on knee arthritis, but there’s no evidence it helps thumb arthritis. We’d still consider a PRP injection for thumb arthritis in people who have failed other treatments, including cortisone. A recent study comparing PRP, cortisone, and hyaluronic acid for thumb arthritis found none was superior.
If a CMC joint injection doesn’t relieve the pain, we consider a surgical procedure such as fusion, bone excision, or thumb joint replacement.
How much does a cortisone injection in the thumb joint cost?
Dr Masci performs the thumb injection as a one-stop appointment — consultation, diagnostic ultrasound, and the injection in a single visit. At the Chelsea clinic (the most cost-effective location), a consultation with an ultrasound-guided cortisone injection is £400; other clinic locations cost more. See the full one-stop injection fees here and our clinic locations.
Frequently asked questions about a cortisone injection in the thumb joint
Is a cortisone injection in the thumb painful?
Thumb injections are notorious for being painful, because the joint space is small and tight. In our experience, doing the injection under ultrasound makes it more accurate and a little more comfortable. Local anaesthetic is used, and any soreness usually settles within a few days.
How long does a thumb cortisone injection last?
Cortisone injections for thumb arthritis give good pain relief for up to six months, and some people get even longer. Combining the injection with hand therapy and a splint helps the benefit last.
What is the success rate of a thumb cortisone injection?
In our experience, around 80% of people feel relief after a cortisone injection into the thumb — better still when it’s done accurately under ultrasound.
How many cortisone injections can you have in the thumb?
We limit the number. Over time the effect tends to lessen, and there’s some evidence that repeated injections over a few years can hasten the arthritis. If injections stop working, we look at other options, including surgery.
Is it normal to have a flare after a thumb injection?
Yes. A post-injection flare is common for up to five days after a cortisone injection, and can last longer after a hyaluronic acid injection. Ice and simple painkillers help. Seek advice if the pain is severe or you’re worried about infection.
Can a thumb cortisone injection cause skin discolouration?
Occasionally. Cortisone can cause skin thinning and depigmentation around the injection site. It looks cosmetically unappealing but is harmless, and usually normalises over 6–12 months. Ultrasound guidance reduces the risk by placing the cortisone accurately in the joint.
Does a thumb cortisone injection cause weight gain?
No. One or two cortisone injections are very unlikely to cause weight gain.
Final word from Sport Doctor London about a cortisone injection in the thumb joint
Thumb arthritis is a common condition, causing pain during simple activities and restricted thumb movement. Simple treatments such as hand therapy and splints help many people, and an ultrasound-guided steroid injection for thumb arthritis is an effective next step. Choose a doctor experienced in injecting under ultrasound.
To discuss a cortisone injection in the thumb joint with Dr Masci in London, contact the team here or call +44 (0) 203 488 0350.
I am suffering from a flare up of the base of both thumbs and it has been with me for some time. I do not think it is going to go away anytime soon, so I am maybe looking for relief in the way of having cortisone injections to relieve the pain, can you help me please?
yes I think a cortisone injection is a good option. About 80% of patients feel relief after a cortisone injection. I’d suggest, however, you do these injections under ultrasound to improve accuracy.
Lorenzo
What does having a cortisone injection in thumb joint under ultrasound mean please
It means using ultrasound to guided the needle into the right spot of arthritis at the base of the thumb.
I have received two rounds of these shots. The last round lasted almost 8 months and I just recently received the second round. It is a game changer. I highly recommend it if you have thumb arthritis.
I had a cortisone injection in each of my thumbs, plus two in my right wrist. Not done with ultrasound. They were all very painful, but the ones in my thumbs were horrendous. As in scream/yelling at the top of my voice awful.It would take a lot of convincing to do that again. That was yesterday, so don’t know yet how helpful they’ll be.
Hi Sandra, Unfortunately, thumb injections are notorious for being painful. Generally, having injections done under US make them a little less painful IMO.
I had a cortisone injection in my right thumb without the guided ultrasound by a regular physician and to be honest my thumb is swollen and hurts worse than before. I can’t wait for it to go away how can I alleviate the pain in the mean time
Hi Tomas, It depends on when you had the injection. If you had it more than 6 weeks ago, you could have another injection. If less than 6 weeks, then I’d treat the thumb with anti-inflammatory treatments such as ibuprofen tablets/gel etc.
Can cortisone injections in the thumb joint due to arthritis cause weight gain?
No. The effect of one or two cortisone injections is unlikely to cause weight gain.
I understand that injections can only be done a limited number of times. Is this true?
Generally yes. We think that over time the effect lessens. Also, there is some evidence that repeated injections over a few years can hasten arthritis changes. see this blog – which discusses these issues in a little more detail.
https://sportdoctorlondon.com/how-long-does-it-take-for-a-cortisone-shot-to-work/
Lorenzo
Thanks for the information. I have had my first injection and trusted the Dr, hurt like you wouldn’t believe, however this was to be expected and explained. My had yes the next day a bit tender well there was a needle it the joint. Some panadol helped. Looking forward to some relief from arthritis pain.
Hi
I have just had a injection into the base of my thumb under ultra sound,, it was not cortisone but cannot remember the name..
After numbing the area I had syringe put to the needle which broke, they then put another syringe to the needle but found the thread and damaged,,
So the needle was withdraw and a new needle/syringe inserted ..
This was Wednesday and my hand is still very swollen and painful and tender..
Would this be normal I cannot use my hand
HI Steve, It is common to have a flare after an injection for up to 5 days with cortisone and even longer for other injections such as hyaluronic acid.
Lorenzo
I received cortisol injections over a year ago and I still have a horrible sensation in my thumb .like pins and needles all day long .even my clothes rubbing off my thumb is so irritating, I’m wondering is there another injection I can get to take away this sensation as it is driving me mad ..
Hi Frances – unusual reaction. I think you’ve had a nerve reaction to the injection.
I would avoid further injections.
You could try topical creams such as capsaicin – which help to reduce sensitivity.
I had a cortisone shot, it helped 50%. but now after months is remains black and blue all the time. Is there anything i can do so my hand doesn’t look sooo bad?
Hi Carol, I suspect you’ve developed skin discolouration from the cortisone injeciton: see this blog regarding side effects.
https://sportdoctorlondon.com/do-cortisone-shots-cause-weight-gain/
Although it looks cosmetically unappealing, I can reassure you that the effects will normalise slowly over next 6-12 months (perhaps longer if you have pigmentation).
I am 57 years old. I have been negative in both arthritis and osteoporosis . The main swelling is in my thumbs but within the last couple of weeks some of my fingers and toes are crossing over, which the consultant didn’t see.
I am booked in for bilateral injections into my thumbs , with no discussion with my consultant . I have cancel the appointment as I have had no discussion about this .
Please can you advise me on what I should do.
Kind regards
Michele Coe
Hi Michelle, I think you should discuss your concerns with your consultant. Nevertheless, a cortisone injeciton into the thumb joints for pain is a low risk.
LM
Both my Thumbs are shot, my right thumb had been slowly going bad but I don’t know if this aggravated but right after my 2nd Covid shot my left thumb went bad almost immediately and my right thumb got worse. Maybe a coincidence but questionable. But now I have 2 bad thumbs and I’m still painting houses. Most things I have to do involve holding a handle so it’s not as bad. I wish Everytime I have to sign my name I get angry that’s it’s painful to just hold a pen . I try my best to not use my thumbs and use my whole hand for things or even 2 hands but you kind of need your thumbs. I wish I could take my thumb joint out, send it down and put it back in, I’m kind of surprised there isn’t an operation for that I might as well add in at the same time that both my knees are troublesome as well. Very frustrating.
You could try a hyaluronic acid injection. Or surgery is an option.
LM
I have this arthritis in my left thumb for two years almost. I just went to see this female doctor and she said its inflammation, so I need a steroid injection in my thumb. I looked up for this injection, it’s no good. I am 67yo, I have never had a covid injection. I know it’s killing a lot of people around the world. I am still working as a bus driver. I am not going to this doctor again and I will not going to have an injection in my thumb. I massage my thumb with black seed oil, bcos it’s good to drink organic black seed oil for inflammation. Now I massage my thumb with it. I know every time I ate sweet stuff like yesterday I almost finished a packet of a cream biscuits now it’s very sore. Please stay away from sweet stuff. I am massaging my thumb with the black see oil and I take a tablespoon of it as well. It helps with our arthritis.