Dr. Erickson's Hand Care

What is basilar thumb arthritis?

Basilar thumb (CMC) arthritis is a common cause of pain and dysfunction in many middle-age and elderly people. At the base of the thumb is a specialized joint called the carpometacarpal (CMC) joint. This joint normally allows for a wide-range of thumb motion. The ability to touch the thumb to the small finger, known as "opposition," is a function which distinguishes our hands from the hands of many animal species. Because of this mobility, the base of the thumb is exposed to a large amount of “wear and tear” stress. Over time, this joint can "wear out" or become arthritic. The normal smooth cartilage which allows pain-free motion in the joint wears away, leading to “bone-on-bone” contact. This can result in pain, weakness, and decreased range of motion. Trauma and family history of osteoarthritis may also contribute.

Basilar thumb arthritis is a common form of degenerative joint disease, also known as osteoarthritis. Osteoarthritis is not just a disease of the elderly; it can be diagnosed in people in their 40's.

How do I know if I have thumb arthritis?

Most people notice a gradual onset of symptoms over time. Pain is usually located at the base of the thumb, but may radiate into the wrist, forearm, or hand. At first the pain may feel like a dull "ache" but it may become worse. Occassionally, sudden "sharp" pains can occur in the thumb. Activities such as opening a jar, turning door knobs, knitting, or using a key can be difficult. Some people feel that they do not have the strength they used to have in the hand. Some people notice swelling or a bump at the base of their thumb, which may be painful to the touch.

How is this diagnosed?

The diagnosis is made after reviewing the patient's history, physical examination, and x-rays. MRI and CT scans are not required. Interestingly, the severity of arthritis seen on the x-rays does not always correlate with symptoms. In other words, some patients have severe x-ray findings, but yet only have mild symptoms.

The x-ray below demonstrates bone spurs (also called "osteophytes") and joint space narrowing in an arthritic thumb CMC joint (red arrows). These are common x-ray findings in patients with osteoarthritis. 

What are the treatment options?

Non-operative treatment is helpful for most patients. Over-the-counter anti-inflammatory medications such as Naproxen (Aleve), Tylenol, and Ibuprofen (Motrin) can help reduce the pain. A thumb brace is often helpful during activities. Occupational therapists can also make a custom brace or thermoplast splint. One or two steroid injections (cortisone shot) into the CMC joint can also alleviate pain. Chondroitin Sulfate may reduce pain in patients with hand osteoarthritis. Avoiding forceful or repetitive pinching can rest the thumb and reduce symptoms in some patients. Some people find relief from topical heating pads, topical anti-inflammatory gels, or paraffin wax treatments.

Non-operative treatments:

• Thumb brace
• Anti-inflammatory medications
• Chondroitin sulfate
• Topical medications
• Cortisone injection

When non-operative treatment has failed to reduce symptoms to a manageable level, surgery may be offered. The decision to undergo surgery is based primarily on your symptoms, not on the severity of the arthritis on x-rays. Many people can avoid surgery with activity modification, oral or topical medications, and use of a thumb brace. 

What surgery is recommended?

Basilar thumb arthroplasty is a commonly performed hand procedure in the United States. The surgery is performed on an outpatient basis. General anesthesia can be avoided by using a temporary nerve block (regional anesthesia). During surgery, the arthritic bone at the base of the thumb (trapezium bone) is removed. This is termed "trapeziectomy" (in medical terms, "ectomy" typically means "removal of" such as an "appendectomy"). This procedure eliminates the bone-on-bone grinding responsible for most of the pain. In addition, a tendon from the patient's forearm can be used to fill the space at the base of the thumb and/or reconstruct the ligaments at the thumb base. These options will be discussed with you in the office.

What are the results from surgery?

Basilar thumb arthroplasty has been performed with excellent results for several decades in the United States. This surgery has a proven track record in published studies with good long-term outcomes for the majority of patients. Most patients report less pain, improved grip strength, and better function after surgery.

What are other surgical options?

Some surgeons insert artificial or manufactured implants such as metal, silicone, or fiber in the base of the thumb. Doing so may have a higher complication rate, and long-term outcomes are still unknown. Therefore, I do not use artificial implants during this procedure.

What can I expect after surgery?

Your wrist and thumb will be protected in a plaster splint after surgery. This is removed in clinic along with the stitches after 2 weeks. At this point, patients are provided a custom-made splint or cast which they wear for an additional 4-6 weeks. I recommend avoiding heavy lifting, pinching, or gripping for approximately 8 weeks after surgery. Hand therapy is helpful to improve range of motion and strength during the recovery.

This procedure is not a “quick fix” but more like an "investment." It takes about 3 months for most people to feel that their thumb is better than before surgery. Surgery recovery can be painful at first. Patients should understand that the recovery is slow and maximum improvement can take 6 months or so. The good news is that the majority of people are satisfied with the decrease in pain and improved function with surgery.

What are the complications from surgery?

Possible complications include bleeding, infection, stiffness, pain, and damage to the surrounding structures such as nerves. Irritation of a nerve can cause a painful condition called a neuroma. Other complications are also possible but are uncommon. Due to these risks, the decision to offer surgery to a patient is carefully evaluated.

Updated 6/21/2012

For additional information

Please call our office at 919-872-3171 to  make a clinic appointment. Also, feel free to visit these reliable websites for accurate information:

American Society for Surgery of the Hand: www.assh.org

American Academy of Orthopaedic Surgeons: www.orthoinfo.org