Basilar Joint Arthritis of the Thumb

Arthritis is a disease that causes inflammation and stiffness in the joints. It can be the result of many factors, including heredity, biomechanical stress, and natural aging. It often effects the joint at the base of the thumb known as the basilar carpometacarpal joint. Arthritis in this location is usually the result of degenerative arthritis, also known as osteoarthritis, as opposed to the more widespread disease known as rheumatoid arthritis. Basilar joint arthritis is most common in women over 40, but anyone can get it. Often, both thumbs are involved. Repeatedly gripping, twisting, or turning objects with the thumb and fingers may make the arthritis worse, although it usually does not actually “cause” the arthritis. The most common symptom is pain in the lower part of the thumb.

There is no cure for arthritis, which is a progressive process. If arthritis is diagnosed early, it often responds to treatment without surgery. Nonsurgical treatments involve splinting, muscle strengthening exercises, occupational therapy, anti-inflammatory medications, lifestyle and employment changes, and cortisone injections. If these nonsurgical treatments do not relieve the pain, and if your lifestyle and employment have become significantly effected due to the pain and disability of your thumb, then surgery is recommended. In most patients like this, we recommend a surgical technique, which removes the arthritic bone, and where part of a tendon in the forearm is used to stabilize the thumb, and the excess tendon is rolled up and inserted as a type of “bumper.”

The surgery is performed under general anesthesia, in an operating room, as an outpatient. You will wear a non-removable splint or cast for four weeks, followed by a removable splint as needed until you feel strong enough to go without it. Occupational therapy is absolutely mandatory following this surgery to ensure a good result . We have a certified hand therapist on site in our office. You will probably not feel confident using the hand following surgery for at least three months; gradual use of the hand and increase in strength occur by six months; and the final result takes at least one year. Although the surgery is technically sophisticated, and although multiple doctor visits and occupational therapy sessions are necessary, most patients are relieved of their pain and are satisfied with the surgery.