Mr Prash Jesudason MB, ChB, MSc., FRCSEd (Trauma & Orth), Dip. Hand Surg (Br)

Consultant Hand & Orthopaedic Surgeon

Basal Thumb Joint Arthritis

 

The base of thumb is the commonest site of for osteoarthritis in the hand and wrist. It is commoner in women than men, and usually presents in patients after the age of 50.

 

What are the symptoms?

It usually presents with pain at the base of the thumb, worse on activity. Patients also complain of deformity, stiffness and loss of function.

 

What is the cause?

As with all osteoarthritis, it is generally a genetic predisposition. However arthritis can be secondary to injuries, fractures or a long history of manual work.

 

How is it treated?

Mild symptoms and early arthritis is generally treated without surgery. I tend to advise the use of painkillers, an occupational therapy functional assessment to help with activity modification and a custom made splint. I also offer a steroid injection into the joint, which I tend to perform under X-ray control.

 

For severe symptoms that don’t respond to the above, surgery can be offered, and this is tailored to the age of the patient, functional demands and severity and pattern of the arthritis.

 

Options include:

  • Joint arthroscopy and debridement (keyhole surgery)
    • For patients with early arthritis, but with severe pain
    • Usually improves, but doesn’t “cure” the symptoms
    • Often buys time, but doesn’t generally offer a permanent solution

•Ligament reconstruction

  • A segment of wrist tendon is used as a “graft” to re-create a ligament that can stabilise the thumb base

•Joint fusion

  • Generally reserved for young patients with high demand manual jobs
  • Generally provides excellent pain relief, but at the cost of increased stiffness at the thumb base. This is thought to improve grip and pinch strength, but reduces dexterity and maneuverability of the hand

•Trapeziectomy

  • Remove of the trapezium, which is a wrist bone that sits at the base of the thumb
  • This removes the painful articulation and tends to give excellent pain relief

•Trapeziectomy & LRTI (Ligament reconstruction / tendon interposition)

  • The above procedure is done with an additional step. I take a segment of wrist or thumb tendon as a “graft” and use this to create a ligament at the thumb base, some of the tendon material is then interposed in the space were the trapezium bone used to be. This helps to stabilise the joint, and provides a soft “cushion” for the thumb base to rest on.

•Basal thumb joint replacement

  • In certain situations I may recommend a joint replacement. However the risks are higher with this procedure than the others

     

What are the results?

If the correct operation is chosen for the correct patient and stage of arthritis the results of all these operations are generally good.

Both fusion and trapeziectomy can give excellent pain relief, with success rates of around 90%.

Arthroscopy of the thumb base is less predictable, but with good patient selection most do improve.

Joint replacement tends to give excellent pain relief and motion, but the complication rate is higher than with trapeziectomy. The main risks are dislocation of the joint, and loosening of the implant over time

 

What is the likely recovery period?

With any of the above procedures the recovery period is 6 to 12 weeks, with most patients being unable to drive for around 6 weeks. The exception to this is arthroscopy, which generally has a quicker return to function.

 

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