Basal Thumb Joint Arthritis

The base of thumb is the commonest site of for osteoarthritis in the hand and wrist, and is probably the commonest site for arthritis anywhere in the human body. 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, inflammatory conditions 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, a hand  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:

•Ligament reconstruction

A segment of wrist tendon is used as a graft to re-create a ligament that can stabilise the thumb base. This is usaully preserved for pain and instability after trauma when there is little in the way of arthritis

•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 can reduce 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

This is the commonest proecedure I undertake for basal thumb arthritis

Occasionally I undertake an additional procedure in which I undertake an LRTI (Ligament reconstruction / tendon interposition). 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 is thought to help to stabilise the joint, and provides a soft “cushion” for the thumb base to rest on.

•Basal thumb joint replacement

Replacing the joint, in my opinion, can give a better result than the above options. It can give a more natural and stable feel to movement. However the risks can be higher with this procedure than the others, with the longeivty of the implant in question being the main concern.

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%.

Joint replacement tends to give excellent pain relief and motion. I use the ARPE prosethesis (Zimmer Biomet), which has been in use for over 10 years. The most recent data seem to suggest the survival rate  is up to 90% - 95% at ten years.

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.