Thumb arthritis is the most common form of osteoarthritis affecting the hand
Also called basal joint arthritis, thumb arthritis occurs when the cushioning cartilage wears away from the adjoining ends of the bones that form your thumb joint (carpometacarpal joint). Thumb arthritis can cause severe hand pain, swelling, and decreased strength and range of motion, making it difficult to do simple household tasks, such as turning doorknobs and opening jars. Treatment for thumb arthritis may include self-care measures, splints, medication or corticosteroid injections. If you have severe thumb arthritis, you may need surgery.
Surgical Options for Thumb Basal Joint Arthritis
Early Surgical Treatments
One of the earliest surgical treatments described was complete excision of the trapezium. This was a simple operation, first described by Gervis in 1949. It is ironic that we have come full circle regarding surgical treatment, since Meals recently described a similar procedure in the literature nearly 50 years later.
A more complex modification of this procedure has been described as the LRTI (ligament reconstruction tendon interposition). This has been, and remains, the most commonly used surgical procedure for treatment of painful basal joint osteoarthritis. This relatively complex operation combines several previously described procedures, encompassing the complete excision of the trapezium bone and stabilization of the metacarpal base, using a strip of the flexor carpi radialis wrist tendon in order to stabilize the newly formed joint.
While reports in the literature are generally favorable in terms of the outcome, there are several problems that remain with this operation. One of them is that the recovery process is relatively long and can be painful. More details about this early surgical option can be found here.
Patient Testimonial: Thumb Joint Replacement. No pain.
Total Joint Arthroplasty
Total joint replacement remains a viable alternative in older patients where functional recovery is rapid, and there is a good salvage potential if necessary. While long-term studies are scarce, it is implicit that loosening of the implants can occur in scenarios where a great deal of stress is placed on the joint. For this reason, alternatives have been sought and a new concept has recently been developed.
The Role of Arthroscopy
The concept of arthroscopy may be most beneficial in the early stages of basal joint arthritis. The earliest presentation of this painful condition has few surgical options once conservative treatment has been exhausted. It is obvious that a 35-year-old active woman may not agree to a complete open excision of the trapezium, even when her symptoms are persistent.
The other surgical options discussed are also relatively aggressive for the younger, active patient. Hence, failed conservative treatment of basal joint osteoarthritis in the younger, active patients remains a dilemma. However, there is now a viable alternative in arthroscopy.
The patient who continues to have pain, despite several cortisone injections and prolonged splinting, may agree to an arthroscopic procedure. This is because a minimally invasive procedure at this small joint presents the same advantages that it does in larger, but more accepted, procedures, such as knee arthroscopy.
An arthroscopic evaluation of this joint gives us the true stage of arthritis and minimizes the importance of radiographic staging. In fact, an arthroscopic classification has been suggested, and may well lead to the treatment options.
More advanced arthroscopic stages dictate more aggressive treatment. Learn more about arthroscopic stages.
Future options for the painful osteoarthritic basal joint of the hand
As the population ages and continues to be more active, it will be necessary to provide different options for the painful osteoarthritic basal joint of the hand. Newer technologies, such as small joint arthroscopy, or advances in biomaterials will lead to greater treatment options at this small but critical joint. Resection arthroplasty, or fusion, will likely continue to have a role in treatment, but I suspect that over time it will not be the primary option as is currently the gold standard.