Basal Joint Surgery

Pain in the basal joint caused by arthritis makes it difficult for patients to grip and hold or twist objects between the thumb and fingers. This surgical procedure removes and rebuilds the basal joint.

Arthritis of the thumb, also known as basal joint arthritis, occurs when the cartilage of the thumb joint (carpometacarpal joint) wears away from the bone. This cartilage normally acts as a cushion between the bones of the joint, and when it is worn away, the direct contact and friction between the bones causes pain, swelling, decreased strength and limited range of motion.

Basal joint arthritis is commonly caused by inflammation in the lining of the joint, which in addition to pain, may result in stiffness, swelling and loss of movement in the thumb area. The condition may also lead to difficulty in performing simple tasks such as turning a doorknob, opening a jar and pinching or gripping an item. Although it may be successfully treated with conservative measures such as medications, severe cases of basal joint arthritis usually need surgery.

Causes of Basal Joint Arthritis

Basal joint arthritis usually occurs because of trauma or injury to the joint caused by overuse. Patients who have experienced prior fractures or injuries to the carpometacarpal joint may be more vulnerable to developing this condition. The basal joint may be more susceptible to arthritis than other joints because of its frequent use, since it gives the thumb the ability to pinch, grip and grasp objects. Basal joint arthritis is also more common in women than men and usually occurs over the age of 40. Some research indicates that it may be a genetic condition.

Symptoms of Basal Joint Arthritis

While cartilage usually covers the ends of the bones and allows them to move smoothly, arthritic joints have deteriorated cartilage that does not protect the bones, causing them to rub against each other. Basal joint arthritis causes pain in the base of the thumb when gripping, grasping or pinching an object, or when applying force. Some individuals may also experience pain during sleep or even when the thumb is not in use.

Other symptoms of basal joint arthritis of the thumb may include:

  • Swelling
  • Stiffness
  • Tenderness
  • Decreased strength
  • Decreased range of motion
  • Bony joint appearance

Diagnosis of Basal Joint Arthritis

Basal joint arthritis is typically diagnosed after the doctor conducts an evaluation of the patient's symptoms and obtains a medical history. One of the tests used during an examination of the hand involves holding the joint firmly while moving the thumb. If pain results or a grinding sound is heard, it is an indication that the bones are rubbing directly against each other. An X-ray may be taken as well, to determine whether there is any deterioration within the joint, or if bone spurs or calcium deposits have developed.

Basal Joint Arthritis Treatment

Basal joint arthritis may initially be treated with a combination of conservative treatments, including the use of non-steroidal anti-inflammatory drugs and wearing a splint to support the thumb and limit movement. However, severe cases of basal joint arthritis usually require surgery to relieve pain and other symptoms.

Basal Joint Surgery

To effectively treat more extensive cases of basal joint arthritis, arthroscopic surgery is often performed. Basal joint surgery is performed on an outpatient basis. There are several surgical options for basal joint arthritis, and the technique will be determined based on the patient's specific needs. The procedure may involve repairing the joint structures or debriding damaged tissue. In other cases, arthroplasty is performed to fuse, reposition or replace the basal joint.

Options for basal joint surgery include:

  • Joint fusion, or arthrodesis. This procedure permanently fuses together the bones in the basal joint, increasing stability and reducing pain.
  • Osteotomy, or bone-cutting. With this procedure, the surgeon will reposition the bones in the basal joint to correct deformities.
  • Trapeziectomy. This procedure removes the trapezium, one of the bones in the thumb joint.
  • Joint replacement, or arthroplasty. During this procedure, the surgeon will remove part or all the basal joint and replace it with a graft taken from one of the patient's tendons. Metal devices, or prostheses, may also replace the joint.

Recovery from Basal Joint Surgery

After undergoing a basal joint surgery, the patient will usually need to wear a cast or splint over the thumb and wrist for up to six weeks. Once the cast is removed, physical therapy may be recommended to help regain hand strength and a full range of movement. A complete recovery from basal joint surgery may take up to six months.

Have a Question?

  • American Orthopaedic Society for Sports Medicine
  • American Association for Hand Surgery
  • American Academy Of Orthopaedic Surgeons
  • The American Board of Pediatrics