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What is basal thumb arthritis?

Basal thumb arthritis affects the universal joint at the base of the thumb, between the metacarpal and trapezium bones. It is a type of osteoarthritis, characterized by the loss of smooth cartilage covering the ends of the bones in the joint. This cartilage deterioration leads to roughness and rubbing of the bone ends, causing pain and discomfort.

The symptoms of basal thumb arthritis can include:

  • Pain at the base of the thumb, exacerbated by thumb use.
  • Tenderness when pressure is applied to the base of the thumb.
  • Difficulty performing tasks such as opening jars or turning keys due to pain and stiffness.
  • Stiffness of the thumb and limited ability to move it away from the hand.
  • In advanced cases, a visible bump may develop at the base of the thumb, and the middle thumb joint may hyperextend, resulting in a zigzag appearance.

How is basal thumb arthritis treated?

While basal thumb arthritis cannot be reversed, treatment options aim to address symptoms and improve hand function. These range from simple non-surgical measures, to non-surgical interventions and ultimately surgery.

  1. Activity Modification: Avoiding activities that exacerbate pain, if possible.
  2. Medication: Analgesic and/or anti-inflammatory medication can help alleviate pain and inflammation. Consultation with a pharmacist or family doctor is recommended.
  3. Splinting: Using a splint to support the thumb and wrist can provide relief. While rigid splints (metal or plastic) are effective, they may restrict thumb movement. Flexible neoprene rubber supports are more practical.
  4. Steroid Injection: Injection of corticosteroids into the affected joint can reduce pain and inflammation in many cases. While the effect may wear off over time, improvement is often noticeable within a few days to several weeks. Repeat injections may be necessary.
  5. Surgery: Reserved as a last resort when symptoms persist despite non-surgical treatments. Various surgical options are available, with trapezium removal being the most common procedure. Surgeons will provide guidance on the most suitable surgical approach based on individual circumstances.

What outcomes can I expect from surgery?

Overall, the treatment approach for basal thumb arthritis aims to alleviate pain, improve function, and enhance overall quality of life for affected individuals. It is recommended to start with lower level, less invasive techniques first as these have the least potential for complications, and reserve invasive techniques for resistant symptoms. In particular, surgery can offer excellent outcomes but the rehabilitation and recovery spans months, and so is not to be undertaken lightly. Your surgeon will guide you through a stepwise approach that takes into account your individual situation.

What questions should I ask my plastic surgeon about Basal Thumb Arthritis surgery?

  • Are you vocationally registered with the Medical Council of New Zealand as a specialist plastic surgeon?

  • Are you a member of the New Zealand Association of Plastic Surgeons?

  • Will the procedure be conducted in a hospital or office-based setting, and is the facility accredited for this type of surgery?

  • What type of anaesthesia is needed for this procedure?

  • Based on my medical history and condition, is surgery the best option for me? If so, am I a suitable candidate for this surgery?

  • Which surgical technique do you recommend for my case, and why?

  • What are the realistic expectations for the outcome of this procedure in my case?

  • What steps or lifestyle changes are necessary for me to get the best result from my surgery?

  • What is the anticipated duration of recovery, and what assistance will I need during this period?

  • What potential risks and complications are associated with this procedure? How would you manage these should they arise?

  • How will my results change over time?

  • If I’m unhappy with the outcome, what recourse options are available?

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Disclaimer: This website is intended to provide you with general information only. This information is not a substitute for advice from your Specialist Plastic Surgeon and does not contain all the known facts about this procedure or every possible side effect of surgery. It is important that you speak to your surgeon before deciding to undergo surgery. If you are not sure about the benefits, risks and limitations of treatment, or anything else relating to your procedure, ask your surgeon to explain. Patient information provided as part of this website is evidence-based, and sourced from a range of reputable information providers including the American Society of Plastic Surgeons, Better Health Channel and Mi-tec medical publishing.