Basal Joint Arthritis

About

Osteoarthritis of the thumb (basal joint arthritis) is the most common type of hand arthritis, occurring earlier and most often in women. It’s the CMC (carpometacarpal) or basilar joint of the thumb that brings on the pain of basal joint arthritis. The CMC is located at the base of the thumb, allowing us to grip, pinch and pick up objects.

When basal joint arthritis occurs, the grip begins to weaken as pain in the joint increases, making life difficult for those suffering from this condition. The CMC joint is the victim of significant wear and tear due to the unique movement and frequent use of the thumb. That’s why people can develop arthritis in this spot, even if they don’t have it in the rest of the body.

Non-surgical treatments of basal joint arthritis tend to only work temporarily. Repeated recurrence of pain and weakness in this key area of the hand bring many patients to the New Jersey plastic and reconstructive surgeon’s office for basal joint restoration.

Symptoms and Causes of Degenerative Basal Joint Arthritis

Symptoms of basal joint damage and thumb osteoarthritis may include:

• Tenderness at the base of the thumb.
• Swelling at the lower part of the thumb where it joins the palm.
• Stiffness between thumb and index/pointer finger.
• Hand and thumb weakness when grasping objects.
• Pins and needles or numb sensation in the lower thumb, nearby palm and lower index finger.
• Inability to pick up small or heavy items.
• Limited range of motion in the thumb.
• Bony appearance or dislocation at the thumb’s base, where it connects with the hand.
• Contracture of the thumb toward the palm may occur and could become permanent.

This incredibly common joint condition is brought about by wear and tear–and the unique structure of the thumb joint. This joint helps provide both mobility and stability to the thumb. The cartilage in the thumb joint normally cushions the thumb/hand bones from scraping against one another.

Hand arthritis causes the cartilage cushion to wear away from the area between the bones, resulting in pain as bones rub together, damaging bones and joints. The CMC joint sits between the trapezium bone and the lower thumb bone (metacarpal bone) and is the most subject to this type of pain.

The small trapezium bone also connects to other bones in the palm and the index finger—so the tendency toward wear and tear is really no surprise in this key position. Injuries can contribute to the thumb joint wear-and-tear problem.

Considering Surgery For Basal Joint Arthritis

Total joint reconstruction is the most common, and typically most effective, treatment offered by skilled hand surgeons to restore function to the thumb and eliminate the pain of CMC joint arthritis. Other types of hand surgery may be appropriate in specific cases.

Roughly 80 percent of patients are helped by thumb joint surgery, with best results expected before the condition progresses to the point of contracture. Thumb adduction contracture causes the thumb to be pulled toward the palm.

Patients should consult a reconstructive hand surgeon in NJ before this happens if possible. However, thumb surgery can still be successful afterwards, when performed by an experienced reconstructive hand surgeon in Northern NJ.

Hand surgery for basal joint arthritis (or thumb arthritis) can eliminate pain. Basal joint arthritis is a degenerative condition, which only responds temporarily to non-invasive treatment.

Hand surgery can provide a permanent solution, preventing permanent weakness and impaired movement in the thumb and hand. Many Northern NJ patients with thumb arthritis avoid disfigurement with the help of an expert hand surgeon with plastic and reconstructive surgery expertise.

Hand surgery for basal joint arthritis helps to prevent thumb contracture. Patients who can benefit from basal joint arthritis surgery from a NJ thumb surgeon are:

• People who have trouble with essential daily tasks like turning a door knob, opening a car door or removing jar lids, etc.
• Patients whose thumbs are becoming misshapen.
• Those with recurring or constant thumb swelling and hand pain.
• Individuals who are unable to open the hand flat to grasp a large object.
• Patients who begin dropping things and want to remain independent.
• People who need to use hands and thumb fully at work or for leisure pursuits.
• Individuals who have repeatedly tried non-surgical treatments like:
  • Over-the-counter anti-inflammatories for pain and swelling
  • Rest
  • Steroid injections
  • Splinting of the hand or thumb
• Patients with restricted thumb movement that is annoying or crippling

How is Basal Joint Surgery Performed?

Basal joint surgery is an outpatient procedure performed using local anesthesia to numb the hand. A Bergen County plastic surgeon will make a small scalpel incision to access the CMC joint at the base of the thumb. The joint may be removed and reconstructed with a tendon graft from another area of the body or an artificial graft.

The graft is placed after the NJ hand surgeon removes the trapezium bone at the thumb’s base. The surgeon then connects the base of the thumb and index finger with the graft, which keeps the thumb in proper position.

More graft material is used to create a cushion between bones in place of the trapezium, which eliminates painful and damaging bone-on-bone friction. A steel pin may temporarily hold the bones in place.

Fusion is another surgical option, which your surgeon may discuss with you if appropriate. Once healed, patients typically enjoy freedom of movement without pain or swelling.

Risks and Recovery of Basal Joint Arthritis Hand Surgery

Surgical risks include nerve injury, bleeding, infections and stiffness. Specific additional risks may apply, depending upon the patient’s case details, which the Bergen County hand surgeon will explain before any surgery is scheduled.

Many surgical complications can be minimized or prevented by choosing a hand joint surgeon with microsurgery experience, who is board certified in plastic surgery.

Recovery and healing typically takes at least 4 weeks in a cast (except when bathing). The thumb and hand will feel numb and sore at times, gradually improving as healing progresses.

Physical therapy or hand and thumb exercises may be prescribed when cast is removed continuing for 1 or 2 more months. Patients return to normal activities gradually.

Choosing the Best Hand Surgeon for Basal Joint Arthritis

Cohen/Winters plastic surgery practice in Bergen County specializes in thumb surgery for basal joint arthritis. We have helped thousands of hand surgery patients eliminate pain and regain dexterity, strength and freedom of movement.

To learn more, please contact Cohen/Winters Aesthetic & Reconstructive Surgery.