Basilar (Basal) Thumb Arthritis

The base of the thumb (the trapeziometacarpal joint) is commonly affected by arthritis. The arthritis often causes pain during pinching and gripping. It may be especially severe when opening jars or turning a key. It may progressively worsen until most/all hand activities become painful.

The basilar thumb joint is especially stressed by pinching and gripping small objects. When gripping or pinching a small object, for every 1 pound of force you apply to your thumb tip, the basilar joint experiences 12 pounds of force. To decrease stress on this joint it’s better to avoid manipulating small objects and to pinch and grip big. Big, thick pens with rubber grips on them are much easier on your joint than are small, metal pens. Kitchen-aid or simlar devices can slip over jar lids to make them larger and easier to grasp. You can buy devices that slip over keys to make turning them easier. Whatever you grab with your arthritic thumb, try to make it bigger.
A splint can also be helpful. Most patients prefer a soft, neoprene, rubber-like splint that doesn’t interfere much with hand function. A steroid injection can also provide good relief. If the symptoms are mild, these measures may be all that you need. However, unfortunately, they will not provide permanent relief from the pain of significant arthritis.

If nonoperative management is not effective and the pain is significant, surgery can be a very effective cure. There are many different types of surgery for this problem. I prefer the LRTI (ligament reconstruction tendon interposition). It is the current ‘gold standard’, the most popular and most effective procedure, with a low complication rate. It’s been around since the mid-1980s. It uses your body’s natural tissues to provide both stability and a new joint.

This is one case where newer procedures that use artificial materials to create artificial joints are less effective with a higher complication rate. Artificial joint replacements almost always have a higher complication rate and a lower success rate than the LRTI procedure.

During the LRTI, the arthritic bone that your thumb rests on (the trapezium) is removed. A small cut is made in the forearm to release a tendon, which is moved to the base of the thumb to fill in the area from which the trapezium bone was removed. So now instead of your thumb resting on a hard piece of arthritic bone (which is painful), it rests on a soft tendon pillow. A small suture anchor is placed into a thumb bone. It’s like a small harpoon with stitches on it to hold everything together. It stays in forever.

Basilar thumb arthritis often co-exists with carpal tunnel syndrome. If this happens, an endoscopic carpal tunnel release can be performed at the same time.

Following the LRTI, a post-operative splint is worn for one week, then a cast is worn for three weeks. Once the case is removed, you may get the hand wet. Some patients may need some hand therapy to regain thumb motion, but most don’t need much therapy at all. The stitches are absorbable, and there are no stitches to remove. Once the cast is removed a removeable splint is worn full-time for two weeks, except when bathing, and then only as needed.
While some patients note a fair amount of pain for the first few days after surgery, the surgical pain quickly decreases. It is important to avoid forceful gripping and heavy lifting for 3-4 months after this surgery. Typing and computer use are fine, and may be performed the day after surgery.