Base of Thumb Arthritis

The thumb is vital for pretty much any task involving the hand as it’s responsible for gripping and grasping objects. When arthritis develops in the basal joint (the joint connecting the thumb to the wrist), all hell could break loose from the sheer pain that will ensue. The most common type of arthritis that could affect the basal joint is osteoarthritis, although rheumatoid arthritis may also be a cause. Patients who already have arthritis in other parts of the body are more prone to basal joint arthritis.

The base of thumb arthritis often starts with the loosening of ligaments at the joint, which then leads to dislocation. Consequently, the articular cartilage in the first carpometacarpal (CMC) joint breaks down, leaving the bones at the joint unprotected, and they begin to rub against each other. The result is inflammation at the base of the thumb, stiffness, and chronic (if not persistent) pain.

Day-to-day manual activities become increasingly hard to fulfil as the patient starts feeling weak at the joint. Moreover, some kind of deformity may also be evident around the thumb. Based on statistics, women are more likely to get basal joint arthritis than men, although the reasons for this apparent disparity are not entirely known.

Diagnosis and Treatments

When you come to our plastic surgery clinic, we will perform some X-Ray tests to gauge how severe the condition is before implementing a treatment plan for thumb arthritis. If it’s mild, our veteran doctor may prescribe some topical and oral anti-inflammatory medications to relieve the pain, a thumb splint, steroid injections, or some rest and a break from some manual duties.

Bear in mind, however, that these solutions are non-surgical and may only provide temporary relief. So, after trying out these treatments without much success, it will be time to start thinking about surgery to treat the condition once and for all. At our plastic surgery London facility, we correct the base of thumb arthritis via one of two procedures: trapeziectomy (with or without ligament reconstruction) and thumb base denervation. Here’s what they involve:

a) Trapeziectomy (With or Without Ligament Reconstruction)

This is a procedure where the trapezium bone is removed to alleviate pain from basal joint arthritis and increase the mobility of the affected thumb. Other symptoms that can be relieved by trapeziectomy include crookedness in the thumb, gripping, pinching, or grasping, and snapping or popping of the thumb with movement.

As part of the procedure, taking the bone out also decreases the chances of arthritis reoccurring. The thumb is numbed using local anaesthesia, an incision is made at the base of the thumb from the back of the hand, and the trapezium bone is carefully taken out.

There are different approaches that the surgeon may use before sealing the incision with sutures. The first is to close it right away, and eventually, scar tissue will develop in the gap. Another step is to do a ligament reconstruction by repurposing one of the flexor tendons in the wrist joint, where it’s cut and reattached to the metacarpal bone. As the scarred area heals, the tendon will tighten around the bone, providing stability in place of the removed bone. Finally, our surgeon may also use an implant (silicone or metal) to replace the trapezium bone.

Recovery could take anywhere between 3 to 6 months. The patient may have to take a considerable amount of time from work, especially if it involves carrying out manual tasks.

b) Thumb Base Denervation

Denervation is a surgical procedure that decreases the downtime of more invasive surgeries like trapeziectomy while keeping the structure of the joint intact. The aim is to permanently destroy a nerve (or some nerves) to stop the patient from experiencing any more pain.

The thumb base denervation procedure is performed under X-Ray screening after administering anaesthesia. Denervation can keep the pain away for up to 4 years before the nerves regrow. Recovery takes about two weeks, and you’ll have to take a leave from work to encourage faster healing.

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