Consultant – Gavin Brigstocke

What is Basal Thumb Arthritis?
Osteoarthritis is the loss of cartilage between bones and commonly occurs in the joint at the base of the thumb. This is a common site for osteoarthritis as the joint moves in several planes and transmits high forces during pinch grip. The lack of cartilage means the exposed bone surfaces of the trapezium and metacarpal can rub together resulting in pain, swelling, stiffness and deformity.

What treatments are available?
The methods for relieving discomfort in any arthritic joint include activity modification, analgesic and anti-inflammatory medications, splints, targeted steroid injections and finally surgery. With basal thumb arthritis flexible neoprene splints can be both effective and practical. Injections can be very effective at relieving pain as the steroid works as a powerful anti-inflammatory.

Surgery is considered when other measures have failed and the pain is affecting activities of daily living. Trapeziumectomy, when the trapezium bone is removed, remains the gold-standard surgical option for base of thumb arthritis. This procedure can result in some weakness of pinch grip and there are several other surgical options including tendon interposition, fusion and joint replacement. The type of operation depends upon the extent of the arthritis, your age and activity level and your surgeon will be able to advise the best way forward.

What are the outcomes?
Surgery is very effective form of pain relief, however it is associated with a loss of power in the thumb which can take up to a year to gain maximal improvement. Complications are rare and will be discussed with you prior to surgery.

Further information:
https://www.bssh.ac.uk/patients/conditions/24/basal_thumb_arthritis