Symptoms:
The most common symptom of thumb basal joint arthritis is a deep, aching pain at the base of the thumb. The pain is often worsened with activities that involve pinch, including opening jars, turning door knobs or keys, and writing. As the disease progresses, patients may experience pain at rest and at night, and patients often note loss of pinch and grip strength. In severe cases, a “bump” develops at the base of the thumb, which is caused by the thumb metacarpal moving out of position in relation to the trapezium. At this point, thumb motion becomes limited and the space between the thumb and index finger narrows, making pinch activities difficult. The next joint up may hyper-extend to compensate.
Treatment Options
A variety of surgical options are available which can reduce or eliminate the pain and improve thumb position and function. The common surgery includes removal of the arthritic joint and replacement of a cushion or spacer. Some patients may also undergo realignment procedures. However, minimally-invasive arthroscopic procedures from the American Hand Institute have become available. These procedures require advanced surgical training and highly specialized surgical equipment.
Procedure
Arthroscopic MINIMALLY-INVASIVE CMC The innovative, newer arthroscopic method performed by the American Hand Institute surgeons does not require a large incision or tendon graft. Only the affected area is treated. The thumb is placed in a cast or splint for only 2 to 3 weeks, and some home therapy may be required once the cast is removed. This procedure is less invasive, less painful and typically allows for faster recovery.
Open CMC
The older, traditional CMC procedure requires a large incision and removal of the entire trapezium bone. Then, a second incision is made to remove a tendon from the arm. This tendon is used to fill the gap left by the removed bone. A cast is usually applied for 4-6 weeks. A formal therapy program is generally needed to regain motion. Return of function can require up to a full year.
The numbness and tingling may improve quickly or slowly, and it may take several months for the strength in the hand and wrist to improve. Cubital tunnel symptoms may not completely resolve after surgery, especially in severe cases.
