Base of Thumb Arthritis

Hand & Wrist Diseases & Conditions

As individuals age, many experience arthritis in their hands and wrists. Arthritis at the base of the thumb (within the first CMC joint) is very common, and this can cause intense pain and impede everyday activities and abilities. Base of thumb suspensionplasty can be performed to restore thumb function.

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Dr Oscar Brumby-Rendell | ASULC | Adelaide Shoulder & Upper Limb Clinic | Hand and Wrist Surgery

Causes of Arthritis at the Base of the Thumb

Arthritis at the base of the thumb is common due to the first CMC joint's highly flexible nature. This property means that this joint is used frequently in everyday activities and, as a result, becomes worn and damaged from overuse. Although pain is often only experienced later in life, the joint generally starts to become damaged in an individual's 30s and 40s.

Common Causes and Risk Factors

Age and repetitive use: Regular pinch or grip motions, even in everyday tasks, gradually wear down cartilage in the CMC joint.
Female gender: Women are disproportionately affected due to anatomy and hormonal influences.
History of injury or joint laxity: Past thumb trauma, sprains, or congenital joint laxity can accelerate degeneration.

What is base of thumb suspensionplasty?

Base of thumb suspensionplasty is a surgical procedure used to treat arthritis at the base of the thumb, specifically in the carpometacarpal (CMC) joint.

In this surgery, Dr Oscar Brumby-Rendell will make an incision at the thumb's base. Then, he will remove the arthritic trapezium bone - or a fragment of it - at the base of the joint. A tendon graft from the wrist is used to restabilise the joint, and the thumb is cushioned and suspended where the trapezium bone was removed with the remaining tendon.

Key Benefits of Suspensionplasty

Long-Lasting Pain Relief from Thumb Arthritis

Suspensionplasty relieves pain caused by base of thumb arthritis by removing the worn-out trapezium bone. This removes the bone-on-bone contact at the CMC (carpometacarpal) joint, which is the main source of pain in thumb osteoarthritis. Patients would often report significant and lasting pain relief following this surgical procedure.

Improved Grip and Pinch Strength After Surgery

By stabilising the thumb using the patient’s own tendon, suspensionplasty restores function and improves grip and pinch strength. This lets patients to perform daily tasks like opening jars, holding a pen, or turning keys with less discomfort. It's a highly suggested for patients with weak thumb function due to arthritis.

Preserves Natural Thumb Movement

Unlike thumb joint fusion, suspensionplasty maintains the natural range of motion in the thumb. This makes it ideal for individuals who want pain relief without sacrificing mobility. Retaining thumb movement is critical for fine motor activities like writing, buttoning clothes, or using digital devices.

When should I consider base of thumb suspensionplasty?

Suspensionplasty is typically recommended when non-surgical treatments for base of thumb arthritis no longer provide relief and daily activities become painful or difficult. If you're experiencing persistent pain at the base of your thumb, especially during gripping, pinching, or twisting motions, this surgery may be a suitable next step.

Frequently Asked Questions

What is the long-term outlook for non-surgical treatment?

Non-surgical treatments like exercise therapy plus use of an orthosis (splint) often provide satisfactory relief that is maintained over time.

A recent study showed that for patients using orthoses and doing thumb base exercises, pain and limitations in daily activities did not significantly worsen over more than 5 years.

What patient-factors predict worse outcomes or faster deterioration?

How common is it to have symptom severity that doesn't match imaging findings?

Are there lifestyle changes that can slow progression or reduce symptoms in the long term?

Yes. Some of the recommended strategies include:

Using ergonomically adapted tools or assistive devices to reduce stress on the thumb CMC joint during daily tasks.
Modifying activities that aggravate symptoms (e.g. reducing repetitive pinching or heavy gripping) and pacing tasks.
Hand therapy / exercises plus wearing a supportive orthosis when needed. These help stabilize the joint, improve function, and reduce pain.

Which surgical options exist, and how do they differ in terms of trade-offs?

When non-surgical measures fail, several surgical procedures are available. The choice depends on severity, desired movement vs strength, patient age, and other health considerations. Some options include:

Trapeziectomy (removal of the trapezium bone), often combined with tendon suspension or ligament reconstruction. This tends to relieve pain and preserve motion fairly well.
Joint fusion (arthrodesis), which stabilizes the joint and reduces pain but limits movement.

What happens if thumb arthritis is left untreated or treatment is delayed?

If left untreated, or treatment is delayed, several outcomes are more likely:

Gradual worsening of joint pain, stiffness and reduced thumb mobility, especially for pinching and gripping.
Loss of strength (grip/pinch) and possibly muscle wasting in the thenar area (thumb side of the palm).
Increased deformity such as subluxation (partial dislocation) of the joint, or collapse of the thumb metacarpal base. Over time, this can make tasks more difficult and may require more complex surgery.

How can Dr Oscar Brumby-Rendell help?

What can he help with suspensionplasty?

Base of thumb suspensionplasty usually takes around 60 minutes. This surgery comes with risks and a rehabilitation process.

Before your surgery, Dr Oscar Brumby-Rendell will discuss risk considerations with you. Generally, this surgery achieves strongly positive results, increasing a patient's quality of life by decreasing pain and restoring thumb function.

Recovery from this surgery takes between 3 and 6 months and includes cast and/or split wearing, hand exercises and monitoring.