Thumb CMC Arthroplasty for Basal Joint Arthritis
Pain at the base of the thumb can make everyday activities such as opening a jar, turning a key, gripping a steering wheel, or pinching objects difficult. One of the most common causes is thumb CMC arthritis, also called basal joint arthritis or thumb carpometacarpal arthritis.
Most patients begin with nonsurgical treatment, including activity modification, bracing, anti-inflammatory medications, and corticosteroid injections. When these treatments no longer provide adequate relief and thumb pain interferes with daily activities, thumb CMC arthroplasty may be considered.
Dr. Thomas Neustein performs CMC arthroplasty using a MicroLink™ Suture Button (ConMed) suspensionplasty technique. The damaged trapezium bone is removed, and the thumb metacarpal is stabilized with a suture-button implant. The goal is to alleviate pain, preserve thumb motion, and restore function without harvesting a tendon for reconstruction.
Patients from Dawsonville, Duluth, Braselton, and surrounding communities can be evaluated to determine whether CMC arthroplasty is appropriate for their thumb arthritis.
Understanding the Thumb CMC Joint
The thumb CMC joint, or thumb carpometacarpal joint, is located at the base of the thumb where the first metacarpal meets the trapezium bone in the wrist. It is also called the trapeziometacarpal joint.
The shape of this joint allows the thumb to move in multiple directions. This mobility is essential for gripping, grasping, and pinch strength, but it also places considerable stress across the joint.
With thumb carpal metacarpal arthritis, the cartilage covering the joint surfaces gradually wears away. As the joint space narrows, the painful thumb carpometacpal joint can become stiff and osteophytes, or bone spurs, may form. In advanced disease, patients may develop weakness, deformity, and significant difficulty using the hand.
Arthritis may also involve nearby joints, including the scaphotrapezial or STT joint. Evaluation of the entire area is important when determining the source of a patient's pain and the appropriate treatment.
Who Gets Thumb CMC Arthritis?
Arthritis of the thumb can affect both men and women but is particularly common in women over 40 and becomes increasingly common after menopause. Previous injury, genetics, repetitive use, and the mechanical demands placed on the thumb may also contribute.
Having arthritis on an X-ray does not necessarily mean treatment is required. Some patients have significant radiographic arthritis with relatively little discomfort, while others develop severe pain and functional limitations.
Treatment is therefore based on the patient's symptoms and hand function rather than the appearance of an X-ray alone.
Symptoms of Thumb CMC Arthritis
The most characteristic symptom of CMC joint arthritis is pain at the base of the thumb, particularly during activities requiring forceful gripping or pinching.
Common symptoms include:
- Pain opening jars, bottles, or containers
- Pain turning keys or doorknobs
- Difficulty gripping or pinching
- Reduced pinch strength
- Tenderness and swelling at the base of the thumb
- Stiffness or loss of motion
- Weakness during everyday hand use
- A visible prominence or deformity around the CMC joint in more advanced arthritis
For some patients, the pain becomes severe enough to interfere with work, hobbies, exercise, and routine daily activities.
How Is Thumb CMC Arthritis Diagnosed?
Diagnosis begins with a clinical assessment, including the patient's history and a physical examination of the hand and thumb.
X-rays are commonly obtained to evaluate the thumb carpometacpal joint for joint space narrowing, osteophyte formation, and other signs of arthritis. The nearby scaphotrapezial joint may also be evaluated because arthritis can occur in more than one location around the base of the thumb.
X-rays alone, however, do not determine whether someone needs surgery. Radiographic findings should be considered together with the patient's pain, physical examination, functional limitations, and response to nonsurgical treatment.
Nonsurgical Treatments for Thumb CMC Arthritis
Surgery is usually not the first treatment for thumb arthritis. Depending on the severity of symptoms, non surgical treatments may include:
- Activity modification
- A thumb brace or splint
- Anti-inflammatory medications when medically appropriate
- Corticosteroid injections
- Hand therapy and exercises
These treatments can provide meaningful relief for many patients. Surgical management becomes an option when symptoms persist despite appropriate conservative treatment.
When Is Thumb CMC Arthroplasty Recommended?
Thumb CMC arthroplasty is generally considered when persistent pain from CMC arthritis interferes with hand function and nonsurgical treatments are no longer providing adequate relief.
The decision is individualized. Factors include the severity and location of pain, examination findings, X-rays, activity demands, hand function, and the patient's goals.
Surgery may be appropriate for someone with advanced arthritis and severe daily pain, but an abnormal X-ray by itself is not necessarily an indication for surgery.
What Is Thumb CMC Arthroplasty?
CMC arthroplasty is a surgical treatment for painful thumb carpometacarpal arthritis. One of the most established approaches involves removing the damaged trapezium bone, a procedure called a trapeziectomy.
Once the trapezium is removed, the painful arthritic surfaces no longer rub against each other. The thumb metacarpal must then be appropriately supported while the area heals.
Several surgical techniques can accomplish this. Traditional procedures may use ligament reconstruction, tendon interposition, or an FCR tendon graft. These techniques use the surrounding soft tissues and ligamentous stabilizers to support the thumb after trapeziectomy.
Other techniques use suture-button suspensionplasty to support the thumb metacarpal without harvesting a tendon.
The best surgical procedure depends on the patient's anatomy, arthritis pattern, activity level, and surgeon's assessment.
MicroLink™ Suture Button Suspensionplasty
Dr. Neustein commonly performs trapeziectomy with MicroLink™ Suture Button suspensionplasty.
After the damaged trapezium is removed, the suture-button construct provides support between the thumb metacarpal and index finger metacarpal. This helps maintain the thumb in proper position while the surgical site heals.
Because the construct provides immediate structural support, Dr. Neustein's postoperative protocol allows patients to begin gentle motion relatively early rather than undergoing a prolonged period of immobilization.
Another advantage of this surgical technique is that it does not require harvesting a tendon solely to create the suspension.
The objective is not to create a new artificial CMC joint. Instead, the operation removes the painful arthritic bone contact and supports the thumb while the area heals, with the goals of reducing pain, preserving motion, and restoring useful hand function.
How Is CMC Arthroplasty Performed?
Thumb CMC arthroplasty is typically performed in an operating room as an outpatient surgical procedure, allowing most patients to return home the same day. An isolated CMC arthroplasty generally takes approximately 30 to 60 minutes, although surgical time varies depending on the individual patient and whether any additional procedures are necessary.
During surgery:
- An incision is made near the base of the thumb.
- The damaged trapezium bone is carefully removed.
- The thumb metacarpal is positioned appropriately.
- The MicroLink™ suture-button construct is placed between the thumb and index finger metacarpals to provide suspension and stability.
- The surgical site is closed, and the thumb is protected in a postoperative splint.
Anesthesia may include a regional nerve block to help with postoperative pain control in addition to other anesthesia selected for the procedure.
Recovery After Thumb CMC Arthroplasty
Recovery occurs gradually. Patients should expect some pain, swelling, bruising, and soreness during the early postoperative period. Some soreness can persist for several weeks and gradually improves as healing progresses.
Dr. Neustein's typical recovery protocol after MicroLink™ suspensionplasty is designed to allow early controlled motion without a prolonged period in a thumb cast.
First Week
The hand and thumb remain protected in the postoperative splint. Patients return approximately one week after surgery for their first postoperative evaluation.
At Approximately One Week
Patients transition to a removable brace. Because of the stability provided by the suture-button construct, gentle thumb range of motion can usually begin at this stage.
Hand therapy is typically ordered at this visit, and patients can begin working with a hand therapist on gentle motion.
Weeks 1–4
Patients progressively work on gentle motion while continuing to use the removable brace for protection as directed. Pain, swelling, stiffness, and soreness should gradually improve during this period.
Around Four Weeks
Most patients can discontinue the brace and focus more fully on restoring motion and normal hand use.
After Approximately Two Months
Strengthening generally begins after the second month, including progressive work on grip and pinch strength.
Long-Term Recovery
Recovery does not end when the brace comes off or strengthening begins. Motion, strength, endurance, and comfort can continue improving for several months.
Many patients are performing substantially more normal activities within the first few months, but long-term outcomes should not be judged too early. Grip and pinch strength recover progressively, and some patients may continue to notice improvement for up to 9 to 12 months after surgery.
Recovery is not identical for every patient. Preoperative stiffness, weakness, the severity of arthritis, other medical conditions, and the physical demands placed on the hand can all influence recovery time.
Some soreness or weakness during the first several months can be part of normal healing and does not necessarily indicate that the surgery has failed.
When Can I Return to Work?
Return to work depends heavily on the demands placed on the hand.
Patients with a desk job or work that does not require significant use of the operative hand may return earlier than patients whose jobs involve repetitive gripping, lifting, tools, or physically demanding jobs.
Patients performing heavier work may require several weeks or longer before they can safely return to all job duties. Heavy objects and forceful gripping should be avoided until healing has progressed sufficiently and strength has returned.
Dr. Neustein provides individualized work restrictions based on each patient's occupation and stage of recovery.
What Results Can I Expect?
The main goal of thumb CMC arthroplasty is substantial pain reduction while preserving useful thumb motion and improving hand function.
Strength does not return immediately. Grip and pinch strength typically improve progressively as healing occurs and strengthening advances.
The goal of surgery is not necessarily a completely painless thumb immediately after recovery begins. Rather, successful treatment aims to provide durable relief from arthritic pain, restore function, preserve useful motion, and allow patients to return to activities that had become difficult because of their arthritis.
Final results can take many months to develop, particularly with respect to strength and endurance.
Risks and Complications
As with any hand surgery, CMC arthroplasty has potential risks. These can include:
- Infection
- Bleeding or wound problems
- Nerve irritation or numbness
- Persistent pain
- Stiffness
- Weakness
- Implant-related problems
- Complex regional pain syndrome
- Continued or recurrent symptoms
- Need for additional or revision surgery
Infection risk exists with any surgical procedure, although infection after CMC arthroplasty is uncommon. Revision surgery may occasionally be necessary if persistent symptoms, implant problems, or another complication develops.
Dr. Neustein discusses the expected benefits, limitations, and individual risks of surgery before deciding with a patient whether surgical treatment is appropriate.
Frequently Asked Questions About Thumb CMC Arthroplasty
How Painful Is Thumb CMC Arthroplasty?
Pain, swelling, bruising, and soreness are expected after surgery, particularly during the early postoperative period. Pain generally improves as healing progresses, although soreness may persist for several weeks.
The anesthesia plan may include a regional nerve block to improve pain control immediately after surgery.
How Long Does Thumb CMC Arthroplasty Take?
An isolated thumb CMC arthroplasty generally takes approximately 30 to 60 minutes. The exact operating time varies depending on the patient's anatomy and whether any additional procedures are performed.
How Long Is the Thumb Immobilized After Surgery?
With Dr. Neustein's MicroLink™ suspensionplasty protocol, there is not typically a prolonged period of immobilization.
Patients are usually seen approximately one week after surgery, transitioned into a removable brace, and allowed to begin gentle range of motion. This differs from some CMC arthroplasty protocols that use longer periods of immobilization.
When Does Hand Therapy Start?
Hand therapy is typically ordered at the one-week postoperative visit. Therapy initially focuses on gentle range of motion and progresses as healing allows.
When Can I Stop Wearing the Brace?
Most patients are able to come out of the brace at approximately four weeks after surgery, although the exact timing may vary based on healing and individual circumstances.
When Does Strengthening Begin?
Strengthening generally begins after the second postoperative month. Grip and pinch strength then improve progressively over time.
Does Removing the Trapezium Cause Problems?
The trapezium is the arthritic bone involved in the painful CMC joint. After it is removed, the thumb metacarpal is supported using a suspension technique.
The goal is to eliminate painful bone-on-bone contact while maintaining a stable and functional thumb.
What Is the Difference Between Traditional LRTI and Suture-Button Suspensionplasty?
Traditional ligament reconstruction and tendon interposition, or LRTI, techniques use tendon tissue to help stabilize or fill the space after trapeziectomy.
Suture-button suspensionplasty uses a strong suture construct to stabilize the thumb metacarpal without harvesting a tendon solely for the reconstruction. Both are established approaches, and the appropriate technique depends on the individual patient.
How Long Does Full Recovery Take?
CMC arthroplasty recovery is gradual. Motion begins early with Dr. Neustein's protocol, while strengthening begins later.
Patients can resume many activities well before the hand has reached its final result. Strength, endurance, and comfort may continue improving for many months, and some patients continue to see improvement for up to 9 to 12 months after surgery.
Thumb CMC Arthroplasty in Dawsonville, Duluth, and Braselton, Georgia
Dr. Thomas Neustein is a board-certified, fellowship-trained orthopedic hand and upper-extremity surgeon who treats thumb CMC arthritis and other conditions of the hand, wrist, and elbow.
He evaluates patients with thumb basilar arthritis at offices in Dawsonville, Duluth, and Braselton, Georgia, and provides both nonsurgical and surgical treatment based on each patient's symptoms, examination, X-rays, activity demands, and goals.
If arthritis of the thumb is making it difficult to grip, pinch, work, exercise, or perform everyday activities, schedule an appointment with Dr. Neustein to discuss whether continued nonsurgical treatment or thumb CMC arthroplasty with suspensionplasty is appropriate for you.
