Fellowship-Trained Expertise in Thumb Joint Surgery
The thumb carpometacarpal joint, also known as the CMC joint or basal joint, is a common source of pain and stiffness as we age. When the cartilage wears away and bone spurs form at the base of the thumb, daily activities such as gripping, turning keys, or opening jars become painful. Thumb arthritis at this joint is often called basal joint arthritis or thumb CMC arthritis.
Dr. Thomas Neustein, a board-certified and fellowship-trained orthopedic hand and upper extremity surgeon, offers advanced treatment options for thumb arthritis, including thumb CMC denervation. This minimally invasive procedure targets the tiny nerves that transmit pain from the affected joint, offering long-lasting relief without removing bone or replacing the joint.
Understanding Thumb CMC Arthritis
Thumb CMC arthritis occurs when the cartilage that cushions the carpometacarpal joint wears down. The CMC joint connects the thumb metacarpal to the trapezium bone in the wrist. As this cartilage acts as a smooth surface between the bones, degeneration leads to friction, inflammation, and pain.
Patients often describe pain at the base of the thumb, especially when pinching, gripping, or twisting. Over time, the joint becomes enlarged, stiff, and unstable due to lax joint ligaments. The thumb may drift into a crooked or subluxed position.
The Role of the CMC Joint
The thumb CMC joint is a saddle-shaped joint that allows rotation, opposition, and grasp. It provides much of the thumb’s strength and flexibility for daily activities. When the joint deteriorates, the loss of function significantly limits independence and quality of life.
Basal thumb arthritis and thumb CMC arthritis are common in people over 40 and are more frequent in women. Repetitive use, genetic predisposition, and hormonal factors may contribute to this condition.
Common Symptoms of Thumb Arthritis
Patients with thumb basal joint arthritis typically experience:
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Pain and tenderness at the base of the thumb
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Stiffness, especially in the morning or after activity
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Swelling and enlargement of the basal joint
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Grinding or popping sensations when moving the thumb
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Difficulty opening jars, turning doorknobs, or using large zipper pulls
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Weak pinch strength and decreased grip
In advanced cases, the joint becomes visibly deformed, and the thumb drifts away from the palm due to joint subluxation.
Diagnosing Thumb CMC Arthritis
Diagnosis begins with a detailed medical history and physical exam. Dr. Neustein evaluates pain location, range of motion, and joint stability. He may perform the “grind test,” rotating the thumb against the wrist bone to reproduce symptoms.
X-rays reveal narrowing of the joint space, bone spurs, and early cartilage wear. In some cases, mild carpal tunnel symptoms or nerve irritation may also contribute to thumb pain.
Early Stages and Conservative Care
In the early stages of thumb CMC joint arthritis, non-surgical options can often reduce inflammation and improve function. These may include:
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Activity modification and ergonomic tools to protect joints
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A supportive thumb brace or splint for stability
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Voltaren arthritis pain gel or other topical medications
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Prescription pain relievers or anti-inflammatory medication
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Physical or occupational therapy focusing on thumb strengthening
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Corticosteroid injections for temporary pain relief
These approaches help decrease inflammation, improve motion, and reduce stress across the joint.
When to Consider Surgery
Surgery is recommended when conservative measures no longer control symptoms and thumb pain interferes with daily life. Patients who continue to have severe pain, difficulty gripping, or poor motion despite medication and therapy may benefit from surgical treatment.
While ligament reconstruction and tendon interposition arthroplasty remain standard procedures for advanced disease, many patients achieve excellent outcomes from a less invasive approach—thumb CMC denervation.
What Is Thumb CMC Denervation
Thumb CMC denervation, or carpometacarpal joint denervation, is a surgical technique that interrupts pain signals traveling from the joint to the brain. Instead of removing or fusing the joint, the surgeon identifies and gently divides small sensory nerve branches supplying the painful thumb carpometacarpal joint.
This joint denervation offers good pain relief while preserving motion and strength. It can be performed as an isolated procedure for thumb carpometacarpal osteoarthritis or combined with other hand surgeries when appropriate.
How Thumb CMC Denervation Works
The thumb CMC joint receives sensory input from several small nerves, including the lateral antebrachial cutaneous nerve, radial sensory nerve branches, and the ulnar nerve component. These nerve fibers transmit pain from the arthritic joint to the brain.
During the procedure, these tiny branches are carefully identified along the base of the thumb and gently divided. By removing the sensory input to the painful joint, the patient experiences lasting relief without changing the joint’s mechanical structure.
Advantages of Thumb CMC Denervation
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Less invasive than joint replacement or fusion
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Preserves normal thumb motion
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Provides long-term pain relief
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Allows early return to activity
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May delay or eliminate the need for future arthroplasty
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Minimal risk of complications
Because the structural integrity of the thumb carpometacarpal joint is maintained, patients retain excellent hand function and strength.
The Surgical Technique
Thumb CMC denervation is performed on an outpatient basis under regional or local anesthesia. A small incision is made at the base of the thumb near the radial artery. The surgeon uses magnification to identify the tiny sensory nerves around the thumb carpometacarpal joint.
These nerves are divided using microsurgical instruments while preserving motor branches and the surrounding tendons. The incision is closed with fine sutures, and a light dressing or splint is applied.
The surgical time is less than one hour, and patients go home the same day.
Recovery and Rehabilitation
After thumb CMC denervation, the hand is lightly bandaged, and patients are encouraged to move their fingers immediately to prevent stiffness. A soft thumb brace may be worn for comfort for up to eight weeks, depending on activity level and comfort.
Most patients notice decreased pain within days, with continued improvement over several weeks. Hand therapy or occupational therapy may be recommended to restore motion and build strength.
Returning to Daily Activities
Patients typically resume light activities within a few days and normal use of the hand within several weeks. Because the surgery does not alter bone structure or joint alignment, there are no restrictions on thumb motion once the incision heals.
This approach allows patients to return to daily tasks, hobbies, and work activities faster than after ligament reconstruction or joint replacement.
Long-Term Outcomes
Published studies and systematic reviews, including those in Plastic and Reconstructive Surgery and Bone Joint Surg, show consistent pain relief and high satisfaction following thumb CMC denervation. Many patients maintain excellent function and minimal pain years after surgery.
If arthritis progresses over time, other surgical options—such as ligament reconstruction and tendon interposition or joint replacement—remain available. Denervation can safely delay or complement those future procedures.
Comparison to Other Surgical Options
Traditional thumb arthritis surgeries, such as ligament reconstruction and tendon interposition (LRTI), involve removing part of the trapezium bone and reconstructing the joint using a tendon graft. While effective, recovery can take several months.
Joint fusion eliminates motion in exchange for stability but limits flexibility. Joint replacement introduces a human-made joint, which may eventually wear or loosen.
Thumb CMC denervation provides pain relief without removing bone, fusing the joint, or implanting hardware. For many patients, it offers the best balance between reduced pain and preserved motion.
Pain Management and Medications
Following surgery, mild discomfort is managed with over-the-counter or prescription pain relievers as directed by your healthcare professional. Swelling is typically minimal and improves with rest, elevation, and ice.
Dr. Neustein and his team review all your medicines and medical history to ensure a safe recovery and to avoid drug interactions.
Hand Therapy After Surgery
Although recovery is generally fast, hand therapy may be recommended to maintain thumb flexibility and improve strength. Therapists focus on safe motion, scar care, and ergonomic strategies for joint protection.
Therapy also teaches ways to reduce strain on the thumb joint during daily tasks—helping patients use tools, perform household activities, and protect joints effectively long term.
Risks and Complications
Complications from thumb CMC denervation are rare but may include temporary numbness or sensitivity near the incision. Because no bone or tendon is removed, risks are much lower than traditional thumb arthritis surgery.
A small percentage of patients may experience recurrent pain over time if additional nerve branches regenerate, but this can often be treated with minor revision surgery.
Who Is a Candidate for Thumb CMC Denervation
This procedure is ideal for patients with moderate thumb arthritis or those seeking pain relief while maintaining natural motion. Candidates include individuals who:
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Have persistent pain despite conservative therapy
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Have early to moderate carpometacarpal joint arthritis
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Are not ready for or wish to avoid joint replacement
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Desire faster recovery and less downtime
Dr. Neustein evaluates each case carefully and suggests the treatment plan most appropriate for the affected joint and lifestyle goals.
Why Choose Dr. Thomas Neustein
Dr. Thomas Neustein is a fellowship-trained orthopedic hand and upper extremity surgeon specializing in thumb arthritis treatment, joint denervation, and reconstructive hand surgery. He provides state-of-the-art care for patients suffering from thumb pain, stiffness, and arthritis of the base of the thumb.
Patients describe Dr. Neustein as a caring, attentive, and skilled surgeon with excellent bedside manner. His amazing team ensures every patient feels supported and informed throughout the process.
Schedule an Appointment for Thumb CMC Arthritis Evaluation
If you suffer from persistent thumb pain or difficulty using your hand due to basal joint arthritis, thumb carpometacarpal osteoarthritis, or CMC arthritis, schedule an appointment with Dr. Thomas Neustein today. Early evaluation allows for personalized care and faster recovery.
Experience the benefit of specialized hand care close to home at Specialty Orthopaedics in Duluth, Dawsonville, or Braselton.
