Basal thumb surgery, frequently referred to as basal joint reconstruction or CMC (carpometacarpal) arthroplasty, is a surgical procedure performed to alleviate pain and restore function in the thumb, primarily for individuals suffering from severe arthritis at the base of the thumb.
Understanding the Basal Joint
The basal joint, located at the base of the thumb where it meets the wrist, is crucial for the thumb's wide range of motion and its ability to pinch and grasp. This specific joint is formed by the trapezium bone and the first metacarpal bone. When arthritis affects this joint, the cartilage that cushions the bones wears away, leading to bone-on-bone friction, pain, swelling, and a loss of strength and mobility.
Why is Basal Thumb Surgery Performed?
This surgery is typically recommended when non-surgical treatments have failed to provide adequate relief for patients experiencing significant pain and functional limitations due to basal joint arthritis. Common symptoms that might lead to considering basal thumb surgery include:
- Persistent pain at the base of the thumb, often worsening with activity.
- Stiffness and difficulty moving the thumb.
- Weakness when pinching or gripping objects.
- Swelling and tenderness at the thumb's base.
- A grinding sensation or sound during thumb movement.
The Surgical Procedure
The primary goal of basal thumb surgery is to remove the arthritic bone and create space to prevent bone-on-bone rubbing. During basal joint reconstruction surgery, an orthopedic hand surgeon removes the degenerated trapezium bone or a portion of it. This space can then be left empty, filled with a tendon graft (often from the patient's own wrist), or replaced with an artificial implant, depending on the specific technique chosen.
Different surgical techniques for basal thumb arthritis include:
- Trapeziectomy: This is the most common procedure, where the entire trapezium bone is removed. The space left behind may naturally fill with scar tissue or be supported by a tendon.
- Ligament Reconstruction Tendon Interposition (LRTI): After removing the trapezium bone, a portion of a nearby tendon (e.g., from the wrist) is used to create a cushion or sling in the empty space, preventing the first metacarpal from sinking into the wrist bones.
- Fusion (Arthrodesis): Less common for the basal joint, this involves fusing the bones of the joint together to eliminate movement and pain, though it results in a permanent loss of motion.
- Arthroplasty (Joint Replacement): Involves replacing the damaged joint surfaces with an artificial implant.
Recovery and Outcomes
Recovery from basal thumb surgery typically involves a period of immobilization, followed by hand therapy to regain strength and motion. The recovery timeline can vary, but most patients experience significant pain relief and improved function in their thumb, allowing them to resume daily activities with greater ease. For more detailed information on treatment and recovery, you can refer to resources on basal joint reconstruction.
