Thumb Base Joint Replacement 

Thumb base joint replacement Sydney

The base of the thumb, where the lowest bone of the thumb joins the wrist, is a common site for arthritis. Damage to this joint can have a significant impact on your daily life. People with thumb arthritis generally lose grip strength. They may find it hard to twist the cap off a bottle, open a doorknob, or button up clothing. This can make it very difficult for a person to live independently.

People with thumb arthritis have a few different treatment options available. One of the options is to replace the joint at the base of the thumb. What’s involved with thumb base joint replacement? What are the alternative options to consider?

Where is the thumb base joint?

The joint at the base of the thumb is technically known as the first carpometacarpal, or first CMC, joint. To understand this joint and how it moves, let’s consider the bones of the hand.

There are two bones in your thumb itself, which are known as phalanges. (The other fingers each have three phalanges.) Below these is the first metacarpal. This is the long bone at the base of the thumb, located in the hand. The first metacarpal forms a joint with one of the carpals, known as the trapezium. The carpals are often called the wrist bones, although their location is more in the “heel” or base of the hand.

The joint between the first metacarpal and the trapezium is the first carpometacarpal, or first CMC, joint. Movement at this joint is crucial for allowing the thumb to have such a wide range of motion. Try placing the fingers of your opposite hand over the first CMC joint, and moving your thumb in a circle. Notice how much movement occurs at this joint when you perform this motion. Without movement at the first CMC joint, the movement of the thumb is greatly restricted.

What are the options for treating thumb base joint arthritis?

For people who have arthritis at the base of the thumb, there are a few different treatment options that may be helpful. Usually, the least invasive options are tried first, gradually moving towards more invasive options if necessary. In order from less invasive to more invasive, the options include:

• Physical therapy of the hand
• Braces to support the base of the thumb 
• Oral anti-inflammatory medications
• Injections of a steroid (strong anti-inflammatory medication) into the joint
• Surgery – either surgical fusion or replacement of the joint

For those who have tried the less invasive treatment options and are still finding that their symptoms are interfering with their lives, surgery may be a good option. Fusion is often effective at relieving pain, but if it’s successful, the joint will not move at all afterward. This can significantly impact a person’s ability to function. By contrast, joint replacement can address pain while also maintaining mobility in the joint.

How is thumb base joint replacement performed?

The first part of the procedure involves removing the damaged joint tissue, which is causing the pain and stiffness. In some cases, this involves removing one of the carpals entirely. In other cases, only part of this bone will be removed. It’s necessary to remove the damaged joint tissue to relieve symptoms like pain and also to make space for the new joint.

There are then two different options for reconstructing the joint. One option uses a certain tendon from your forearm. This tendon is redundant, and removing it generally doesn’t have a huge impact on the arm’s function. However, taking this tendon from its original location does require an additional incision. Many people prefer to avoid damaging a healthy part of the arm in order to reconstruct the damaged CMC joint.

Another option is to use an artificial joint. This option, which is also known as joint replacement, doesn’t require an additional incision on your arm, and leaves the arm’s tendons intact. The artificial joint is made of both metal and plastic. The surgical technique for placing the artificial joint is challenging, and getting a good outcome from this procedure depends on following good surgical technique very precisely.

What is the recovery like after thumb base joint replacement?

Immediately after surgery, you’ll notice a limited range of motion. This is due to swelling from the surgery. You will likely not even be able to touch the thumb to the pad of your pinky finger at first. With proper hand therapy, the range of motion usually returns to normal within about six weeks, although it can take a little longer in some people.

The strength in your thumb will be reduced for a longer period. It can take six months or even longer to regain full strength. Being diligent about performing your hand therapy exercises is crucial to help you regain strength and mobility. We will refer you to a good hand therapist, who can help you to recover as well as possible from your surgery.

Research has shown that when thumb base joint replacement is performed well, the recovery is generally quicker than from other types of surgery, like fusion. In addition, this type of surgery preserves the length of the thumb and the overall function of the hand better than other surgical options. When a joint is fused or is otherwise not functioning normally, other neighboring joints may experience abnormal movement, and may later develop arthritis as a result. By maintaining the function of the thumb, first CMC joint replacement helps to avoid this issue.

Thumb base joint replacement Sydney

The specific technique used to perform thumb base joint replacement is crucial to getting a good outcome from this procedure. The joint is small, and there are many important structures in the area. It takes an expert surgeon to perform this procedure well.

Dr. Sungaran has devoted his career to performing surgery on the hand and wrist. He performs a range of joint replacement procedures, including total wrist replacement as well as finger joint replacement. Dr. Sungaran regularly attends conferences to stay up-to-date on the latest surgical techniques, and his patients can trust that he’s extremely well-qualified to perform their procedures. 

If you’re experiencing arthritis at the base of your thumb and are considering thumb base joint replacement, we invite you to schedule a consultation with Dr. Sungaran to get personalised advice on your treatment options. You can then decide how you’d like to proceed.