The unique pattern of movement of the thumb carpometacarpal joint (basal joint) is the basis of its gross and fine motor activities, which make the human hand so special. But these movements also subject the thumb basal joint to incessant multiplanar forces, which can lead to premature arthritis in one of three women and one of eight men.
As with all osteoarthritis patients are located at different points along the spectrum of disease severity. The most important criteria for the individualized treatment of osteoarthritis of the thumb basal joint are the severity of symptoms and the degree of functional loss in the hand, not the impression derived from a X-ray alone.
Non-operative treatment includes modification of the pattern of motion in the thumb, splinting, nonsteroidal antiinflammatories, dietary supplements, and steroid injections into the thumb carpometacarpal joint (thumb basal joint). While the first three concepts are supported at least in early stages of osteoarthritis of the carpometacarpal joint by data in the scientific literature, the latter two are controversial – some studies argue in favor and others against the use of these forms of treatment.
Patients who continue to complain about pain despite sufficient conservative treatment and loss of hand function are potential candidates for surgical therapy.
Numerous methods for operative treatment of arthritis of the thumb carpometacarpal joint are available. Selection of an operative technique depends on the stage of arthritis, patient factors and preferences of the surgeon. “Silver Bullets” in the form of universally applicable techniques for all patients in any stage of disease do not exist in our opinion.
If osteoarthritis of the carpometacarpal joint is characterized more by subluxation than bony changes in the thumb basal joint, then reconstruction of the volar capsular ligament has high chances of success. More serious bony changes in the carpometacarpal joint are an accepted indication for resection arthroplasty and its variants, or with or without tendon interposition, especially if the adjacent scaphotrapeziotrapezoidal joint (STT joint) shows changes consistent with arthritis. Fusion of the thumb basal joint (arthrodesis) is an option in younger patients with posttraumatic (as opposed to degenerative) arthritis. Prosthetic replacement of the thumb basal joint has to our knowledge not been shown to be successful in any objective clinical study (ie not conducted or sponsored by the manufacturer of the respective implant).