What is basal thumb joint surgery?

What is the basal joint?

The basal joint is located at the base of the thumb, and allows you to move the thumb toward the palm of your hand. This joint can be weakened due to illness, injury, or repetitive use. These injuries can cause:

  • Weakness in the ligaments (tough tissue) that attach bone to bone
  • Wearing away of the slick cushion of cartilage that allows bone to move against each other
  • Pain when grasping or holding items or inability to maintain a hold on something

The most common type of basal joint surgery is called an arthroplasty. Arthroplasty is a procedure to remove the damaged part of a joint and replace them with artificial (man-made) parts or with your own soft tissues.

Arthroplasty may be recommended when other medical treatments no longer relieve joint pain and disability. These treatments include:

  • Anti-inflammatory medicines, such as steroids
  • Pain medicines, such as ibuprofen, aspirin, or naproxen
  • Limiting painful activities
  • Physical therapy

After arthroplasty, patients usually have improvement in their joint pain, improved ability to perform activities, and better quality of life.

Surgical options that may be considered include:

  • Ligament reconstruction. Damaged ligaments are taken out and replaced with a piece of tendon.
  • Ligament reconstruction and tendon interposition (LRTI). A small bone in the wrist (trapezium) is removed and replaced with a piece of tendon.
  • Hematoma and distraction arthroplasty. The trapezium is removed and replaced with a piece of wire that fixes the thumb in place. The wire is taken out a few weeks later after the joint heals.
  • Fusion (arthrodesis). The trapezium and the lower thumb bone (metacarpal) are reshaped and joined together with a pin or screw. The pin holds the thumb bone in place while the joint fuses (grows together).

There are pros and cons with each of these surgeries. Talk with your doctor to see which one might be the best fit for you.

What are the risks and/or side effects?

There may be other risks depending on your specific medical condition. Be sure to talk with your doctor and ask any questions you may have before deciding to have any procedure.

There are certain risks with any surgery, including reaction to anesthesia or unexpected bleeding. Other risks include:

Infection

Incomplete healing

Blood clots

Injury to nearby nerves or blood vessels (rare)

Continued pain

No improvement in function

Malfunction of the artificial joint

What are the benefits?

The potential benefits of basal joint surgery include less or no pain, and better grip and function. This may allow you to cut back on or stop taking certain medicines, perform better at work, and have a better quality of life overall.

How do I prepare?

Before surgery, your doctor will do a thorough examination and ask about your medical history. You may need blood tests to rule out anemia or blood clotting disorders. Your doctor will talk with you about any new medicines that you may need to take after surgery. Be sure to tell your doctor about all medicines you are currently taking, including prescription medicines, over-the-counter drugs (such as allergy pills or cough syrup), inhalers, patches, vitamin supplements, and herbal remedies. You may need to stop taking some of these in the days before your surgery.

You will likely meet with a physical therapist to talk about your rehabilitation before and after surgery.

You will be asked to not eat or drink anything several hours before surgery. It is important to follow these instructions to avoid complications with the anesthesia. If you don’t follow these instructions, your surgery may have to be postponed.

How is it done?

The steps and procedures for each type of surgery are different. In general, you can expect the following:

  • A member of the anesthesia team will talk with you about your options. The most common types of anesthesia are general anesthesia (you are put to sleep) or a regional nerve block (you are awake, but your body is numbed in certain areas).
  • A nurse or member of your healthcare team will put an intravenous (IV) line in your vein before you are brought into the operating room for surgery.
  • You are given anesthesia.
  • The surgeon makes an incision (cut) in the skin to reach and work on the joint and any other structures in the wrist or hand.
  • The incision is closed with stitches or staples. The wound is bandaged and the hand is placed in a protective device to keep it still while it heals.
  • You are moved to recovery until your anesthesia wears off.
  • Depending on the type of surgery you are having, you may be able to go home the same day.

When will I know the results?

Full recovery from basal joint surgery can take several months.

What are follow-up requirements and options?

Your doctor may want to set several follow-up appointments to check your progress while you heal. You will likely need to see a physical therapist to help you regain strength and motion in your thumb and hand.