Home
English
English தமிழ் Português 中文 Tiếng Việt Filipino ਪੰਜਾਬੀ Automatic translation — English is the definitive version.
Education · hand

Basal Thumb Arthritis Info Evidence

Reviewed by Dr Kieran Hirpara, Specialist Orthopaedic Surgeon Last reviewed

Also on YouTube.

Video transcript

Basal thumb arthritis affects the small joint at the base of the thumb, where it meets the wrist. As the smooth cartilage wears away, this joint becomes painful, especially with pinching and gripping. Everyday tasks like opening jars, turning keys, and twisting lids can become sore and weak. The base of the thumb may ache after use, and over time can look a little more squared-off. It is a common form of arthritis, particularly later in life. Many people manage well for a long time without surgery. A supportive splint rests the joint, and can take the strain out of painful activities. Anti-inflammatory medication, and a cortisone injection into the joint, can give good relief. A hand therapist can show you ways to protect the thumb and keep it working. When these measures are no longer enough, an operation can help. There are two main operations for a worn-out thumb joint. The long-established option is a trapeziectomy, where the small arthritic bone at the base of the thumb is removed, so the painful surfaces no longer rub together. A newer option is a joint replacement, known as a Touch arthroplasty, where the worn joint is replaced with a small ball-and-socket implant, much like a miniature hip replacement, that lets the thumb move and pinch again. Both are done through a small incision at the base of the thumb, and aim to relieve the pain while keeping the thumb working. You go home the same day, with the thumb supported. A hand therapist guides your recovery, which is an important part of a good result. The thumb is protected at first, then eased back into movement as it heals. One reason a joint replacement may be chosen is that movement and strength often return sooner than after a trapeziectomy. Most people are back to light daily tasks over the first few weeks, with pinch and grip building up over the following months. As it settles, the goal is a comfortable thumb, that lets you get back to what you enjoy.

What you're feeling

You likely feel pain at the base of your thumb, right where it meets your wrist. This is where your thumb bone connects to your hand bones. The pain often starts gradually. It may feel like a deep ache or a sharp sting when you move the joint. You might notice swelling or stiffness in this area.

Your symptoms tend to worsen with activities that require pinching or gripping. Simple daily tasks can become difficult. You might struggle to open a jar lid. Turning a key in a lock may hurt. Picking up a heavy coffee mug or a book can trigger pain. Even holding a phone for a long time might feel uncomfortable.

The pain often flares up after you have been using your hand for a while. You may feel stiff when you first wake up in the morning. This stiffness usually loosens up as you move your hand around. However, if you push through the pain, it can lead to a flare-up later in the day.

Some people find that resting their hand helps reduce the discomfort. Others notice that wearing a supportive brace provides relief. Custom-made braces often work better than store-bought ones, especially for your dominant hand. These braces help stabilize the joint and reduce pain during daily activities.

If the arthritis progresses, you might feel a grinding sensation when you move your thumb. The joint may feel less stable. You might find it hard to grasp large objects, like a tennis ball or a watering can. The range of motion in your thumb may decrease, making it harder to spread your fingers wide.

It is common to feel frustrated when simple tasks become challenging. You are not alone in this experience. Many people with basal thumb arthritis face similar difficulties. Understanding these symptoms can help you manage your condition better. Your surgeon can guide you on the best next steps based on how these symptoms affect your life.

What's actually happening

The base of your thumb is a saddle-shaped joint where your thumb bone meets your wrist bone. This area handles most of the force when you grip or pinch. Over time, the smooth cartilage that cushions these bones wears away. This is known as wear-and-tear arthritis. Without that protective layer, the bones rub against each other. This causes pain and stiffness during everyday tasks.

Think of this joint like a car’s shock absorber. The cartilage acts as the cushion that absorbs impact. When it thins out, the metal parts of the joint begin to grind together. Your body may respond by forming extra bone, called bone spurs, around the edges. These spurs can limit movement and catch on surrounding tissues. This mechanical irritation is what makes simple actions like opening a jar difficult.

The stability of this joint relies on strong ligaments, which are tough bands of tissue connecting the bones. The strongest of these is the dorsoradial ligament. In some cases, these ligaments can stretch or tear. This allows the thumb bone to shift out of its normal position, a problem called subluxation. This instability adds to the pain and makes the joint feel loose or weak.

Your surgeon will examine how this joint moves to confirm the diagnosis. They may use specific tests to see if shifting the thumb bone reproduces your pain. These provocative tests help distinguish arthritis in this joint from other wrist issues. Understanding this mechanical breakdown helps explain why rest and splints often provide only temporary relief. The structural wear requires targeted treatment to restore function and reduce discomfort.

What we can do about it

Dr Kieran Hirpara, an upper-limb surgeon at Mater Private Hospital Rockhampton, approaches this condition by matching the treatment to your specific needs. We guide you through a clear pathway that starts with the least invasive options and moves to surgery only if necessary. Patients reach our clinic by GP or physiotherapist referral. A clinic assessment, including history, examination, and imaging where needed, establishes the diagnosis. For degenerative or long-standing problems, we usually try non-operative care first. This includes activity changes, physiotherapy or hand therapy, splinting, and injections. We consider surgery when this has not given enough improvement. For structural or acute problems, surgery may be recommended straight away, without a preceding non-operative trial.

You can start managing pain at home by changing how you use your thumb. Avoid activities that cause sharp pain or require strong pinching. Your physiotherapist will teach you exercises to keep the joint moving and strengthen the surrounding muscles. We often recommend splints to support the joint. Custom thumb orthotics show a greater clinical effect than prefabricated ones for improving function and reducing pain, particularly in the dominant hand. CMC stabilizing splints improve hand function and reduce pain without interfering with pinch strength after four weeks of use. Some evidence suggests that after four weeks, individuals with this arthritis had modest but significantly greater pain relief from Hybrid splints compared to Comfort Cool splints. We advise giving these conservative measures a fair trial before considering further steps.

If pain persists, we discuss medical management options. Pain medication and anti-inflammatories can help control symptoms. Injections into the joint may also provide relief. Cortisone injections reduce inflammation and pain for a limited time. Hyaluronic acid injections aim to lubricate the joint. Platelet-rich plasma (PRP) injections use your own blood components to promote healing. The duration of benefit varies for each type, and we discuss which option suits your situation during our consultation. These treatments aim to reduce pain and improve function, allowing you to continue with daily activities.

Surgery is considered when conservative care has reached its limit and pain continues to affect your life. Our surgical preferences are based on current evidence and your individual anatomy. For example, simple trapeziectomy is an effective operation for osteoarthritis at the base of the thumb. Outcomes of secondary trapeziectomy after failed joint replacement generally do not differ from primary results. Ligament reconstruction and tendon interposition remains a predominant surgical option, though nonprosthetic arthroplasty is showing increased utilization. Total joint arthroplasty may be considered for advanced arthritis, offering superior pain relief and greater improvement in functional disability compared to trapeziectomy with ligamentoplasty. We present these options as a shared decision, ensuring you understand the potential benefits and risks of each path.

What to expect

Your thumb pain and stiffness from wear-and-tear arthritis at the base of the thumb often persist without treatment. You may find daily tasks like opening jars or turning keys become increasingly difficult. If non-operative care does not help, surgery is a reasonable next step. Many patients see significant relief and improved function after treatment.

Recovery feels different depending on the procedure chosen. Some options focus on removing the damaged bone to create space, while others replace the joint with an implant. At one year, patients with joint replacement often report stronger pinch grip and better thumb movement compared to those who have the bone removed alone. However, overall hand function scores are similar between these approaches. You might notice your thumb feels longer or more stable with certain implants.

Outcomes are generally positive, but they vary. Some procedures offer stronger pinch strength, while others carry a lower risk of needing further surgery. For example, some implant options provide better strength but have a higher chance of requiring revision compared to simpler tendon-based repairs. If a joint replacement fails later, a subsequent bone-removal surgery usually works just as well as the first time.

Arthroscopic techniques are an option for some, though they are less common. For younger, very active patients or those with unstable joints, fusing the bones together can restore strong key pinch, though it limits how wide you can open your hand for large objects.

There is no single "best" surgery for everyone. Surgeons do not have a single guideline to follow because high-quality evidence comparing all methods is still evolving. Your surgeon will discuss which path fits your lifestyle and hand needs. Most patients return to normal activities, though full recovery takes time. You should expect a gradual improvement in strength and comfort over several months rather than an instant fix.

When to see someone

Ask for a specialist review if you have persistent pain at the base of your thumb that does not improve with rest. Seek help if you notice weakness, instability, or a sensation of locking or giving way. These symptoms may interfere with your sleep or daily work tasks. A sudden worsening of pain is also a reason to book an appointment. Early assessment helps determine if non-operative treatments, such as custom orthotics, are suitable for you. If these options do not provide relief, your surgeon can discuss surgical pathways, including trapeziectomy or joint replacement, to restore function and reduce discomfort.

Reviewed by Dr Kieran Hirpara · 10 June 2026.

Talk to your treating clinician for advice specific to you.

Evidence & references

Overview

  • Basal thumb arthritis is a common condition [1].
  • A comprehensive history and clinical examination are sufficient for the diagnosis of basal thumb arthritis [1].
  • Osteoarthritis is likely the most common indication for basal joint arthroscopy [13].
  • Chronic pain and inflammation are useful indications for metacarpophalangeal arthroscopy [13].
  • Basal thumb osteoarthritis surgery improves health state utility irrespective of the surgical technique used [6].
  • Trapeziectomy for basal thumb osteoarthritis does not increase the risk of developing wrist osteoarthritis in the long term [2].
  • Long-term clinical outcomes of trapeziectomy for basal thumb arthritis are very positive [5].
  • Interpositioning as an isolated procedure appears clinically to be the preferred treatment for basal thumb arthritis despite greater radiological degradation compared to suspensionplasty [5].
  • Patients who underwent suture-button suspensionplasty (SBS) surgery for thumb CMC osteoarthritis achieve excellent long-term outcomes by maintaining favorable subjective and objective results [9].
  • Some radiographic subsidence occurs over time in patients who underwent suture-button suspensionplasty for thumb CMC osteoarthritis [9].
  • The use of Swanson silastic interposition arthroplasty in revision thumb-base surgery for failed trapeziectomy yields good medium-term results and high satisfaction rates [8].
  • Swanson silastic interposition arthroplasty is advocated as an effective treatment option for revision thumb-base surgery provided other treatable causes of poor outcome are excluded [8].
  • Pyrocarbon implants are used for the surgical treatment of basal thumb arthritis [10].
  • The Artelon CMC Spacer is no longer used for the management of basal joint arthritis of the thumb due to an unacceptably high complication rate [11].
  • Porous Polyurethaneurea (Artelon) Joint Spacer use has been abandoned for the treatment of basilar thumb osteoarthritis [17].
  • Denervation, joint lavage, and capsular imbrication could be a good alternative to more invasive surgical options in patients with earlier stages of thumb carpometacarpal joint osteoarthritis [20].
  • Denervation, joint lavage, and capsular imbrication offer advantages including a low rate of complications, low invasiveness, and short recovery times [20].

Anatomy & Pathophysiology

  • Thumb basal joint arthritis is a progressive disease [4].
  • A reduction in cylindrical grasp is associated with early symptomatic and radiographic CMC OA [12].
  • Gross grasp is not associated with early thumb CMC OA [12].
  • Wrist biomechanics are significantly altered following trapeziectomy [30].
  • Ligament reconstruction with tendon interposition (LRTI) most closely resembles intact wrist biomechanics in a cadaveric model [30].
  • Total joint arthroplasty restores thumb function but cannot fully replicate the kinematics of the healthy TMC joint [31].
  • Kinematic analysis of the thumb CMC joint differentiates surgical treatments used for end-stage OA [32].
  • Thumb motion capability is unaffected by sex and handedness [33].
  • A rationale for dynamic stabilization of the thumb is based on its unique anatomy [34].
  • The inter-metacarpal distance method is the most reliable tool for measuring thumb abduction [35].
  • Surgical treatment is usually indicated to restore the anatomy and biomechanics of the trapeziometacarpal joint in fractures and dislocations of the base of the thumb metacarpal, as conservative treatment often yields poor results [36].
  • Thumbs in patients with TMC-OA have different kinematics during first dorsal interosseous (FDI) maneuvers compared to healthy thumbs [37].
  • An atrophic FDI may not be an efficient dynamic stabilizer [37].
  • During thumb oppositional motion, internal rotation of the first metacarpal occurs, with the palmar base rotating primarily with respect to the dorsal base [38].
  • The position of the thumb metacarpophalangeal joint exerts a strong influence on contact-pressure patterns in the trapeziometacarpal joint [39].
  • Metacarpophalangeal joint flexion shifts the center of pressure in the trapeziometacarpal joint dorsally [39].
  • Metacarpophalangeal joint hyperextension produces the most palmar contact pattern in the trapeziometacarpal joint [39].
  • Trapeziectomy results in proximal migration of the first metacarpal [40].
  • Suture suspensionplasty mitigates proximal migration of the first metacarpal while maintaining normal motion [40].
  • Proximal migration of the thumb metacarpal does not appear to influence functional outcome [41].
  • Altered thumb rotation patterns during pinch may contribute to joint misalignment and the development of osteoarthritis [42].
  • Automated analysis of TMC joint kinematics using four-dimensional computed tomography significantly decreases analysis time [43].
  • Ergonomic solutions are necessary to decrease thumb motions or strenuous effort at work, especially for women, to reduce the risk of thumb CMC osteoarthritis [44].
  • Carpometacarpal and metacarpophalangeal joint collapse is associated with increased pain but not functional impairment in persons with thumb CMC osteoarthritis [45].
  • Directionally coupled motion patterns in the CMC joint are similar in men and women [46].

Classification

  • Basal thumb arthritis is a common condition where a comprehensive history and clinical examination are sufficient for diagnosis [1].
  • Thumb basal joint arthritis is a progressive disease with substantial new biomechanical and longitudinal clinical studies changing prevailing opinions on serial degenerative changes [4].
  • Subjects presenting with early CMC OA had significantly lower bone density as assessed with HU at the thumb CMC joint (trapezium and first metacarpal base) [7].
  • The metacarpal surface of the trapezium demonstrates three distinct patterns of wear in arthritic surgical specimens [26].
  • Radiological imaging of the trapeziometacarpal joint involves various measurements and classifications used to evaluate the joint [19].
  • The radiological classification does not describe all stages of carpometacarpal joint osteoarthritis accurately enough to permit reliable and consistent communication between clinicians [25].
  • There is not a reliable system for classification of disease severity in CMC joint disease based on radiographs [28].
  • Ulnar instability should be included in the classification of thumb CMCj osteoarthritis stages and considered in treatment options [55].

Clinical Presentation

  • Basal thumb arthritis is a common condition [1].
  • A comprehensive history and clinical examination are sufficient for the diagnosis of basal thumb arthritis [1].
  • Thumb basal joint arthritis is a progressive disease [4].
  • Serial degenerative changes in thumb basal joint arthritis are described by new biomechanical and longitudinal clinical studies [4].
  • Radiographic development of trapeziometacarpal arthrosis is an expected part of human aging [27].
  • Clinically significant, functionally limiting trapeziometacarpal arthrosis is less common than radiographic development [27].
  • The development of clinically significant trapeziometacarpal arthrosis may be unrelated to hand use [27].
  • Subjects with early thumb carpometacarpal joint osteoarthritis have significantly lower bone density at the trapezium and first metacarpal base as assessed with Hounsfield Units [7].
  • A reduction in cylindrical grasp strength is associated with early symptomatic and radiographic thumb carpometacarpal osteoarthritis [12].
  • Gross grasp is not associated with early thumb carpometacarpal osteoarthritis [12].
  • Cylindrical grasp may be a better tool than gross grasp to detect changes in thumb and hand function during early disease stages [12].
  • Power Doppler ultrasound has a significant relationship with pain severity in thumb base osteoarthritis, suggesting it may be useful for understanding pain aetiology [22].
  • The high prevalence of other symptomatic hand disorders requires a complete and standardized clinical examination of the hand to consider these disorders during surgical planning [21].
  • Osteoarthritis is likely the most common indication for basal joint arthroscopy [13].
  • Chronic pain and inflammation are useful indications for metacarpophalangeal arthroscopy [13].
  • The metacarpal surface of the trapezium demonstrates three distinct patterns of wear in arthritic surgical specimens [26].

Investigations

  • A comprehensive history and clinical examination are sufficient for the diagnosis of basal thumb arthritis [1].
  • Radiographic development of trapeziometacarpal arthrosis is an expected part of human aging [27, 62].
  • Clinically significant, functionally limiting trapeziometacarpal arthrosis is less common than radiographic changes [27, 62].
  • The development of clinically significant trapeziometacarpal arthrosis may be unrelated to hand use [27].
  • Subjects with early CMC OA have significantly lower bone density at the thumb CMC joint (trapezium and first metacarpal base) as assessed with Hounsfield Units (HU) [7].
  • The volar-ulnar quadrant of the trapezium has significantly greater trabecular bone volume, thickness, and connectivity compared to the dorsal-radial and dorsal-ulnar quadrants [58].
  • The greatest compressive loads at the first carpometacarpal joint occur at the volar-ulnar quadrant of the trapezium [58].
  • The volar-ulnar quadrant of the trapezium represents a consistently affected region of wear in both normal and arthritic states [58].
  • A reduction in cylindrical grasp strength is associated with early symptomatic and radiographic CMC OA [12].
  • Gross grasp is not associated with early thumb CMC OA [12].
  • Cylindrical grasp may be a better tool than gross grasp to detect changes in thumb and hand function during early disease stages [12].
  • Power Doppler ultrasound has a significant relationship with pain severity in thumb base OA, suggesting it may be useful in understanding pain aetiology [22].
  • Radiological imaging reviews provide an overview of different radiological views, historical origins, positioning, measurements, and classifications used to evaluate the trapeziometacarpal joint [19].
  • Radiographic classification of osteoarthritis at the trapeziometacarpal joint does not describe all stages of CMC joint OA accurately enough to permit reliable and consistent communication between clinicians [25].
  • Radiographs assist in the assessment of CMC joint disease, but there is not a reliable system for classification of disease severity [28].
  • A negative grind test does not necessarily reflect negative radiographic evidence of thumb CMC osteoarthritis [63].
  • Wrist radiographs demonstrate 47% sensitivity and 94% specificity in predicting end-stage ST joint arthritis [56].
  • Direct visualization of the ST joint is important after trapeziectomy due to the limitations of wrist radiographs in predicting end-stage ST joint arthritis [56].

Treatment

Non-Operative Management

  • Nonoperative modalities are effective for early stages of degenerative arthritis of the thumb carpometacarpal (CMC) joint [48].
  • Surgical options for thumb CMC arthritis are reserved for cases refractory to conservative measures [48].
  • Denervation, joint lavage, and capsular imbrication are good alternative treatments for earlier stages of thumb CMC joint osteoarthritis, offering a low rate of complications, low invasiveness, and short recovery times [20].

Arthroscopic Techniques

  • Osteoarthritis is likely the most common indication for basal joint arthroscopy [13].
  • Chronic pain and inflammation are useful indications for metacarpophalangeal arthroscopy [13].
  • The use of arthroscopic-assisted techniques for thumb CMC osteoarthritis is still limited but may be a reasonable option for patients who do not respond to non-operative treatment [53].

Trapeziectomy and Interposition/Suspensionplasty

  • Trapeziectomy with interposition or suspensionplasty yields very positive long-term clinical outcomes [5].
  • Interpositioning as an isolated procedure appears to be the preferred treatment clinically, despite greater radiological degradation compared to suspensionplasty [5].
  • Suture-button suspensionplasty (SBS) achieves excellent long-term outcomes by maintaining favorable subjective and objective results, despite some radiographic subsidence over time [9].
  • Suture-button suspensionplasty (SBS) achieves excellent long-term outcomes by maintaining favorable subjective and objective results, despite some radiographic subsidence over time [16].
  • The multiplicity of treatment modalities for carpometacarpal joint arthritis suggests that underlying trapezium excision is probably the prime factor in patients' clinical improvement [15].
  • Thumb index metacarpal stabilization needs to be based on each individual clinical scenario [15].
  • Trapeziectomy for basal thumb osteoarthritis does not increase the risk of developing wrist osteoarthritis in the long term [2].

Joint Replacement and Implants

  • Health state utility gains occur after basal thumb osteoarthritis surgery regardless of the surgical techniques used [6].
  • The ISISVR prosthesis is a reliable implant for treating disabling thumb basal joint arthritis, with a low complication rate and long-lasting clinical and functional improvements [18].
  • Pyrocarbon implants are used for the surgical treatment of basal thumb arthritis [10].
  • The Artelon CMC Spacer is no longer used for the management of basal joint arthritis of the thumb due to an unacceptably high complication rate [11].
  • The use of Porous Polyurethaneurea (Artelon) Joint Spacer has been abandoned for the treatment of basilar thumb osteoarthritis due to findings indicating poor outcomes or high complications [17].

Revision Surgery

  • Swanson silastic interposition arthroplasty is an effective treatment option for revision thumb-base surgery for failed trapeziectomy, showing good medium-term results and high satisfaction rates, provided other treatable causes of poor outcome are excluded [8].

Complications and Outcomes

  • Common complications after surgery for basal thumb arthritis include those associated with resection arthroplasty, joint replacement, and joint fusion, with specific management strategies available for different types of complications [3].
  • Despite 70 years of research and numerous treatment options, the best management for trapeziometacarpal arthritis remains debated, with a constant proportion of patients remaining unhappy or symptomatic post-surgery [52].

Ongoing Research

  • The SCOOTT trial is a multicentre, three-arm randomized controlled trial designed to determine the clinical and cost-effectiveness of treating basal osteoarthritis of the thumb with or without surgery, and to compare trapeziectomy versus thumb CMC joint arthrodesis (CMCJA) [51].

Complications

  • Basal thumb arthritis surgery complications are reviewed for resection arthroplasty, joint replacement, and joint fusion, including management strategies [3].
  • Trapeziectomy for basal thumb osteoarthritis does not increase the risk of developing wrist osteoarthritis in the long term [2].
  • Long-term clinical outcomes of trapeziectomy are very positive, with interpositioning appearing clinically preferred despite greater radiological degradation compared to suspensionplasty [5].
  • Health state utility gains after basal thumb osteoarthritis surgery occur irrespective of the surgical technique used [6].
  • Revision thumb-base surgery using Swanson silastic interposition arthroplasty yields good medium-term results and high satisfaction rates, provided other treatable causes of poor outcome are excluded [8].
  • The Artelon CMC Spacer is no longer used for the management of basal joint arthritis of the thumb due to an unacceptably high complication rate [11].
  • Simultaneous dual prosthetic replacement of the trapeziometacarpal and scaphotrapezial-trapezoid joints in pantrapezial osteoarthritis achieves a low complication rate [14].
  • Suture-button suspensionplasty (SBS) for thumb CMC osteoarthritis maintains favorable subjective and objective results despite some radiographic subsidence over time [9, 16].
  • The ISISVR prosthesis is a reliable implant for treating disabling thumb basal joint arthritis, with a low complication rate and long-lasting clinical and functional improvements [18].

Recovery

  • Basal thumb arthritis is a common condition where a comprehensive history and clinical examination are sufficient for diagnosis [1].
  • Thumb basal joint arthritis is a progressive disease with substantial new biomechanical and longitudinal clinical studies changing prevailing opinions on serial degenerative changes [4].
  • Subjects presenting with early CMC OA had significantly lower bone density as assessed with HU at the thumb CMC joint (trapezium and first metacarpal base) [7].
  • Increased degenerate-like changes were observed after simple excision of the trapezium at 6-year followup but these did not influence the clinical outcome [64].
  • Trapeziectomy for basal thumb osteoarthritis does not increase the risk of developing wrist osteoarthritis in the long term [2].
  • Long-term clinical outcomes of trapeziectomy for basal thumb arthritis are very positive, with interpositioning as an isolated procedure appearing, clinically, to be the preferred treatment despite greater radiological degradation when compared to suspensionplasty [5].
  • The use of Swanson silastic interposition arthroplasty in revision thumb-base surgery for failed trapeziectomy yields good medium-term results and high satisfaction rates, advocating the technique as an effective treatment option for revision thumb-base surgery provided other treatable causes of poor outcome are excluded [8].
  • Patients who underwent SBS surgery for thumb CMC osteoarthritis achieve excellent long-term outcomes by maintaining favorable subjective and objective results, despite some radiographic subsidence over time [9].
  • The SSA technique for thumb CMC arthritis reconstruction yields good to excellent long-term clinical outcomes at 12- to 14-year follow-up [54].
  • Simultaneous dual prosthetic replacement of trapeziometacarpal and scaphotrapezial-trapezoid joints in pantrapezial osteoarthritis achieves favorable functional outcomes and a low complication rate, making it a potentially superior alternative for patients with high functional demands or those requiring durable long-term results [14].
  • The ISISVR prosthesis is a reliable implant for treating disabling thumb basal joint arthritis, with a low complication rate and long-lasting clinical and functional improvements at a minimum follow-up of 5 years [18].
  • Outcomes of denervation, joint lavage and capsular imbrication for painful thumb carpometacarpal joint osteoarthritis indicate that this treatment approach could be a good alternative to more invasive surgical options in patients with earlier stages of thumb carpometacarpal joint osteoarthritis, with advantages including a low rate of complications, low invasiveness, and short recovery times [20].
  • Basal thumb osteoarthritis surgery improves health state utility irrespective of technique [6].
  • Advanced radiographic arthritis, current smoking status, and a history of ipsilateral hand surgery were patient-specific factors that predicted progression to surgery following injection [29].
  • Patients treated with hand therapy had significantly longer times to surgery, and the 2-year surgery rates were significantly higher in those who did not undergo therapy treatment [65].

Key Evidence

  • [L4] Basal thumb arthritis is a common condition where a comprehensive history and clinical examination are sufficient for diagnosis. [1] (10.1136/pgmj.2006.046300)
  • [L3] Removal of the trapezium as treatment for basal thumb osteoarthritis does not increase the risk of developing wrist osteoarthritis in the long term. [2] (10.1186/s13018-021-02856-x)
  • [L5] The article reviews the most common complications after surgery for basal thumb arthritis, emphasizing resection arthroplasty, joint replacement, and joint fusion, and highlights possible management strategies for the different types of complications. [3] (10.1177/17531934231197787)
  • [L5] Thumb basal joint arthritis is a progressive disease with substantial new biomechanical and longitudinal clinical studies changing prevailing opinions on serial degenerative changes. [4] (10.5435/jaaos-d-17-00374)
  • [L3] Long-term clinical outcomes of trapeziectomy for basal thumb arthritis are very positive, with interpositioning as an isolated procedure appearing, clinically, to be the preferred treatment despite greater radiological degradation when compared to suspensionplasty. [5] (10.1016/j.otsr.2016.08.014)
  • [L3] This study demonstrates health state utility gains after basal thumb osteoarthritis surgery regardless of surgical techniques used. [6] (10.1177/1753193420909753)
  • [L2] Subjects presenting with early CMC OA had significantly lower bone density as assessed with HU at the thumb CMC joint (trapezium and first metacarpal base). [7] (10.1016/j.jhsa.2017.09.004)
  • [L4] The study found good medium-term results and high satisfaction rates, advocating the technique as an effective treatment option for revision thumb-base surgery provided other treatable causes of poor outcome are excluded. [8] (10.1177/1753193412447496)
  • [L4] Patients who underwent SBS surgery for thumb CMC osteoarthritis achieve excellent long-term outcomes by maintaining favorable subjective and objective results, despite some radiographic subsidence over time. [9] (10.1016/j.jhsg.2023.12.002)
  • [L4] This paper focuses on the surgical techniques and outcomes of pyrocarbon implants for the treatment of basal thumb arthritis. [10] (10.1016/j.hansur.2020.08.012)
  • [L4] Due to an unacceptably high complication rate, we no longer use the Artelon CMC Spacer for the management of basal joint arthritis of the thumb. [11] (10.1016/j.jht.2013.12.001)
  • [L3] A reduction in cylindrical grasp is associated with early symptomatic and radiographic CMC OA, whereas gross grasp is not associated with early thumb CMC OA, suggesting that cylindrical grasp may be a better tool to detect changes in thumb and hand function seen during early disease stages. [12] (10.1007/s11999-016-5151-2)
  • [L5] Osteoarthritis will likely remain the most common indication for basal joint arthroscopy while chronic pain and inflammation are useful indications for metacarpophalangeal arthroscopy. [13] (10.1016/j.jhsa.2007.02.020)
  • [L4] By preserving carpal stability and thumb function, this approach achieves favorable functional outcomes and a low complication rate, making it a potentially superior alternative for patients with high functional demands or those requiring durable long-term results. [14] (10.1016/j.jhsa.2025.12.013)
  • [L5] The multiplicity of treatment modalities for carpometacarpal joint arthritis shows that the underlying trapezium excision is probably the prime factor in patients' clinical improvement, and thumb index metacarpal stabilization needs to be based on each individual clinical scenario. [15] (10.1016/j.jhsa.2007.02.013)
  • [L4] Our findings demonstrate that patients who underwent SBS surgery for thumb CMC osteoarthritis achieve excellent long-term outcomes by maintaining favorable subjective and objective results, despite some radiographic subsidence over time. [16] (10.1016/j.jhsg.2025.100855)
  • [L3] Due to these findings, we have abandoned its use for treatment of basilar thumb osteoarthritis. [17] (10.1016/j.jhsa.2013.05.013)
  • [L4] The ISISVR prosthesis is a reliable implant for treating disabling thumb basal joint arthritis, with a low complication rate and long-lasting clinical and functional improvements. [18] (10.1177/17531934221123166)
  • [L5] This review provides an overview of different radiological views described for the thumb, emphasizing their historical origin and positioning, and describes various measurements and classifications used to evaluate the trapeziometacarpal joint. [19] (10.1177/17531934221137979)
  • [L4] The findings indicate that the presented treatment approach could be a good alternative to more invasive surgical options in patients with earlier stages of thumb carpometacarpal joint osteoarthritis, with advantages including a low rate of complications, low invasiveness, and short recovery times. [20] (10.1177/1753193416632149)
  • [L3] The high prevalence of other symptomatic disorders of the hand requires a complete and standardized clinical examination of the hand, as they must be considered during surgical planning. [21] (10.1177/17531934231220644)
  • [L4] The significant relationship of power Doppler with pain severity in thumb base OA suggests this might be a useful tool in understanding pain aetiology. [22] (10.1186/s12891-019-2610-4)
  • [L3] The radiological classification does not describe all stages of carpometacarpal joint osteoarthritis accurately enough to permit reliable and consistent communication between clinicians. [25] (10.1016/j.jhsa.2014.09.007)
  • [L5] Radiographic development of trapeziometacarpal arthrosis is an expected part of human aging, although clinically significant, functionally limiting trapeziometacarpal arthrosis is less common, and its development may be unrelated to hand use. [27] (10.1016/j.jhsa.2015.04.038)
  • [L1] Review of the literature demonstrates that radiographs assist in the assessment of CMC joint disease, but there is not a reliable system for classification of disease severity. [28] (10.1007/s11999-013-3208-z)
  • [L4] Advanced radiographic arthritis, current smoking status, and a history of ipsilateral hand surgery were patient-specific factors that predicted progression to surgery following injection. [29] (10.1016/j.jhsa.2020.03.025)
  • [L5] Wrist biomechanics were significantly altered following trapeziectomy, and of the reconstructions tested, LRTI most closely resembled the intact biomechanics in this cadaveric model. [30] (10.1016/j.jhsa.2019.10.003)
  • [L4] We also showed that, whereas total joint arthroplasty is able to restore thumb function, it cannot fully replicate the kinematics of the healthy TMC joint. [31] (10.1016/j.jhsa.2017.10.011)
  • [L5] Kinematic analysis of the thumb CMC joint is effective in differentiating surgical treatments used for end-stage OA. [32] (10.1016/j.jhsa.2007.02.009)
  • [L3] Thumb motion capability was unaffected by sex and handedness. [33] (10.1016/j.jhsa.2014.08.012)
  • [L5] A rationale for a dynamic stabilization approach is presented based on the unique anatomy of the thumb. [34] (10.1016/j.jht.2022.06.007)
  • [L4] Currently, it is the most reliable tool for measuring thumb abduction. [35] (10.1016/j.jht.2021.03.001)
  • [L4] Surgical treatment is usually indicated to restore the anatomy and biomechanics of the trapeziometacarpal joint, as conservative treatment often yields poor results. [36] (10.1177/1753193414554357)
  • [L4] Thumbs in patients with TMC-OA and healthy thumbs have different kinematics during FDI maneuvers, and an atrophic FDI may not be an efficient dynamic stabilizer. [37] (10.1016/j.jhsa.2024.12.018)
  • [L5] During thumb oppositional motion, internal rotation of the first metacarpal occurred, with the palmar base rotating primarily with respect to the dorsal base. [38] (10.1016/j.jhsa.2017.07.028)
  • [L5] The position of the thumb metacarpophalangeal joint exerts a strong influence on contact-pressure patterns in the trapeziometacarpal joint, with flexion shifting the center of pressure dorsally and hyperextension producing the most palmar contact pattern. [39] (10.2106/00004623-200105000-00009)
  • [L5] This biomechanical cadaver study supports the hypothesis that trapeziectomy results in proximal migration of the first metacarpal, which is mitigated by suture suspensionplasty while maintaining normal motion. [40] (10.1016/j.jhsa.2022.05.001)
  • [L1] Furthermore, proximal migration of the thumb metacarpal does not appear to influence the functional outcome. [41] (10.2106/jbjs.d.02630)
  • [L3] Altered thumb rotation patterns during pinch may contribute to joint misalignment and the development of osteoarthritis. [42] (10.1177/17531934251383073)
  • [L4] The automated approach significantly decreased the time needed to analyse each case and makes this model applicable for further research on TMC kinematics. [43] (10.1177/17531934241229948)
  • [L3] Ergonomic solutions are necessary to decrease thumb motions or strenuous effort encountered at work, especially for women. [44] (10.1016/j.jhsa.2007.01.014)
  • [L3] Future studies should determine the relationship between thumb hypermobility and joint collapse and how to manage these conditions effectively. [45] (10.1016/j.jht.2020.07.003)
  • [L4] Directionally coupled motion patterns in the CMC joint are similar in men and women. [46] (10.1007/s11999-013-3063-y)
  • [Paper] Degenerative arthritis of the thumb CMC joint is a common treatable condition where nonoperative modalities are effective for early stages, while surgical options are reserved for cases refractory to conservative measures. [48] (10.1016/j.hcl.2008.03.001)
  • [L2] The SCOOTT trial is a multicentre, three-arm randomized controlled trial designed to determine the clinical and cost-effectiveness of treating basal osteoarthritis of the thumb with or without surgery, and to compare trapeziectomy versus thumb CMCJA. [51] (10.1302/0301-620x.108b1.bjj-2025-0483.r1)
  • [L5] The author notes that despite 70 years of research and numerous treatment options, the best management for trapeziometacarpal arthritis remains debated, with a constant proportion of patients remaining unhappy or symptomatic post-surgery. [52] (10.1177/17531934221122987)
  • [L1] The use of arthroscopic-assisted techniques for thumb CMC OA is still limited; however, it may be a reasonable option for patients with thumb CMC OA who do not respond to non-operative treatment. [53] (10.1177/1753193418757122)
  • [L4] The SSA technique for thumb CMC arthritis reconstruction yields good to excellent long-term clinical outcomes. [54] (10.1177/15589447211003176)
  • [L3] Wrist radiographs demonstrate a 47% sensitivity and 94% specificity in predicting end-stage ST joint arthritis, emphasizing the importance of directly visualizing the ST joint after trapeziectomy. [56] (10.1177/1558944718765246)
  • [L4] The significantly greater trabecular bone volume, thickness, and connectivity in the volar-ulnar quadrant compared with the dorsal-radial and dorsal-ulnar quadrants provides evidence that the greatest compressive loads at the first carpometacarpal joint occur at the volar-ulnar quadrant of the trapezium, representing a consistently affected region of wear in both normal and arthritic states. [58] (10.1016/j.jhsa.2012.10.038)
  • [L5] Radiographic development of trapeziometacarpal arthrosis is an expected part of human aging, although clinically significant, functionally limiting trapeziometacarpal arthrosis is less common. [62] (10.1016/j.jhsa.2015.04.042)
  • [L3] However, a negative grind test does not necessarily reflect negative radiographic evidence of thumb CMC osteoarthritis. [63] (10.1016/j.jht.2010.02.001)
  • [L2] Increased degenerate-like changes were observed after simple excision of the trapezium but these did not influence the clinical outcome. [64] (10.1007/s11999-013-2956-0)
  • [L2] Patients treated with hand therapy had significantly longer times to surgery, and the 2-year surgery rates were significantly higher in those who did not undergo therapy treatment. [65] (10.1016/j.jhsa.2023.05.019)

References

[1] Basal thumb arthritis. Postgraduate Medical Journal. 2007. DOI: 10.1136/pgmj.2006.046300 [2] Trapeziectomy for basal thumb osteoarthritis does not increase the risk of developing wrist osteoarthritis in the long term. Journal of Orthopaedic Surgery and Research. 2021. DOI: 10.1186/s13018-021-02856-x [3] Basal thumb arthritis surgery: complications and its management. Journal of Hand Surgery (European Volume). 2024. DOI: 10.1177/17531934231197787 [4] Thumb Basal Joint Arthritis. Journal of the American Academy of Orthopaedic Surgeons. 2018. DOI: 10.5435/jaaos-d-17-00374 [5] Minimum 10-year clinical and radiological follow-up of trapeziectomy with interposition or suspensionplasty for basal thumb arthritis. Orthopaedics & Traumatology: Surgery & Research. 2016. DOI: 10.1016/j.otsr.2016.08.014 [6] Basal thumb osteoarthritis surgery improves health state utility irrespective of technique: a study of UK Hand Registry data. Journal of Hand Surgery (European Volume). 2020. DOI: 10.1177/1753193420909753 [7] Changes in Local Bone Density in Early Thumb Carpometacarpal Joint Osteoarthritis. The Journal of Hand Surgery. 2018. DOI: 10.1016/j.jhsa.2017.09.004 [8] The use of Swanson silastic interposition arthroplasty in revision thumb-base surgery for failed trapeziectomy; a case series of 10 patients. Journal of Hand Surgery (European Volume). 2012. DOI: 10.1177/1753193412447496 [9] Long-Term Results of Suture-Button Suspensionplasty in the Treatment of Thumb Carpometacarpal Arthritis: A Minimum 10-Year Follow-Up. Journal of Hand Surgery Global Online. 2024. DOI: 10.1016/j.jhsg.2023.12.002 [10] Pyrocarbon implants for the basal thumb arthritis. Hand Surgery and Rehabilitation. 2021. DOI: 10.1016/j.hansur.2020.08.012 [11] The use of the Artelon CMC Spacer for osteoarthritis of the basal joint of the thumb. Journal of Hand Therapy. 2014. DOI: 10.1016/j.jht.2013.12.001 [12] Reduction in Cylindrical Grasp Strength Is Associated With Early Thumb Carpometacarpal Osteoarthritis. Clinical Orthopaedics & Related Research. 2017. DOI: 10.1007/s11999-016-5151-2 [13] Arthroscopy of the Trapeziometacarpal and Metacarpophalangeal Joints. The Journal of Hand Surgery. 2007. DOI: 10.1016/j.jhsa.2007.02.020 [14] Simultaneous Dual Prosthetic Replacement of Trapeziometacarpal and Scaphotrapezial-Trapezoid Joints in Pantrapezial Osteoarthritis: Midterm Results of a Combined Implant Strategy. The Journal of Hand Surgery. 2026. DOI: 10.1016/j.jhsa.2025.12.013 [15] Extensor Carpi Radialis Longus Technique for Thumb Arthritis. The Journal of Hand Surgery. 2007. DOI: 10.1016/j.jhsa.2007.02.013 [16] WITHDRAWN: Long-Term Results of Suture-Button Suspensionplasty in the Treatment of Thumb Carpometacarpal Arthritis: A Minimum 10-Year Follow-Up. Journal of Hand Surgery Global Online. 2025. DOI: 10.1016/j.jhsg.2025.100855 [17] Porous Polyurethaneurea (Artelon) Joint Spacer Compared to Trapezium Resection and Ligament Reconstruction. The Journal of Hand Surgery. 2013. DOI: 10.1016/j.jhsa.2013.05.013 [18] The ISIS® prosthesis in 77 cases of trapeziometacarpal arthritis: outcomes and survival at a minimum follow-up of 5 years. Journal of Hand Surgery (European Volume). 2022. DOI: 10.1177/17531934221123166 [19] Radiological imaging of the trapeziometacarpal joint: a historical and clinical perspective. Journal of Hand Surgery (European Volume). 2022. DOI: 10.1177/17531934221137979 [20] Outcomes of denervation, joint lavage and capsular imbrication for painful thumb carpometacarpal joint osteoarthritis. Journal of Hand Surgery (European Volume). 2016. DOI: 10.1177/1753193416632149 [21] Trapeziometacarpal osteoarthritis: do not forget other disorders. Journal of Hand Surgery (European Volume). 2023. DOI: 10.1177/17531934231220644 [22] Musculoskeletal ultrasound in symptomatic thumb-base osteoarthritis: clinical, functional, radiological and muscle strength associations. BMC Musculoskeletal Disorders. 2019. DOI: 10.1186/s12891-019-2610-4 [25] Inter- and Intrarater Reliability of Osteoarthritis Classification at the Trapeziometacarpal Joint. The Journal of Hand Surgery. 2015. DOI: 10.1016/j.jhsa.2014.09.007 [26] 10.1055-s-0033-1350088. n.d.. [27] Epidemiology of Trapeziometacarpal Arthrosis. The Journal of Hand Surgery. 2015. DOI: 10.1016/j.jhsa.2015.04.038 [28] Intra- and Interobserver Reliability of the Eaton Classification for Trapeziometacarpal Arthritis: A Systematic Review. Clinical Orthopaedics & Related Research. 2014. DOI: 10.1007/s11999-013-3208-z [29] Thumb Carpometacarpal Arthritis: Prognostic Indicators and Timing of Further Intervention Following Corticosteroid Injection. The Journal of Hand Surgery. 2020. DOI: 10.1016/j.jhsa.2020.03.025 [30] The Effect of Surgical Treatments for Trapeziometacarpal Osteoarthritis on Wrist Biomechanics: A Cadaver Study. The Journal of Hand Surgery. 2020. DOI: 10.1016/j.jhsa.2019.10.003 [31] Impact of Osteoarthritis and Total Joint Arthroplasty on the Kinematics of the Trapeziometacarpal Joint: A Pilot Study. The Journal of Hand Surgery. 2018. DOI: 10.1016/j.jhsa.2017.10.011 [32] Joint Kinematics After Thumb Carpometacarpal Joint Reconstruction: An In Vitro Comparison of Various Constructs. The Journal of Hand Surgery. 2007. DOI: 10.1016/j.jhsa.2007.02.009 [33] Effect of Carpometacarpal Joint Osteoarthritis, Sex, and Handedness on Thumb In Vivo Kinematics. The Journal of Hand Surgery. 2014. DOI: 10.1016/j.jhsa.2014.08.012 [34] Dynamic stabilization of the painful thumb: A historical and evidence-informed synthesis. Journal of Hand Therapy. 2022. DOI: 10.1016/j.jht.2022.06.007 [35] Thumb carpometacarpal palmar and radial abduction in adults with thumb carpometacarpal joint pain: Inter-rater reliability and precision of the inter-metacarpal distance method. Journal of Hand Therapy. 2022. DOI: 10.1016/j.jht.2021.03.001 [36] Fractures and dislocation of the base of the thumb metacarpal. Journal of Hand Surgery (European Volume). 2014. DOI: 10.1177/1753193414554357 [37] Kinematics of Trapeziometacarpal Joint During First Dorsal Interosseous Maneuver in Osteoarthritic Patients: An Imaging Study Using Real-Time Magnetic Resonance Imaging and Ultrasonography. The Journal of Hand Surgery. 2025. DOI: 10.1016/j.jhsa.2024.12.018 [38] In Vivo 3-Dimensional Kinematics of Thumb Carpometacarpal Joint During Thumb Opposition. The Journal of Hand Surgery. 2018. DOI: 10.1016/j.jhsa.2017.07.028 [39] Influence of Metacarpophalangeal Joint Position on Basal Joint-Loading in the Thumb. The Journal of Bone and Joint Surgery-American Volume. 2001. DOI: 10.2106/00004623-200105000-00009 [40] First Carpometacarpal Joint Motion and Proximal Migration of the First Metacarpal After Tensioning of a Suture Device Suspensionplasty Compared With Trapeziectomy: A Biomechanical Cadaver Study. The Journal of Hand Surgery. 2023. DOI: 10.1016/j.jhsa.2022.05.001 [41] Ligament Reconstruction with or without Tendon Interposition to Treat Primary Thumb Carpometacarpal Osteoarthritis. Journal of Bone and Joint Surgery. 2005. DOI: 10.2106/jbjs.d.02630 [42] Thumb rotation patterns during pinch in patients with trapeziometacarpal osteoarthritis. Journal of Hand Surgery (European Volume). 2025. DOI: 10.1177/17531934251383073 [43] Automated analysis of trapeziometacarpal joint kinematics using four-dimensional computed tomography. Journal of Hand Surgery (European Volume). 2024. DOI: 10.1177/17531934241229948 [44] Osteoarthritis of the Thumb Carpometacarpal Joint in Women and Occupational Risk Factors: A Case–Control Study. The Journal of Hand Surgery. 2007. DOI: 10.1016/j.jhsa.2007.01.014 [45] Carpometacarpal and metacarpophalangeal joint collapse is associated with increased pain but not functional impairment in persons with thumb carpometacarpal osteoarthritis. Journal of Hand Therapy. 2021. DOI: 10.1016/j.jht.2020.07.003 [46] In Vivo Kinematics of the Thumb Carpometacarpal Joint During Three Isometric Functional Tasks. Clinical Orthopaedics & Related Research. 2014. DOI: 10.1007/s11999-013-3063-y [48] Early Treatment of Degenerative Arthritis of the Thumb Carpometacarpal Joint. Hand Clinics. 2008. DOI: 10.1016/j.hcl.2008.03.001 [51] What is the most effective treatment for basal osteoarthritis of the thumb?. The Bone & Joint Journal. 2026. DOI: 10.1302/0301-620x.108b1.bjj-2025-0483.r1 [52] Trapeziometacarpal arthritis: 70 years after Gervis. Journal of Hand Surgery (European Volume). 2022. DOI: 10.1177/17531934221122987 [53] A systematic review and meta-analysis of arthroscopic assisted techniques for thumb carpometacarpal joint osteoarthritis. Journal of Hand Surgery (European Volume). 2018. DOI: 10.1177/1753193418757122 [54] Suture Suspension Arthroplasty for Thumb Carpometacarpal Arthritis Reconstruction: 12- to 14-Year Follow-up. HAND. 2021. DOI: 10.1177/15589447211003176 [55] 10.1055-s-0039-1697650. n.d.. [56] Comparison of Radiographic and Intraoperative Visual Assessment of Scaphotrapezoid Joint Arthritis in Patients With End-Stage Carpometacarpal Arthritis of the Thumb Base. HAND. 2018. DOI: 10.1177/1558944718765246 [58] Trapezium Trabecular Morphology in Carpometacarpal Arthritis. The Journal of Hand Surgery. 2013. DOI: 10.1016/j.jhsa.2012.10.038 [62] In Reply:. The Journal of Hand Surgery. 2015. DOI: 10.1016/j.jhsa.2015.04.042 [63] Diagnostic Value of Clinical Grind Test for Carpometacarpal Osteoarthritis of the Thumb. Journal of Hand Therapy. 2010. DOI: 10.1016/j.jht.2010.02.001 [64] Degenerative Change at the Pseudarthrosis After Trapeziectomy at 6-year Followup. Clinical Orthopaedics & Related Research. 2014. DOI: 10.1007/s11999-013-2956-0 [65] Is Hand Therapy Associated With a Delay in Surgical Treatment in Thumb Carpometacarpal Arthritis?. The Journal of Hand Surgery. 2025. DOI: 10.1016/j.jhsa.2023.05.019

AffiliationsWhat do these mean? →