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Education · hand

Basal Thumb Arthritis Info In-depth 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 a deep ache at the base of your thumb. This is where your thumb meets your wrist. The pain often starts with daily tasks that require grip or pinch. Opening a jar, turning a key, or lifting a kettle can trigger sharp discomfort. You may notice the joint feels stiff, especially in the morning or after resting your hand.

The pain often worsens with activity. Simple movements like texting, buttoning a shirt, or holding a phone can become difficult. You might feel a grinding sensation or see slight swelling in the area. Over time, the joint may feel unstable, making it hard to hold objects securely. Some days are better than others, but the trend is usually toward increased stiffness and pain with use.

Nighttime pain is common. You may wake up because the thumb throbs or feels sore. This happens because the joint has been working hard all day. Even gentle pressure on the base of the thumb can be tender to touch. If you try to pinch something between your thumb and finger, the pain can be intense. This affects your ability to perform fine motor tasks, like picking up small items or writing for long periods.

We understand how frustrating these limitations can be. Your daily life relies on your hands, and this pain can interfere with simple routines. You are not alone in experiencing these symptoms. Many people with wear-and-tear arthritis at the base of the thumb notice similar patterns. The goal of treatment is to reduce this pain and help you regain strength for the tasks that matter to you.

What's actually happening

Your thumb joint is a saddle-shaped connection between your hand bone and your thumb bone. It allows your thumb to twist and pinch with precision. Over time, the smooth cartilage covering these bones wears away. This is wear-and-tear arthritis. Without this cushion, the bones rub directly against each other.

This friction causes pain and stiffness. You may feel a grinding sensation when you grip objects. The joint can become unstable, making simple tasks like opening jars difficult. In many cases, the base of your thumb bone shifts out of place slightly. This subluxation puts extra stress on the surrounding ligaments. These strong bands of tissue hold the joint together. When they stretch or tear, the joint loses its stability.

In some injuries, the ligaments pull away from the bone with a small piece of tissue attached. This is called an avulsion. While complete dislocations are rare, partial shifts are common. The strongest ligament in this joint, the dorsoradial ligament, often bears the brunt of this stress. If it fails, the joint becomes loose.

Your surgeon looks at these structural changes to understand your pain. The goal is to restore stability and reduce friction. We may recommend surgery if rest and therapy do not help. Options include removing the worn bone or replacing the joint surface. The choice depends on your activity level and joint condition. We aim to relieve your pain while preserving enough movement for daily life.

What we can do about it

Dr Kieran Hirpara, an upper-limb surgeon at Mater Private Hospital Rockhampton, starts with the least invasive options that suit your condition. We begin with self-management and physiotherapy. You can use a stabilizing splint to support the joint. This reduces pain and improves hand function. It does not interfere with your pinch strength after four weeks of use. You may find the Hybrid splint offers modest but significantly greater pain relief than other types after this period. Physiotherapy aims to keep your thumb moving and strong. We usually recommend trying these non-operative measures for a few weeks to see if they help.

If simple measures are not enough, we discuss medical management. This includes pain medication and anti-inflammatories to control discomfort. We may also offer injections into the joint. Cortisone injections can reduce inflammation and pain for a limited time. Hyaluronic acid or PRP (platelet-rich plasma) injections are other options that aim to cushion the joint and promote healing. The effect of these injections varies from person to person. They provide temporary relief while you continue with therapy and activity changes.

Surgery is considered when conservative care has not given enough improvement or if your joint is extremely unstable. We remove the worn bone (trapeziectomy) to create space. We may reconstruct the ligaments using a tendon graft to maintain stability. For some patients, total joint replacement (arthroplasty) provides superior pain relief and greater improvement in function compared to bone removal alone. Arthrodesis (joining the bones) is reserved for younger, highly active individuals who need maximum pinch strength. We discuss the best option for your specific needs during a shared decision-making conversation.

What to expect

Your thumb pain and stiffness usually come from wear-and-tear arthritis at the base of the thumb. This condition tends to persist and slowly progress if left alone. It rarely settles on its own. Without treatment, you may find daily tasks like opening jars or turning keys increasingly difficult. Over time, the joint can become unstable, making grip strength weaker.

If you choose non-surgical care, symptoms often fluctuate. You might have good days and bad days. However, the underlying wear does not reverse. Many people manage well for years with rest and splints, but the structural changes in the joint continue.

When you consider surgery, the outlook depends on the procedure chosen. We offer several options, including removing the worn bone (trapeziectomy) or replacing it with an implant. Most patients see significant pain relief and improved function. For example, total joint replacement often provides better strength and movement range at one year compared to simple bone removal. Other techniques, like using your own tendon to support the joint, have lower risks of needing further surgery.

Recovery is a process, not an instant fix. You will likely wear a splint for a period after surgery to protect the joint. Early movement is often encouraged to prevent stiffness, but heavy lifting is restricted initially. While some implants offer stronger pinch grip, they may carry a slightly higher risk of needing revision surgery later. Simple bone removal remains a reliable, long-lasting option with fewer complications.

Your surgeon will help you weigh these factors. The goal is to reduce pain and restore your ability to use your hand. Most patients return to normal daily activities within weeks to months, though full strength may take longer to build. There is no single "best" procedure for everyone. The right choice depends on your age, activity level, and how unstable the joint feels. We aim to give you a thumb that works well for your life, without making promises about perfect outcomes.

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 if your thumb locks or gives way. These symptoms can interfere with sleep or daily work. Sudden worsening of pain is also a reason to book an appointment. Early assessment helps determine if non-operative treatments like orthotics are suitable, or if surgical options such as trapeziectomy or ligament reconstruction are needed to restore function and reduce discomfort.

Advanced reading: the deeper science (optional)

This section goes further than you need for your own treatment decisions. Thumb base arthritis is worth the extra reading because it is the upper-limb condition where the gap between what patients are offered first and what the evidence supports is widest — and because the surgical options have never separated themselves from one another despite decades of trying.

The non-operative evidence is better than its reputation

Splints and hand therapy are often presented as what you do while waiting for surgery. A systematic review and network meta-analysis of 1,962 patients puts them on firmer ground: multimodal treatment and hand exercises reduced short-term pain and improved grip strength, while a rigid CMC-MCP splint — one that blocks the joint above as well as the thumb base — improved medium-term outcomes [1].

Two details matter. The splint that worked crosses both joints, which is not the soft neoprene sleeve most people are given. And exercise improved grip strength, not merely comfort — this is a joint whose failure is mechanical, and strengthening the muscles that compress and stabilise it is treating the mechanism.

Injection buys weeks, not months

Corticosteroid injection is the usual next step. Pooling 673 patients, intra-articular corticosteroid injection produced short-term improvement but no significant difference in pain and functional outcomes at later follow-up [2].

That is worth hearing plainly. An injection here is a way to get through a defined period — a trip, a deadline, a busy stretch at work — or to confirm the joint is the pain source. It is not a treatment that changes the trajectory, and repeat injections chasing a durable result are chasing something the evidence does not show.

No operation has won

Once surgery is on the table there are several credible options, and the striking thing is how similar their results are.

Arthrodesis — fusing the joint — produces good functional outcomes with low to moderate pain and disability scores, at the cost of a meaningful nonunion rate [3]. It trades movement for durability, which suits a heavy manual hand and suits a pianist badly.

Dual-mobility trapeziometacarpal arthroplasty — replacing the joint — showed improvements in strength, range of motion, pain, function and satisfaction across 1,421 patients, with a 13% complication rate and a 0.6% dislocation risk [4]. Those numbers are respectable, and they are also the reason implants remain a considered choice rather than the default: 13% is not small, and the follow-up in this literature is short relative to how long a thumb has to last.

The honest summary is that the choice turns on what your hand has to do, and on which failure mode you would rather risk — a joint that does not bend, or an implant that may need revisiting.

Why the thumb is so often the first joint to go

The trapeziometacarpal joint is a saddle joint built for an unusual combination of mobility and load. Every pinch generates force at the thumb base many times the force at the fingertip, because of the lever arm. That is the price of opposability: the joint that makes the human hand useful is loaded harder, and more often, than any other small joint in the body — which is why it wears out first, and why strengthening what supports it is not a token measure.

Reviewed by Dr Kieran Hirpara · 10 June 2026.

Talk to your treating clinician for advice specific to you.

References for the advanced reading
  1. Thakker A, Ramchandani JP, Divall P, Sutton A, Johnson N, Dias J. What are the most clinically effective nonoperative interventions for thumb carpometacarpal osteoarthritis? A systematic review and network meta-analysis. Clin Orthop Relat Res. 2024;483(4):719-36.
  2. Krez AN, Wu KA, Klifto KM, Pidgeon TS, Klifto CS, Ruch DS. Efficacy of intra-articular corticosteroid injection for nonsurgical management of thumb carpometacarpal osteoarthritis: a systematic review. J Hand Surg Am. 2024;49(6):511-25.
  3. Dharamsi MS, Caudle K, Fares A, Dunn J. Arthrodesis for carpometacarpal joint arthritis: a systematic review. Hand (N Y). 2022;18(8):1284-90.
  4. Maling L, Rooney A. Outcomes of dual-mobility trapeziometacarpal arthroplasties: a systematic review. J Hand Surg Eur Vol. 2024;50(5):587-95.
Evidence & references

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

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

  • 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].

Investigations

  • Clinically significant, functionally limiting trapeziometacarpal arthrosis is less common than radiographic changes [27, 62].
  • 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].
  • 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

  • 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].
  • 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].

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].
  • 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].
  • 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].
  • 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].

Recovery

  • 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].
  • 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)

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[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

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