Thumb basilar joint (CMC) arthritis wears out the joint where the thumb meets the wrist, at a small bone called the trapezium. It causes aching at the base of the thumb and a weaker pinch. Most people start with activity changes, a thumb splint and a corticosteroid injection. Thumb CMC reconstruction is the surgery considered for advanced arthritis when those measures no longer control the pain.
Warning signs
- Thumb base pain with a positive grind test on exam
- X-rays showing advanced arthritis (Eaton stage III or IV)
- Pain that still limits work, daily activities or sleep after splinting and at least one injection
- Pinch weakness that interferes with daily function
Treatment
The surgery removes the arthritic trapezium and supports the thumb metacarpal in its normal position. Options include trapeziectomy alone, ligament reconstruction with tendon interposition (LRTI), suture suspension arthroplasty, and selected pyrocarbon implants, tailored to anatomy, age, activity level and preference. It takes 60 to 90 minutes under a regional block or general anesthesia. A thumb spica splint is worn for 4 to 6 weeks, followed by 6 to 12 weeks of hand therapy. Desk work often resumes in 1 to 2 weeks in the splint; heavy pinch and manual labor usually wait 12 to 16 weeks.
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Questions patients ask
What is thumb CMC reconstruction?
Thumb basilar joint (CMC) arthritis wears out the joint where the thumb meets the wrist, at a small bone called the trapezium. It causes aching at the base of the thumb and a weaker pinch. Most people start with activity changes, a thumb splint and a corticosteroid injection. Thumb CMC reconstruction is the surgery considered for advanced arthritis when those measures no longer control the pain.
When is thumb CMC reconstruction usually considered?
Thumb base pain with a positive grind test on exam. X-rays showing advanced arthritis (Eaton stage III or IV). Pain that still limits work, daily activities or sleep after splinting and at least one injection. Pinch weakness that interferes with daily function.
What is recovery like after thumb CMC reconstruction?
The surgery removes the arthritic trapezium and supports the thumb metacarpal in its normal position. Options include trapeziectomy alone, ligament reconstruction with tendon interposition (LRTI), suture suspension arthroplasty, and selected pyrocarbon implants, tailored to anatomy, age, activity level and preference. It takes 60 to 90 minutes under a regional block or general anesthesia. A thumb spica splint is worn for 4 to 6 weeks, followed by 6 to 12 weeks of hand therapy. Desk work often resumes in 1 to 2 weeks in the splint; heavy pinch and manual labor usually wait 12 to 16 weeks.
Who performs thumb CMC reconstruction near Southlake and Dallas-Fort Worth?
Dr. Pedro Loredo, a board-certified hand surgeon (General Surgery, American Board of Surgery; Hand Surgery, American Board of Plastic Surgery) at Loredo Hand Care Institute, 431 E State Hwy 114, Suite 380, Southlake, TX. New patients are seen within days. Call (972) 939-4974. Se habla español.
En español: Artritis en la base del pulgar: ¿cuándo se considera cirugía?
La artritis de la articulación basal del pulgar (CMC) desgasta la articulación donde el pulgar se une con la muñeca, en un hueso pequeño llamado trapecio. Causa dolor en la base del pulgar y menos fuerza para pellizcar. La mayoría empieza con cambios de actividad, una férula de pulgar y una inyección de corticosteroide. La reconstrucción CMC del pulgar es la cirugía que se considera en la artritis avanzada cuando esas medidas ya no controlan el dolor.
Señales de alerta
- Dolor en la base del pulgar con prueba de molienda (grind test) positiva en el examen
- Radiografías con artritis avanzada (Eaton etapa III o IV)
- Dolor que sigue limitando el trabajo, las actividades diarias o el sueño a pesar de la férula y al menos una inyección
- Debilidad para pellizcar que interfiere con la vida diaria
Tratamiento
La cirugía retira el trapecio con artritis y sostiene el metacarpiano del pulgar en su posición normal. Las opciones incluyen la trapeciectomía sola, la reconstrucción de ligamento con interposición de tendón (LRTI), la artroplastia de suspensión con sutura y, en casos seleccionados, implantes de pirocarbono, según cada paciente. Dura de 60 a 90 minutos con bloqueo regional o anestesia general. Se usa una férula de pulgar de 4 a 6 semanas y luego de 6 a 12 semanas de terapia de mano. El trabajo de escritorio suele reanudarse en 1 a 2 semanas con la férula; pellizcar con fuerza y el trabajo manual pesado suelen esperar de 12 a 16 semanas.
If this sounds like your hand
Call Loredo Hand Care Institute or start your forms online. New patients are seen within days; surgery, when needed, is scheduled at the first available opening. Se habla español.