Basal Joint Arthritis
Why Does it Occur?
Basal Joint Arthritis is very common, mostly because we use our thumbs for just about everything. After all, the opposable thumb is one of the main things that differentiates us from the rest of the animal kingdom! Just like arthritis in other joints, this tends to be from a "wear and tear" phenomenon. Certain things predispose you to getting Basal Joint Arthritis, and include previous trauma to the thumb, ligamentous laxity (loose joints), or inflammatory disorders such as Rheumatoid Arthritis.
Basal Joint Arthritis can cause hand pain, at the base of the thumb and palm, and is typically made worse with pinching, grasping, opening jars, or turning keys. The onset of pain is usually gradual. Flare-ups may occur because of overuse, mild trauma, weather changes, or sometimes for no particular reason.
X-rays are typically ordered to help confirm the diagnosis and grade the arthritis severity. Other radiologic studies or tests may be ordered to help rule out other diagnoses. Blood tests and/or a Rheumatologic consult may be ordered if an inflammatory component is suspected.
The mainstay of treatment consists of rest and activity modifications to back down on gripping or overuse of the thumb. Use of a small, thumb spica splint for 6 weeks to rest the area is often advised. Anti-inflammatory medications and possible injections such as Platelet-Rich Plasma (PRP) or cortisone may be advised. PRP injections and other stem cell treatments have shown promise. Dr. Steven Lee is one of the world’s experts in the use of PRP in the upper extremity, and was one of the first physicians in NYC to employ its use in the hand and the wrist.
Surgery may be recommended if you have not improved with non-operative treatment. The basis of surgery for most arthritic joints is to prevent the arthritic bones from rubbing on each other causing pain. For the basal joint, this is best achieved by removing one of the bones in the wrist (Trapezium). While this may seem strange to do, this is performed in pretty much all versions of this surgery designed to treat this problem, and it is not unlike a rotten wisdom tooth in that it is not saved, but removed.
In order to maintain this space, a reconstruction is performed. Dr. Steven Lee has designed a reconstruction technique using Internal Brace
Technology that is now widely accepted and used by many other surgeons across the world. The inclusion of Internal Brace Technology has not only quickened and simplified the surgical technique, but allows for a stronger reconstruction and thus faster rehabilitation protocols and ultimately quicker return to normal activities. This surgery which used to take an hour to do, now requires less than 15 minutes to complete. To view his reconstruction technique, you can view it here (Warning: Graphic images!).
After surgery, a splint will be placed on your hand and wrist that must be kept clean and dry. After a week, the splint is removed in office, and we will most likely remove your sutures at that time. You will then be instructed to obtain a custom, more comfortable splint, that you must wear for an additional 5 weeks. This splint can be removed to wash and shower. Hand therapy is started after 5 weeks of custom splint wear. After surgery, you may have some sensitivity at the incision site, especially with gripping, which should go away after about 4 weeks. Hand Therapy is important to help decrease scar tissue, decrease hypersensitivity, and improve range of motion. Patients will be allowed to go back to normal activities about 3 months after surgery, although subtle improvements can continue for up to 1 year.
Immediate Post-Operative Instructions
Please refer to the following pages for more information:
*It is important to note that all of the information above is not specific to anyone and is subject to change based on many different factors including but not limited to individual patient, diagnosis, and treatment specific variables. It is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific orthopedic advice or assistance should consult Dr. Steven Lee or an orthopedic specialist of your choice.
*Dr. Steven Lee is a board certified orthopedic surgeon and is double fellowship trained in the areas of Hand and Upper Extremity Surgery, and Sports Medicine. He has offices in New York City and Scarsdale.