How do I know if my thumb pain is basal joint arthritis?

Basal joint arthritis classically causes pain right at the base of the thumb, the small joint at the wrist end of the thumb, with pinching, opening jars, turning keys, and gripping. Many patients describe a visible 'shoulder' or bump at that spot. A physician's exam and a plain X-ray confirm the diagnosis. Many patients have been told they have 'arthritis' generally, basal joint specifically is a different conversation than wrist or finger arthritis.

Do I need surgery, or will an injection be enough?

Many patients are well-managed for years with bracing, NSAIDs, and PRP injections. Surgery is reserved for patients whose pain is interfering with daily life despite these measures. The decision is symptomatic, not based on the X-ray. Dr. Lee will not push surgery on someone managing well without it.

What is internal brace reconstruction?

It's a modern technique that removes the arthritic trapezium bone and stabilizes the thumb using a synthetic tape (the 'internal brace') anchored into the adjacent index metacarpal. Dr. Lee helped design the anchor system used for this reconstruction. Compared with the traditional LRTI procedure, the internal brace allows for shorter immobilization and faster return of function.

How long until I can use my hand normally?

Light hand use begins within days. Office work and writing return at 2–3 weeks. Most patients are using the thumb normally by 2–3 months, with full strength continuing to improve up to a year after surgery. Compared with older techniques, this is meaningfully faster.

Will I need surgery on my other thumb eventually?

Often, yes. Basal joint arthritis is frequently bilateral, both sides develop arthritis, though usually not at the same rate. Outcomes are reliably good on both sides, and there is no need to operate on the second thumb until it's bothering you. Many patients have one side done, recover fully, and then decide on the other side months or years later.

Basal Joint Arthritis (Thumb CMC), Steven J. Lee, MD

Basal joint arthritis, arthritis at the base of the thumb, where the metacarpal meets the trapezium (the carpometacarpal or CMC joint), is one of the most common conditions in hand surgery. It is more common in women than men, often appears after the fourth or fifth decade of life, and can make even simple tasks like opening a jar, turning a key, or pinching a button feel impossible.

Like many forms of arthritis, basal joint arthritis exists on a spectrum. Some patients live happily with mild arthritis for decades. Others develop disabling pain that no amount of bracing or injection will solve. The good news is that if nonoperative treatment fails, surgical treatment for advanced basal joint arthritis is highly successful, and most patients regain a strong, comfortable thumb.

Symptoms of basal joint arthritis

Patients typically describe:

Pain at the base of the thumb with pinching, gripping, and twisting
A 'shoulder' or bump at the base of the thumb (subluxation of the metacarpal)
Weakness with pinch, dropping objects, difficulty turning keys
Stiffness, especially in the morning
Pain that worsens with use and improves with rest, until the arthritis is advanced

How it's diagnosed

Diagnosis is made by combining the clinical exam (tenderness directly over the basal joint, a positive grind test, and visible deformity) with X-rays that grade the severity. The Eaton-Littler classification is the most commonly used grading system, ranging from Stage I (mild) to Stage IV (joint destruction and involvement of adjacent joints).

Dr. Lee's approach

Surgery for basal joint arthritis is one of the most successful operations in hand surgery, but timing matters. Dr. Lee does not push patients into surgery; mild arthritis is treated conservatively with splinting, injections such as PRP, and activity modification, and many patients live happily with that approach for years.

When surgery is the right call, Dr. Lee uses a modern reconstruction technique that combines removal of the arthritic trapezium with stabilization of the thumb using an internal brace, an anchor and tape construct he helped design. The result is a strong, well-positioned thumb without the prolonged immobilization required by traditional techniques.

Non-surgical treatment

Most patients begin with one or more of the following:

Thumb-spica splinting, usually a removable brace worn as much as possible.
NSAIDs and other anti-inflammatory measures for symptom control
Platelet Rich Plasma (PRP) injections can improve symptoms significantly if bracing fails
Activity modification, minimizing overuse of the thumb

Surgical reconstruction with internal brace

When conservative treatment fails, Dr. Lee performs a basal joint reconstruction, removing the arthritic trapezium, stabilizing the thumb metacarpal with an internal brace anchored into the index metacarpal, and reconstructing the supporting soft tissue. The internal brace construct uses anchors Dr. Lee helped design and provides immediate stability without the long immobilization required by traditional ligament reconstruction techniques.

Recovery timeline

Recovery is faster than the older 'LRTI' technique most patients have heard about:

Weeks 0–2
Splint with thumb included. Light hand use for daily activities. Finger motion encouraged. Most patients are off prescription pain medication within a few days.
Weeks 2–6
Removable thumb-spica brace. Begin gentle thumb motion in therapy. Light typing and writing return.
Weeks 6–12
Discontinue brace for daily activities. Progressive strengthening. Most patients regain functional pinch by 8–10 weeks.
Months 3–6
Full return to manual work, sport, and forceful pinch. Strength continues to improve up to a year after surgery.

What patients commonly misunderstand

Things patients often don't hear elsewhere:

Modern technique avoids long immobilization. The traditional LRTI procedure typically requires 6 weeks of cast immobilization. The internal brace technique Dr. Lee uses provides immediate stability and substantially shortens that timeline.
An injection isn't a cure. Corticosteroid injection can give temporary relief, but does have the side effect of softening the cartilage and actually accelerating arthritis. Therefore Dr. Lee doesn't love the short term gain, long term loss concept. Instead, he prefers PRP injections.
Both thumbs often go. Many patients eventually need surgery on the second thumb. The good news: outcomes are reliably good on both sides, and there is no urgency to operate on the second thumb until it's bothering you.

This page is general educational content authored by Dr. Lee. It is not a substitute for individual medical advice. Every patient's case is different, book a consultation to discuss yours.

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Basal Joint Arthritis: thumb pain, definitively treated.