The thumb is a unique and complex structure, allowing for the wide range of motion and dexterity necessary for daily tasks like gripping, pinching, and twisting. This mobility, however, increases its susceptibility to wear and tear over time. As people age, cumulative stress on the thumb’s primary joint often leads to a degenerative condition that necessitates surgical intervention. The most common operation addresses the breakdown of joint surfaces at the base of the thumb, aiming to restore function and eliminate chronic pain when non-surgical treatments are no longer effective.
The Condition Requiring Most Thumb Operations
The single condition responsible for the vast majority of common thumb surgeries is Carpometacarpal (CMC) joint arthritis, also known as basal joint arthritis. This joint is located at the base of the thumb, connecting the first metacarpal bone to a small wrist bone called the trapezium. The CMC joint’s unique saddle shape allows the thumb to swivel, pivot, and pinch, but also makes it vulnerable to significant forces.
Any force applied to the tip of the thumb, such as when opening a jar, is amplified up to 13 times at the basal joint. Over decades of use, the smooth, protective cartilage covering the ends of the bones wears away due to this high load and frequent movement. Once the cartilage is gone, the bones rub directly against each other, causing inflammation and pain.
Symptoms usually begin with sharp or aching pain specifically at the base of the thumb, worsening during activities involving gripping or pinching. Patients may also notice swelling, stiffness, a loss of grip strength, and sometimes a grinding or popping sensation within the joint. As the condition advances, the joint can develop a bony prominence or an enlarged appearance, further limiting the thumb’s range of motion.
Describing the Most Common Procedure
The most frequently performed surgical intervention for advanced basal joint arthritis is the trapeziectomy. This procedure directly addresses bone-on-bone friction by removing the damaged trapezium bone. The goal is to eliminate painful contact between the thumb metacarpal and the arthritic wrist bone entirely.
During the operation, the surgeon makes an incision at the base of the thumb and removes the trapezium bone. This creates a space between the bones, preventing the joint ends from rubbing together. The procedure is often combined with a technique called Ligament Reconstruction and Tendon Interposition (LRTI).
Ligament Reconstruction and Tendon Interposition (LRTI)
In the LRTI approach, a small section of a nearby tendon, often the flexor carpi radialis tendon, is harvested. The surgeon uses this piece of tendon to create a new, soft cushion or sling within the space where the trapezium bone was removed. This cushion, or spacer, helps maintain the thumb’s alignment and prevents the metacarpal bone from collapsing. The procedure is designed to provide long-term pain relief by creating a new, stable joint substitute.
Life After Surgery: Recovery and Rehabilitation
Recovery from a trapeziectomy is a gradual process requiring adherence to a rehabilitation plan. Immediately following the procedure, the hand is immobilized in a cast or splint for about four to six weeks to protect the surgical site and allow initial healing. Patients are encouraged to keep the hand elevated to minimize swelling, and pain is managed with prescribed medication.
The initial phase focuses on allowing the soft tissues and the newly created tendon cushion to stabilize. While the thumb is immobilized, patients begin gentle exercises with the uncasted fingers, elbow, and shoulder to prevent stiffness in the rest of the limb. Once the immobilization device is removed, the second phase of recovery begins with focused physical therapy.
A hand therapist guides the patient through specific range-of-motion exercises to mobilize the thumb and prevent stiffness. Strengthening exercises are introduced gradually, often several months after surgery, to rebuild supporting muscles. Although initial recovery occurs relatively quickly, it can take three to six months for grip strength and full function to return, with some patients seeing improvements for up to a year.