Thumb base arthritis and joint preserving surgery

Understanding first CMC osteoarthritis

I check whether pain is coming from the CMC joint, a nearby tendon compartment or another joint. An X-ray helps define arthritis, but its appearance alone does not determine which operation is appropriate. Splinting, hand therapy, activity changes and injections may be considered before surgery.

Selective denervation with tendon graft interposition

In selected patients, I offer a joint-preserving approach combining selective denervation with tendon graft interposition and soft-tissue stabilisation. Denervation treats small nerve branches carrying pain from the joint. A tendon graft is used as an interposition or spacer, with adjustment of the supporting soft tissues according to the findings. The trapezium bone is retained.

This is a tailored approach within my practice, intended to address pain and support while preserving the native joint. It does not regenerate cartilage or reverse osteoarthritis. Suitability depends on where the pain originates, the pattern of arthritis, stability and your expectations. The graft source also depends on the available tendons.

Alternatives and the limits of the evidence

Trapeziectomy, which removes the trapezium, is an established option for thumb base arthritis. It may be considered initially or later if a joint-preserving operation does not provide sufficient relief. Joint denervation has published clinical evidence, but those studies do not establish the outcomes of my particular combined tendon-graft and stabilisation technique. Its durability and the possibility of further surgery require an explicit discussion.

Persistent pain, recurrent symptoms, stiffness, altered sensation, tendon donor-site problems and further surgery are possible. The aim is worthwhile improvement for an appropriately selected patient; an individual result cannot be promised.

Recovery

Recovery depends on whether treatment involves denervation alone, grafting, stabilisation or another procedure. Adding a graft or soft-tissue repair changes the protection required. Gentle movement, splint use and return to loading are planned around the operation performed. An early return to modified duties does not mean the thumb is ready for heavy pinch or grip.

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