Abhinav Gulihar is a highly experienced orthopaedic surgeon providing specialist care for patients in London and Kent. As a consultant with a specialist interest in hand and wrist surgery, he treats a wide range of conditions, including base of thumb arthritis, tendon disorders, and complex wrist injuries such as distal radius fractures.
Base of thumb arthritis—also known as carpometacarpal (CMC) joint arthritis—is a common cause of pain, weakness, and loss of hand function. Activities such as opening jars, turning keys, writing, or gripping objects may become increasingly difficult. Treatment is tailored to the severity of symptoms, starting with non-operative options and progressing to surgery when pain and functional limitation persist.
Understanding Base of Thumb Arthritis
The base of the thumb is formed by the CMC joint, a saddle-shaped joint that provides stability and a wide range of motion. Over time, ligament laxity and cartilage degeneration can lead to joint instability, inflammation, and painful bone-on-bone contact.
This condition is particularly common in women over the age of 50, though it can affect men and younger individuals, especially those with repetitive thumb use, previous injury, or inflammatory conditions.
Non-Operative Treatment Options
Non-operative treatment is often effective in the early and moderate stages of base of thumb arthritis. These treatments aim to reduce pain, improve function, and delay or avoid surgery.
Activity Modification
Reducing activities that place excessive strain on the thumb—such as repetitive pinching or gripping—can significantly improve symptoms. Ergonomic adjustments at work or home may also help.
Splinting and Supports
Thumb splints or braces support the CMC joint, improve stability, and reduce painful movement. Many patients experience meaningful symptom relief with regular splint use, particularly during activities.
Pain Relief and Anti-Inflammatory Medication
Simple painkillers and anti-inflammatory medications can help manage pain and swelling, especially during flare-ups.
Hand Therapy
A specialist hand therapist can provide:
- Strengthening and stabilisation exercises
- Advice on joint protection techniques
- Custom splints if required
Steroid Injections
Corticosteroid injections into the CMC joint can reduce inflammation and pain. Relief may be temporary but can last several months. Repeated injections may become less effective over time.
When Non-Operative Treatment Is No Longer Enough
Surgery is considered when pain persists despite appropriate non-operative treatment, when grip and pinch strength decline, or when daily activities and quality of life are significantly affected.
Surgical Options for Base of Thumb Arthritis
Mr Gulihar offers several surgical solutions. The primary goal of surgery is reliable pain relief while preserving useful thumb strength and movement. The most appropriate procedure is chosen through shared decision-making.
Trapeziectomy with Ligament Reconstruction and Tendon Interposition (LRTI)
Trapeziectomy with LRTI is one of the most established and widely performed procedures for base of thumb arthritis.
The arthritic trapezium bone is removed, and a nearby tendon is used to reconstruct the stabilising ligament and create a soft-tissue cushion in the space left behind.
Key benefits
- Excellent long-term pain relief
- Durable, well-proven outcomes
- Suitable for a wide range of patients
Success rates are approximately 95–96%, with long-lasting improvement.
Thumb CMC Joint Replacement (Arthroplasty)
CMC joint replacement is a motion-preserving alternative that replaces the damaged joint surfaces with an artificial implant.
Potential advantages
- Preservation of thumb movement
- Less thumb shortening
- Faster early functional recovery for selected patients
Modern implant designs have improved outcomes, but careful patient selection is essential. Implant wear, loosening, or dislocation remain considerations, particularly in younger or highly active individuals.
Joint Fusion (Arthrodesis)
Fusion permanently joins the CMC joint, eliminating movement and pain. It provides excellent strength but sacrifices flexibility.
This option is used less frequently and is generally reserved for selected younger patients with high manual demands.
Comparison of Surgical Options
| Procedure | Main Aim | Advantages | Considerations |
| Trapeziectomy (LRTI) | Pain relief + function | Proven durability, excellent outcomes | Gradual recovery |
| CMC Joint Replacement | Pain relief + motion | Preserves movement, faster early recovery, excellent outcomes | Implant longevity |
| Joint Fusion | Pain relief + stability | Very strong thumb | Loss of movement |
What to Expect from Surgery
Most patients experience:
- Significant pain reduction
- Improved grip and pinch strength
- Better performance of daily activities
Recovery is gradual, with strength and confidence continuing to improve for up to 12 months.
Recovery After Base of Thumb Arthritis Surgery
First 2 Weeks
- Thumb immobilised in a temporary cast
After 2 Weeks
- Cast removed and removable splint applied
- Hand therapy begins
6-12 Weeks
- Return to most daily activities
Up to 12 MonthsContinued improvement in strength and endurance (quicker with a joint replacement)
Potential Complications and Risks
Although surgery is highly successful, potential risks include:
General Risks
- Infection
- Bleeding or bruising
- Delayed wound healing
Nerve and Sensory Issues
- Temporary numbness or tingling
- Rare permanent nerve injury
Functional Issues
- Stiffness
- Persistent weakness
- Ongoing pain
Procedure-Specific Risks
Trapeziectomy: thumb shortening, tendon irritation
CMC Replacement: implant loosening, dislocation, wear
Fusion: non-union, stress on nearby joints
Rare Complications
Complex Regional Pain Syndrome (CRPS)
Frequently Asked Questions
1. When should I consider surgery?
When pain persists despite splints, therapy, injections, and activity modification.
2. Can non-operative treatment cure thumb arthritis?
No, but it can effectively control symptoms for many patients.
3. Is joint replacement better than trapeziectomy?
Both are excellent options in selected patients; the best choice depends on individual factors.
4. How long will I be off work?
Desk work: 2-4 weeks. Manual work: 3–6 months.
5. Will I need hand therapy?
Yes, therapy is essential for recovery.
6. Can arthritis return after surgery?
Arthritis can develop in the small joints adjacent to the thumb base joint.
7. Will I regain full strength?
Most patients regain good functional strength, though not always normal.
Book Your Appointment with Mr Abhinav Gulihar
If thumb pain is limiting your independence or daily activities, specialist assessment can help determine the most effective treatment. To book a consultation with Mr Abhinav Gulihar in London or Kent, please get in touch.