Basilar Joint Arthritis Treatment Specialist Q&A

Basilar Joint Arthritis (also referred to as Basal Joint Arthritis) is a condition that affects the joint at the base of the thumb. The basilar joint attaches to the wrist and is the most mobile joint in the hand. Basilar joint arthritis occurs when the cartilage, a smooth coating that covers the joint and allows painless and smooth movement, wears away. Basilar joint arthritis can affect both thumbs.

As the disease progresses, Basilar Joint Arthritis can affect both thumbs with weakness and decreased flexibility.

Basilar joint arthritis is a result of thinning of the cartilage between the thumb and the wrist. The joint then becomes inflamed leading to pain and swelling. It is seen with all forms of arthritis including rheumatoid, osteoarthritis, and gout. It can occur after fractures or injuries to the thumb although most cases have no clear causes. Like other forms of arthritis, it is more common in women than men.

The diagnosis is made from the patient’s history of an ache or soreness in the thumb, followed by an examination and x-rays. The thumb mobility may be decreased and with manipulation of the thumb, the pain is reproduced. Eventually the base of the thumb may enlarge because of swelling in the joint or formation of bone spurs.

Basilar joint arthritis can cause a range of symptoms making it difficult to do simple, everyday tasks. The initial symptom is usually pain in the wrist or thumb with activities that involve gripping, pinching, or twisting. Some patients notice pain with weather changes.

Pain, tenderness, and stiffness felt at the base of the thumb when trying to grip, pinch, or clasp something between the thumb and index fingers are usually the first signs of basilar joint arthritis. There may also be pain with such things as turning a key in a lock, snapping the fingers or turning a door handle. A lingering ache may follow the initial pain, although a high level of pain doesn’t always mean the arthritis is more severe.

Over time, pain and inflammation can reduce the strength and range of motion of the hand and these become particularly obvious when pinching or clasping an object tightly. Opening jars, holding a drink, or fastening zippers or buttons can become increasingly difficult. In severe cases, small routine motor tasks become too painful to attempt, and often cannot be accomplished without assistance.

The thumb may appear swollen, especially at the base, and a bony bump may develop, making the base of the thumb appear enlarged. Thumb arthritis can also result in an improper alignment of the joint as it moves from its normal position. This may affect the joint above the base as well, creating a bent-back appearance. In severe cases, the thumb cannot move from the palm of the hand.

There are several treatment options that can be utilized for basilar joint arthritis before surgery becomes necessary:

Self-help: Avoid repetitive movements that involve pinching, twisting or clenching the hands when carrying things. Pain and inflammation can be relieved by applying alternate heat and cold compresses. Use devices where possible to help open jars, grasp objects, open doors etc., to reduce strain on the joint

Medications: Try over-the-counter anti-inflammatory medications or pain relievers. Stronger prescription medication may work if these are ineffective. Corticosteroids are another option, which are usually injected directly into the affected joint. They can relieve pain and reduce inflammation for a longer period of time than some other medications.

Splints: Splints provide temporary support and pain relief for the thumb and wrist by limiting movement so the joints can rest. It can also help with correcting the position of the joints if they have become misaligned. A splint can be worn whenever it is needed and can be particularly useful at night.

Surgery: If non-surgical treatments don’t work, then surgery is an option. The surgical procedure called ‘carpometacarpal arthroplasty with tendon transfer’ is the “gold standard” for basilar joint arthritis and is performed by our specialists. The surgery generally takes about 30 minutes and is usually done under a regional block and mild sedation, (not general anesthesia) in an outpatient basis.

Although we currently have no cure for arthritis, the pain from basilar joint arthritis responds very well to treatment. The initial treatment is a steroid injection in conjunction with the use of a brace. We recommend a short period of activity modification after the injection to enhance its ability to work properly. Ice, heat or other topical medicines may also be helpful. These treatments are the most effective non-surgical treatments for this condition and will usually be offered to you at your initial visit. This will often lead to significant improvement. If non-surgical treatment is unsuccessful, surgery may be suggested.

Surgery involves making two small incisions one over the basilar joint, and one in the anterior forearm. 

removing the trapezium bone to create a “scar tissue” joint (carpometacarpal joint arthroplasty) and reconstructing it with an expendable tendon from your forearm (tendon transfer). The tendon removed does not lead to any loss of arm or hand function. The surgery generally takes about 30 minutes and is usually done in an ambulatory surgery center. General anesthesia is not usually necessary.

If you or a loved one would like to know more about basilar joint arthritis and how we can help contact Florida Hand Center today! We are an advanced medical facility dedicated to the treatment of hand and arm conditions with locations in Port Charlotte FL and Fort Myers FL and are proud to serve patients statewide. Call us or schedule an appointment today! We serve patients from Port Charlotte FL, Fort Myers FL, Punta Gorda FL, Cape Coral FL, Estero FL, Lake Suzy FL, Charlotte Harbor FL, Murdock FL, Harbour Heights FL, and Solana FL.