How to Repair a Basal Joint

There are a variety of surgical treatments used to repair the basal joint of the thumb, also known as the carpo-metacarpal joint (CMC). The choice of treatment depends upon the degree of arthritis and the desired levels of activity, mobility and strength.



The surgical treatments used for basal joint repair are loosely divided into those implemented in the early stages of arthritis and those demanded by the damage present in late-stage arthritis.

Things You'll Need

• X-Rays
• Splint

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Instructions

• 1

  X-rays help determine the degree of arthritic involvement.

  Determine the degree of arthritic involvement in the basal joint and surrounding area through patient history, physical examination and X-rays. Diagnose the arthritis in the CMC joint as early or mild, moderate, or late and severe.

• 2

  The type of surgery used depends upon how far the arthritis has progressed.

  Employ either ligament reconstruction or metacarpal osteotomy if the arthritis is early or mild. These surgical treatments preserve thumb appearance, motion and strength, reports Cedar Valley Hand Surgery.

  Ligament reconstruction is used when there is softening but no cartilage loss in the basal joint. A portion of the flexor carpi radialis tendon is inserted at the basal joint base, passed through a surgically-created bone tunnel in the CMC joint, and wrapped around the joint and sutured to itself. This palmar beak ligament reconstruction can prevent the progression of arthritis in two-thirds of patients, reports Carrie Swigart of the Yale University School of Medicine.

  Metacarpal osteotomy is used to extend the metacarpal by 30 degrees with a wedge. This surgical treatment reduces force on the thumb joint and is used when the first signs of cartilage loss have appeared.

• 3

  Casts and splints are used to immobilize the joint and allow it to heal.

  Decide between trapeziectomy and fusion for basal joint repair in late stages of arthritic involvement. The trapezium is the small bone in the palm at the base of the CMC joint. This bone may be removed alone or along with other soft tissue. Tendon tissue may be used to rebuild the basal joint ligament and fill the absent space. Strength recovery takes at least a year and may continue over the years.

  If the patient requires high strength and use of the hand, arthrodesis or fusion should be used. The basal joint is replaced with solid bone. Range of motion in the thumb is compromised for strength. The choice of this surgical treatment depends upon the degree of arthritis in adjacent joints.