The thumb is the most important digit of the hand. The basal joint is the keystone of hand function. The unstable bony structure with its strong ligament support make this joint with proper laxity and stability.
Osteoarthritis of thumb carpo-metacarpal(CMC) joint is a common disabling condition, with 10 % lifetime prevalence and often as a result of athletic injury or cumulative trauma associated with an arduous occupation or hobby. It mostly affects women over 45 years of age, approximate one-third of postmenopausal women. Patients with mild arthritis response well to conservative treatment. Surgical intervention is usually indicated in advanced stage and in those with failed conservative treatment. The goal of surgery aims to improve pain and function stability for daily usage. Synovitis associated with arthritis may eventually erode and soften the ligaments that protect the articular surfaces. Arthroscopic synovectomy will be of help in the patients with poor medial control to improve pain and function, and hold the process of arthritic change. Unstable basal joint exhibit gross abnormal alignment and often combine excessive and aberrant mobility. This is often caused by injury, osteoarthritis or inflammatory arthritis. The basal joints show dorsolateral subluxation with loss of abduction, and patients experience pain and weakness. Also abnormal load distribution will lead to focal cartilage wear and inducing early arthritis change. Surgical intervention, including soft tissue re-strengthening or reconstruction were indicated for the patients of symptomatic subluxation or dislocation. Longstanding basal joint subluxation or dislocation will also cause stiffness of basal joint and cause compensating excessive extension of metacarpo- phalangeal joint.
For advanced basal joint arthritis, several surgical techniques have been described, but no single surgical procedure has been proven to be superior to any other. All kinds of procedures can help patient to eliminate pain and improve function. We report our strategy for surgical treatment of different stage of basal joint arthritis.