CMC Arthroplasty As A Solution For Thumb Pain

If you’re experiencing pain and stiffness at the base of your thumb, you might be dealing with CMC (carpometacarpal) arthritis. But don’t worry – you’re not alone. There are effective treatment options available for this common thumb condition that can provide much-needed pain relief and restore motion.

What are the symptoms of CMC arthritis?

Common symptoms include pain at the base of the thumb, especially during pinch and grip activities. The joint also may become swollen and tender to the touch. Typically, CMC arthritis decreases mobility in the thumb, and weakness may develop that makes it difficult to grasp objects.

What causes CMC arthritis?

CMC arthritis is a degenerative condition, often attributed to the aging process. Other contributing factors can include:

• Repetitive use: activities that require repetitive thumb movements can accelerate joint wear and tear.
• Trauma: a previous thumb injury can increase the risk of developing CMC arthritis.
• Genetics: genetic history may predispose some people to joint degeneration.
• Inflammatory conditions: certain immune or inflammatory conditions can contribute to CMC arthritis.

Atlantic Orthopaedics’ hand surgeon Dr. Meyer answers some common questions about CMC Arthroplasty, a life-changing procedure for patients suffering from advanced thumb arthritis.

In your own words, how does this procedure benefit your patients?
Arthritis at the base of the thumb (CMC arthritis) is a common source of pain and disability for adults, affecting one in three women and one in eight men over the course of their lifetime. A variety of treatment options exist, starting with conservative management (bracing, therapy, anti-inflammatories, corticosteroid injections) and progressing to surgery. For advanced thumb CMC arthritis that does not respond to the above treatments, CMC arthroplasty can provide lasting pain relief and improvement in thumb strength and motion.

There are a variety of surgical techniques for CMC arthroplasty. Most involve the removal of the painful, arthritic bone at the base of the thumb (trapezium) and use of a nearby tendon to stabilize the thumb in its native position. Recent innovations in the field of hand surgery have allowed for the use of a non-absorbable suture instead of a patient’s own tendon to maintain the thumb’s resting position. This procedure, termed a suture-button suspensionplasty, avoids complications from harvesting nearby tendons and allows for accelerated rehabilitation and recovery after surgery. While most other techniques require between four to six weeks of immobilization in a cast, I allow my patients to start gentle motion after their first post-operative visit (approximately 10 days after surgery) when using this technique.  

Who is a good candidate for this procedure?
Thumb CMC arthritis can affect anyone, but it becomes more prevalent with older age. This procedure is typically indicated for middle-age and elderly adults who have painful arthritis at the base of their thumb that limits their daily activities.

Where do you perform this procedure ?
I perform thumb CMC arthroplasty procedures at NECOS, Portsmouth Regional Hospital, and York Hospital. 

Do you have a recent patient success story you can share?
A 65-year-old retired professional pianist presented to the office with painful thumb CMC arthritis that failed to improve with bracing and steroid injections. Alleviating pain and preserving thumb motion were her biggest priorities. Due to her activity level, we elected to perform a CMC arthroplasty using the suture-button suspensionplasty technique.

Her surgery and post-operative course both progressed very smoothly. She was seen at her first post-operative visit and transitioned to a removable brace that allowed for gentle motion. At six weeks, she began gentle strengthening under the guidance of our occupational therapy team. At three months, she was cleared to return to full activity. She is back to playing piano and feels that her motion is even better than before surgery because she is no longer limited by pain. We were thrilled to help her get back to one of her favorite activities and to enable her to keep teaching other aspiring pianists.   Anything else you’d like current or future patients to know about this procedure and how it would benefit them?
Thumb CMC arthroplasty yields excellent results, but it is not the only treatment recommendation for patients with thumb CMC arthritis. There are a variety of non-surgical and surgical treatments that can help with pain at the base of the thumb prior to considering a CMC arthroplasty. Every patient evaluation begins with a thorough clinical history, physical examination, and radiographs (x-rays) of the hand. From there, I work with each patient to understand their goals before we collectively decide on an appropriate treatment plan moving forward.

CMC arthritis can be a debilitating condition, but there is help available. For many patients, CMC Arthroplasty has proven to be an effective way to alleviate pain and restore quality of life. If you’re suffering from pain and limited function in your thumb, schedule a consultation with Dr. Meyer to discuss whether CMC Arthroplasty may be right for you.