Carpo-Metacarpal Arthritis – Adelaide
Known as Basal or CMC arthritis
A very common condition with a good prognosis
Carpometacarpal (CMC) arthritis, commonly affecting the base of the thumb, is a very common condition that can significantly affect hand function. At Glenelg Orthopaedics, we offer comprehensive treatment options, including trapeziectomy combined with suspensoplasty, to alleviate pain, improve mobility and return some strength.
Understanding Carpometacarpal (CMC) Arthritis
The CMC joint, is located at the base of the thumb and is the joint which allows a wide range of thumb movements essential for gripping and pinching. Over time, wear and tear can lead to the degeneration of cartilage ( joint surface ) in the joint, resulting in osteoarthritis. This degeneration causes pain, swelling, and reduced thumb strength, affecting even daily tasks.
Symptoms of CMC Arthritis
- Pain at the base of the thumb, especially during gripping or pinching activities.
- Swelling and tenderness around the thumb joint.
- Decreased strength and range of motion in the thumb.
- Development of a bony prominence or bump at the base of the thumb.
Treatment Options
Initial treatment strategies focus on non-surgical interventions:
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Medications: Analgesics like Paracetamol or anti-inflammatories such as Ibuprofen can help manage pain and inflammation.
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Splinting: Using a supportive splint to immobilize the thumb and reduce stress on the joint. The on-site hand therapist can provide a thermoplastic molded to your hand.
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Steroid Injections: Administering corticosteroid injections under ultrasound guidance can provide temporary relief from pain and inflammation, and can be useful in confirming the diagnosis.
When conservative treatments are insufficient, surgical intervention may be considered.
Surgical Treatment: Trapeziectomy and Suspensoplasty
For CMC arthritis which continues to cause symptoms, there are various options including trapeziectomy combined with a suspensoplasty. So as to protect the repair this can be combined with a device to hold the bone in the correct position. At Glenelg Orthopaedics, we commonly perform:
Trapeziectomy – Removing the Arthritic Bone
A trapeziectomy involves the removal of the trapezium, a small bone at the base of the thumb. This eliminates bone-on-bone contact and significantly reduces pain.
Procedure Details:
- Performed under regional or general anesthesia.
- A small incision is made at the base of the thumb.
- The trapezium is carefully removed to create space and alleviate joint pressure.
Suspensoplasty – Restoring Joint Stability
Since the trapezium bone is removed, an additional step, called suspensoplasty, is performed to prevent the thumb from collapsing into the empty space.
Techniques Used in Suspensoplasty
- Ligament Reconstruction (LRTI – Ligament Reconstruction and Tendon Interposition). A small section of a nearby tendon (the Flexor Carpi Radialis – FCR) is used to create a new stabilizing ligament for the thumb. This helps maintain normal function and prevents excessive movement at the base of the thumb.
- Tendon Interposition A rolled piece of the removed tendon is placed in the space where the trapezium was, acting as a cushion between the bones.
- Suture Suspension Techniques. Newer methods use strong sutures or synthetic materials to suspend the thumb, ( Tight-rope suspension). Whilst this device can be used instead of a suspensoplasty, using a tight-rope can protect the repair of the suspensoplasty as well.
Post-Surgery Recovery and Rehabilitation
Immediate Post-Operative Care
- A cast is worn for the first 1-2 weeks to allow healing.
- The cast is changed to a thermoplastic splint to protect the repair for a period from 2 to 6 weeks following surgery. This will be fitted by the hand therapist.
- Elevation and icing help reduce postoperative swelling.
- Pain control with medications is typically needed in the early recovery phase.
Hand Therapy & Rehabilitation
- Week 1-2: Rest in cast and elevate the hands when possible.
- Week 2-6: Gentle thumb mobilization exercises begin with a hand therapist.
- Week 6-12: Strengthening exercises start as function improves.
- 3-6 months: Most patients regain good thumb function and grip strength.
Expected Outcomes
- 85-90% of patients experience significant pain relief.
- Improved thumb function and strength for daily activities.
- Some mild stiffness or weakness can persist, but most patients regain normal hand use.
Why Choose Glenelg Orthopaedics?
At Glenelg Orthopaedics, led by Dr. Gavin Nimon, we specialize in upper limb surgery, including advanced treatments for CMC arthritis.
✅ Experienced Hand and Wrist Specialist
✅ Comprehensive Patient-Centered Approach
✅ Advanced Surgical Techniques for Best Outcomes
✅ Personalized Rehabilitation Plans with Hand Therapist on- site
Book a Consultation
If you are experiencing persistent thumb pain and weakness, contact Dr. Gavin Nimon at Glenelg Orthopaedics to discuss your treatment options.
Frequently Asked Questions
1. How long does recovery take after trapeziectomy and suspensoplasty?
Recovery varies, but most patients notice a benefit within 3 months,. but full recovery continues up to a year.
2. Will I have full movement after surgery?
Yes, but some loss of strength in pinching motions is common compared to normal, but often the strength is better than prior to surgery, because of significant pain relief.
3. Is surgery always necessary?
No. Non-surgical treatments are effective in many cases. Surgery is recommended only if pain is severe and persistent despite other treatments.
4. What are the risks of the procedure?
Like all surgeries, risks include infection, nerve irritation, stiffness, or residual weakness, though these are uncommon.