Understanding the Condition
The Joint at the
Base of Your Thumb
The thumb basilar joint — formally the carpometacarpal (CMC) joint — is where the thumb metacarpal meets the trapezium bone at the wrist. It is a saddle-shaped joint with an extraordinary range of motion: the thumb can flex, extend, abduct, adduct, and rotate in a full arc that allows opposition — the ability to touch the thumb to each fingertip — which is foundational to nearly every hand function humans perform.
That mobility comes at a cost. The CMC joint is one of the most mechanically loaded joints in the hand, bearing forces that can exceed ten times the pinching load during routine activities. Over decades, this loading wears the cartilage — and the joint develops arthritis. Basilar joint arthritis is the most common form of arthritis in the hand, affecting up to a third of postmenopausal women and a significant percentage of men over 50.
The result is a familiar pattern: pain at the base of the thumb with pinching and gripping, difficulty opening jars, weakness with writing or turning a key, and tenderness directly over the joint. In advanced cases, the thumb may develop a characteristic deformity — the metacarpal subluxes dorsally, the CMC joint collapses, and a compensatory hyperextension develops at the thumb MCP joint.
The good news: surgical treatment for basilar joint arthritis is among the most reliably satisfying procedures in all of hand surgery. Pain relief is predictable, motion is preserved, and patients routinely report returning to activities they had given up years earlier.
The trapezium — the arthritic bone shown in red — is removed entirely during suspensionplasty (trapeziectomy). The FCR tendon shown in green is preserved in Dr. Graham's technique, unlike traditional approaches that harvest it as graft material.
The thumb metacarpal is then suspended and stabilized using an Internal Brace construct anchored with a dermal allograft, preventing the metacarpal from migrating proximally into the space left by the trapezium.
Recognizing the Problem
Symptoms of Thumb Basilar Joint Arthritis
The symptoms are characteristic — most patients recognize their own experience in the list below. Onset is gradual and progressive.
Pain Opening Jars
The most commonly reported functional limitation. Pinching against resistance — jar lids, bottles, keys, doorknobs — loads the CMC joint directly and is typically the first activity that becomes painful.
Pain with Writing & Fine Motor Tasks
Writing, typing, sewing, using scissors, or any task requiring a sustained pinch grip triggers pain at the base of the thumb. Many patients describe having to stop mid-task and rest the hand.
Tenderness at the Base of the Thumb
Direct pressure over the CMC joint — just below the thumb metacarpal where it meets the wrist — is exquisitely tender. Swelling and a bony prominence are often visible in more advanced cases.
Weak Pinch & Grip
Pinch strength is disproportionately affected — patients notice difficulty with tasks that used to be automatic. Grip strength also suffers as the thumb can no longer contribute normally to power grip.
Night Pain & Rest Aching
In moderate to advanced arthritis, the thumb aches at rest and may wake patients at night. This is a signal that conservative treatment is no longer adequate and surgical evaluation is warranted.
Thumb Deformity
In advanced disease, the thumb metacarpal subluxes outward (dorsally), giving the hand a characteristic appearance. A compensatory hyperextension deformity at the thumb MCP joint often develops — this may require additional treatment at the time of surgery.
Diagnosis
How Thumb CMC
Arthritis Is Graded
Diagnosis is clinical — tenderness directly over the CMC joint, a positive grind test (axial compression and rotation of the thumb reproduces the pain), and loss of pinch strength are usually sufficient to identify the problem. X-rays confirm the diagnosis and grade severity.
Dr. Graham also uses a diagnostic and therapeutic injection — a corticosteroid injected directly into the CMC joint — both to confirm that the CMC joint is the primary pain source and to provide relief. A meaningful response confirms the diagnosis and helps patients understand what surgical relief might feel like. When injection no longer provides adequate duration of relief, surgery is the appropriate next step.
The Eaton-Littler classification grades CMC arthritis from Stage I (early joint widening, no arthritic changes) to Stage IV (pan-trapezial arthritis involving the scaphotrapezial joint as well). Treatment recommendations — and specifically whether the STT joint needs to be addressed at surgery — depend partly on this grading.
Conservative Treatment First
Non-Surgical Options
Surgery is not the first step. For mild to moderate thumb CMC arthritis, conservative treatment provides meaningful relief and is always tried before recommending surgery.
Thumb Spica Splint
Immobilizing the CMC joint in a resting position reduces inflammation and pain during flares. A custom thermoplastic splint worn at night — and during aggravating activities — is often the first intervention. Many patients get significant symptom control with a well-fitted splint and activity modification.
Activity Modification
Identifying and reducing pinch-loading activities provides relief. Jar openers, ergonomic tools, and technique modifications for writing or gripping can meaningfully reduce symptom burden. Occupational therapy is helpful in teaching joint protection strategies.
CMC Joint Injection
A corticosteroid injection directly into the basilar joint reduces inflammation and provides weeks to months of relief. Dr. Graham uses the injection both therapeutically and diagnostically — a meaningful response confirms that the CMC joint is the primary pain source, and helps patients understand what surgical pain relief might feel like. When injection relief shortens to weeks, surgery is typically the next conversation.
Surgical Treatment
Suspensionplasty — How Dr. Graham Does It Differently
The goal of suspensionplasty is always the same: remove the arthritic trapezium and stabilize the thumb metacarpal. The technique used to achieve that stabilization is where meaningful differences exist.
The traditional approach — ligament reconstruction with tendon interposition (LRTI) — harvests a strip of the flexor carpi radialis (FCR) tendon as the graft material. Half the FCR is divided, threaded through a bone tunnel in the thumb metacarpal, and anchored to reconstruct the ligament. The remaining FCR is anchored in the trapezium space as interpositional material.
- Sacrifices a portion of the FCR — a functioning wrist flexor
- Second incision for FCR harvest
- Longer operative time
- Well-established but technique-dependent outcomes
- Cast immobilization typically 4–6 weeks
Dr. Graham performs suspensionplasty using an Internal Brace construct — a suture tape anchored into the thumb metacarpal — combined with a dermal allograft anchovy-packed into the trapezium void. The FCR tendon is not harvested. It remains intact, preserving its function as a wrist flexor for the life of the patient.
- FCR tendon preserved completely — no donor site morbidity
- No second incision for tendon harvest
- Internal Brace provides immediate structural stability
- Dermal allograft fills the trapezium void as biological interpositional material
- No cast — removable Orthoplast thumb spica brace
Anesthesia
Suspensionplasty is performed at Baptist Beaches Hospital or an affiliated surgery center under local anesthesia with sedation (MAC) or regional block. General anesthesia is rarely required. The procedure takes approximately 45–75 minutes. It is outpatient — patients go home the same day.
Trapeziectomy
The arthritic trapezium is removed through a carefully placed incision over the base of the thumb. Complete removal of the trapezium eliminates the arthritic joint surface entirely — this is the most important step for achieving pain relief and is performed in every case. The FCR tendon, which runs immediately beneath the trapezium, is identified and preserved throughout.
Internal Brace Suspension
With the trapezium removed, the thumb metacarpal must be prevented from migrating proximally (settling into the void) and from subluxing. An Internal Brace construct — a suture tape anchor — is placed through the base of the thumb metacarpal and secured to maintain the metacarpal in proper position. This provides immediate, robust suspension of the thumb without relying on a tendon that will stretch and remodel over time.
Dermal Allograft Anchovy
A dermal allograft — donor connective tissue — is tightly rolled (anchovy technique) and packed into the trapezium void. This interpositional material fills the space, provides a biological cushion, and incorporates over time as a soft tissue spacer. Because it is allograft, the patient's own FCR tendon is not sacrificed to serve this role. The allograft provides equivalent or superior interposition without donor site morbidity.
Closure & Brace Application
The incision is closed and a custom Orthoplast thumb spica brace is fabricated. There is no plaster or fiberglass cast. The brace is removable, adjustable as swelling changes, and allows skin hygiene during the recovery period. Hand therapy begins within the first week to begin gentle thumb motion within the brace.
No Cast — A Removable Orthoplast Brace Instead
Most surgeons still apply a plaster or fiberglass thumb spica cast after basilar joint surgery. Dr. Graham does not. A custom thermoplastic (Orthoplast) thumb spica brace is fabricated at the time of surgery — it is removable for hygiene, adjustable as swelling resolves, and significantly more comfortable than a cast during the first weeks of recovery. It can be cleaned and adjusted without a clinic visit. Patients consistently describe this as one of the most appreciated aspects of their recovery.
When More Is Needed
Additional Procedures Performed at the Same Surgery
Some patients have additional pathology at the time of thumb CMC reconstruction. Dr. Graham addresses these at the same operative setting.
In Stage IV basilar joint arthritis, the scaphotrapeziotrapezoid (STT) joint — the articulation between the scaphoid, trapezium, and trapezoid — is also arthritic. Simply removing the trapezium alone leaves the patient with residual STT pain from the remaining trapezoid.
When STT arthritis is present, Dr. Graham performs a partial excision of the trapezoid and places interpositional allograft material to address the arthritic STT articulation. This prevents the residual pain and the need for a second surgery that can occur when STT disease is overlooked at the primary procedure.
This is a nuanced intraoperative decision that requires recognition of the STT joint's contribution to the patient's symptoms — something that comes from experience with high volumes of CMC arthritis surgery.
As basilar joint arthritis progresses, the thumb develops a compensatory deformity at the MCP (knuckle) joint — the thumb hyperextends to compensate for the collapsing CMC joint. If this deformity is left untreated at the time of suspensionplasty, the hyperextension persists even after the CMC joint is reconstructed, creating a functional problem with tip pinch.
When significant MCP hyperextension is present, Dr. Graham performs a thumb volar plate capsulodesis at the same surgery — tightening the volar (palm-side) plate of the MCP joint to limit hyperextension. This restores a functional pinch posture and completes the thumb reconstruction.
Addressing MCP hyperextension at the time of basilar joint surgery prevents the need for a return to the operating room and ensures the thumb works correctly as a functional unit after healing.
Recovery
What to Expect After Suspensionplasty
Recovery is progressive and well-tolerated. Most patients notice meaningful pain improvement before full strength returns — and full strength returns predictably.
Brace & Rest
Orthoplast thumb spica brace worn continuously. Incision healing. Fingers are free to move. Swelling managed with elevation. Hand therapy evaluation and gentle finger exercises begin.
Protected Motion
Sutures removed at 10–14 days. Gentle thumb motion begins within the brace. Light activities of daily living permitted. Brace can be removed for hygiene and therapy exercises.
Strengthening
Brace discontinued. Progressive pinch and grip strengthening with hand therapy. Most patients performing daily activities without significant restriction. Pain is typically dramatically improved by this point.
Full Function
Final pinch and grip strength restored. Return to all activities — writing, sports, music, manual work. Most patients say they wish they had done this sooner. Pain relief is lasting.
Who Comes for This Surgery
Thumb Arthritis Doesn't Discriminate
The basilar joint arthritis patient population is diverse. Here are some of the groups most commonly seen in Dr. Graham's practice.
Postmenopausal Women
The most common demographic. Thumb CMC arthritis is significantly more prevalent and more severe in women after menopause — the ligamentous laxity and hormonal changes that accompany this transition appear to accelerate cartilage loss in the CMC joint. Many present having adapted around the pain for years before seeking surgical evaluation.
Golfers & Racquet Sports Players
Golfers, tennis players, and pickleball players repeatedly load the CMC joint with grip forces during their sport. Pinching the club, grip tension through impact, and the rotation forces of a golf swing or racquet stroke all concentrate at the basilar joint. Many active patients want to return to their sport — and they do after recovery.
Musicians
Guitarists, pianists, and string players develop thumb CMC arthritis from the sustained pinch loads required by their instruments. The impact on their ability to play — and their career — makes this a high-stakes diagnosis. Precise recovery of pinch mechanics is essential, and the functional outcome of suspensionplasty consistently meets that bar.
Manual Workers & Tradespeople
Carpenters, plumbers, electricians, and others who use their hands for heavy work often present with advanced arthritis from years of high-load pinching and gripping. Return to work is a primary goal and is typically achievable after sufficient recovery — particularly with the near-normal grip strength that suspensionplasty preserves.
Computer Users & Writers
Sustained mouse use, keyboard work, and extended writing place repetitive low-level loads on the CMC joint for hours each day. These patients often present earlier — the arthritis has not progressed as far, but the functional impact is significant because they cannot avoid the aggravating activity.
Crafters, Artists & Gardeners
Knitting, sewing, painting, pottery, and gardening all require fine pinch control and sustained grip. The thumb arthritis patient who can no longer knit or garden has lost a meaningful source of joy — and the restoration of that function after suspensionplasty is among the most gratifying outcomes in hand surgery.
"Dr. Graham has a great sense of humor." He did an excellent job and I am back to everything I love — "compassionate, professional, and has a great sense of humor. Not that I want to see him again, but if I need an orthopaedic surgeon, he's my go-to guy."
Fred Alvarez · Hand Surgery · Verified Google Review ★ 5/5
"An injection of humor to ease my nerves. I really appreciated his personal call to me the day after surgery."
Jean Ward · Finger Surgery · Verified Google Review ★ 5/5
Biologic Treatment Option
Corticosteroid injection is the standard conservative intervention for basilar joint (CMC) arthritis — and for many patients it provides meaningful relief for months at a time. But cortisone does not modify the underlying arthritis; it manages the symptoms. For patients with early to moderate CMC arthritis who want a biologic intervention with potential disease-modifying properties, PRP is a well-reasoned option.
Platelet-rich plasma delivers concentrated growth factors directly into the CMC joint, where they may reduce inflammatory mediators, support the remaining articular cartilage, and potentially slow the progression of joint degeneration. The evidence for PRP in small joint arthritis is accumulating, and the biological rationale is sound. For patients who are not yet surgical candidates — or who want to maximize conservative treatment before considering suspensionplasty — PRP represents a meaningful step between repeated cortisone injections and the operating room.
Dr. Graham does not proactively recommend PRP in every basilar joint case, but he is enthusiastic about discussing it with patients who ask — particularly those with early or moderate arthritis who have had short-lived relief from cortisone. See the PRP treatment page for full procedure details.
Common Questions
Frequently Asked Questions
Next Steps
That Thumb Pain
Is Fixable.
Thumb basilar joint arthritis is one of the most satisfying conditions to treat in hand surgery. Most patients wish they had sought surgical evaluation sooner. A consultation with Dr. Graham starts with understanding your goals — what activities you want to return to, what non-surgical treatment you have already tried, and what your X-rays show. From there, the path forward is clear.
Jacksonville Beach, FL 32250
Surgery days: Mon · Thu
Walk-in evaluation through JOI Now available on clinic days. Thumb pain that has been building for months can often be assessed and a plan made at the first visit.