Painting the Sistine Chapel, playing the violin, holding a fork. Most activities that involve grasping or pinching are possible because of the thumb's remarkable range of motion. But dexterity comes at a price – an increased risk of osteoarthritis in the first carpometacarpal (CMC) joint, where the thumb meets the trapezium bone in the wrist.

Problems often start when the thick ligaments that hold the joint together loosen, allowing it to slip out of place. Over time, changes in joint biomechanics can wear away the articular cartilage that cushions the ends of the bones, causing pain and limiting movement. Rheumatoid arthritis and other forms of inflammatory arthritis can also damage the first CMC joint – also known as the trapeziometacarpal joint (TMC). 

David S. Ruch, MD, chief of the orthopaedic hand service at Duke University in Durham, N.C., says women, especially those older than age 50, are 10 to 20 times more likely than men to develop thumb arthritis, though no one is quite sure why.

"One theory is that women have looser ligaments than men do; another is that men develop bone spurs in the thumb that hold it in place," he explains.

He adds that both women and men respond well, at least initially, to conservative measures such as anti-inflammatories, splints, activity modification and limited steroid injections. For some, these may be the only treatments needed.

"[These therapies] make people feel better, but they don’t stop disease progression, and eventually surgery may be necessary," he says.

Surgical options have expanded considerably in the last few years, and the best approach depends on the stage of the disease and severity of symptoms. Broadly speaking, most thumb surgeries remove some or all of the arthritic bone and use various methods to stabilize the joint. 

Here is a closer look at some of the more common procedures for thumb arthritis.

• Ligament reconstruction

This procedure stabilizes the CMC joint by removing a portion of the damaged ligament and replacing it with a piece of the patient's wrist flexor tendon. The tendon is threaded through a channel created in the base of the thumb's metacarpal bone, then sewn back on itself. "The transposed tendon reconnects and restores mechanical function of the thumb with the rest of the hand," says Stephen Trigg, MD, an orthopaedic hand surgeon at Mayo Clinic in Florida.

Who can benefit

Adults with no cartilage loss whose symptoms result from joint laxity.

Pros

Most people with very early or pre-arthritis experience good to excellent pain relief. Studies suggest ligament reconstruction also prevents disease progression in a majority of patients.