Pain or stiffness at the base of the thumb when gripping, grasping or pinching an object is often a sign of arthritis in the carpometacarpal (CMC) joint – the most common type of arthritis in the hand requiring surgery. Most common in women over 50, CMC arthritis can make simple acts such as opening a door or turning a key in a lock a painful experience.

The CMC joint is where the metacarpal bone of the thumb attaches to the trapezium bone of the wrist. This joint has a very unique shape that permits the thumb to move in multiple directions.

Orthopedic surgeon and hand specialist John Krebs, MD, said for the vast majority of patients less invasive treatments, such as short-term use of anti-inflammatories, splints to stabilize the joint and cortisone injections effectively relieve symptoms. However, when non-surgical treatments fail, CMC arthroplasty (joint replacement) is an effective treatment that maintains proper function of the thumb and hand.

“Of all the joints in the hand, mobility of the thumb is dependent upon the joint. The CMC joint enables the thumb wide range of motion, moving up, down and across the palm,” Dr. Krebs said. “There was a time when doctors would fuse the CMC joint to relieve the pain, but this severely limits the function of the hand. It even prevents a patient from laying their hand flat or even putting their hand in their pocket.”

As opposed to fusing the joint, Dr. Krebs utilizes the more specialized CMC arthroplasty to preserve full hand function for patients. The outpatient procedure involves the removal of the small wrist bone that is part of the CMC joint and replacing it with a patient’s own wrist flexor tendon.

During the procedure, a small incision is made over the CMC joint to remove the arthritic bone and another small incision is made in the forearm to release the wrist flexor tendon. The tendon is then rolled into a ball and placed in the CMC joint.

“This procedure is considered the gold standard for CMC arthritis,” Dr. Krebs said. “I prefer performing this surgery with a patient’s own tendon, rather than using one of the prosthetic devices on the market. As a result, we can successfully preserve all function of the thumb without putting something artificial in a patient’s joint.”

After surgery, the hand is immobilized in a cast for approximately two weeks, followed by another four weeks in a removable brace. Once the cast is removed, patients are referred to physical therapy to regain range of motion. In total, patients can expect recovery in 8 to 12 weeks after surgery.

“At the three-month mark after surgery, we compare the patients’ hand strength through a three point pinch, between the pad of the thumb and the pad of the index and middle fingers. Patients are always amazed at how much stronger their thumb and hand are just three months later,” Dr. Krebs said.

To schedule a consultation with Dr. Krebs at St. Vincent Charity’s downtown or Westlake offices, please contact 216.241.8654.