Thumb CMC Arthritis Treatment Options

Treatment for thumb CMC arthritis depends on the severity of the arthritis, how much pain it causes, and how much it interferes with everyday activities. Many patients can manage symptoms for months or years without surgery. Surgery may be considered when pain persists despite conservative treatment or begins to significantly limit hand function.

Conservative Treatment

Conservative treatment consists of rest, avoiding painful activities, splinting, anti-inflammatories, and injections. Low-profile braces, such as a Meta Grip splint, can help control pain. With conservative, nonsurgical measures, CMC arthritis can often be managed for months to years.

Injection Therapy

Injections consist of corticosteroids and platelet-rich plasma. Corticosteroid injections can provide near-immediate pain relief by suppressing inflammation. However, corticosteroid injections are not intended for long-term repeated use because frequent injections can contribute to additional joint and soft-tissue degeneration.

Platelet-rich plasma, or PRP, is another injection option. PRP is intended to influence the body’s natural healing and inflammatory response rather than simply suppress inflammation. A small amount of the patient’s blood is drawn and processed to concentrate the platelets. Platelet-derived growth factor, or PDGF, is isolated and injected into the joint. This growth factor acts like a stem cell and can facilitate cartilage healing. Healing can take several months, and multiple injections may be needed.

Surgical Treatments

When conservative nonsurgical treatment no longer provides sufficient relief, surgery may be considered. The appropriate procedure depends on the severity of the arthritis, the patient’s age, activity level, occupation, strength requirements, and condition of the joint.

The TOUCH CMC prosthesis

The TOUCH CMC prosthesis is an FDA-approved implant used to treat arthritis of the thumb CMC joint. The implant has demonstrated excellent short- and long-term results with more natural restoration of motion and strength than traditional procedures.

Unlike procedures that remove the trapezium, a small wrist bone at the base of the thumb, the TOUCH procedure replaces the damaged joint while preserving the thumb’s natural length and structure. The implant works like a miniature ball-and-socket joint, helping maintain natural movement.

The goal is to reduce pain while preserving thumb strength, stability, and function. Patients may also experience a faster early recovery because the joint is replaced rather than removed. However, the thumb still requires time to heal before heavier gripping, lifting, and other demanding activities are resumed.

Studies have shown encouraging improvements in pain, pinch strength, and hand function. The procedure is not appropriate for everyone, and adequate bone quality is important to securely support the implant.

Thumb denervation procedure

Thumb denervation is a newer surgical option for treating pain caused by CMC arthritis. Small nerve branches surrounding the joint carry pain signals from the arthritic joint to the brain. During denervation, Dr. Sachar carefully identifies, removes, and cauterizes these specific nerve branches without removing or reconstructing the CMC joint itself.

One advantage is the relatively fast recovery. Because the procedure involves the soft tissues around the joint, recovery is largely determined by the time needed for the incision and surrounding tissues to heal, usually several weeks.

Only the small nerve branches responsible for carrying pain signals from the joint are treated, so normal sensation in the thumb is preserved while arthritis-related pain may be reduced.

Denervation is not appropriate for every patient. The severity and location of the arthritis and pain, along with other individual factors, help determine whether it is a suitable option.

Thumb CMC arthroplasty and suspensionplasty

CMC arthroplasty and suspensionplasty are among the most established surgical treatments for advanced thumb CMC arthritis.

During the procedure, the trapezium, the arthritic bone at the base of the thumb, is removed. Removing this bone eliminates the painful bone-on-bone contact within the damaged joint.

Because removal of the trapezium creates a space beneath the thumb metacarpal, the thumb must then be supported or “suspended” to help maintain its position. Modern suspensionplasty techniques may use nearby tendons, strong sutures, or an internal brace to support the thumb as it heals.

Patients are generally protected in a splint after surgery. Finger movement can often begin early, while thumb activity is gradually increased as healing progresses.

Thumb CMC fusion

CMC fusion, also called arthrodesis, eliminates the painful movement of the arthritic joint rather than removing or replacing it.

During the procedure, the thumb metacarpal is permanently joined to the trapezium. Screws or a plate hold the bones together while they heal into one solid unit, and bone graft may sometimes be used to encourage healing.

Fusion creates a very stable and strong thumb. For this reason, it may be considered for younger or highly active patients whose jobs or activities require substantial grip and pinch strength.

The tradeoff is that movement at the CMC joint is permanently eliminated. Other joints of the thumb continue to move, however, allowing many patients to maintain very good overall hand function.

There is no single treatment that is appropriate for everyone with thumb CMC arthritis. Dr. Kavi Sachar considers the severity of the arthritis, symptoms, daily activities, strength requirements, and response to previous treatments when recommending an approach. Contact Dr. Sachar at The Steadman Clinic in Vail, Frisco, or Basalt, Colorado, to schedule your consultation today. Dr. Sachar regularly sees patients from Denver and throughout the U.S.