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I've had arthritis at the base of my left thumb for 10 years now. It's time to do something about it. What are my options?

If there's a hand surgeon in your area, make an appointment for a consult. A physical exam and testing will be done to find out the severity of joint damage. This will help guide the physician in making recommendations.

You may be a candidate for conservative care with medications and hand therapy. A physical or occupational therapist may be able to help you manage your symptoms without surgery. You'll learn safe ways to lift, pinch, pull, and use your hands in general. The therapist may give you some exercises to restore motion and improve strength. Splinting may help with the symptoms as well.

If conservative treatment fails, then surgery may be the next option. There are several operations that can be done. Removing the trapezium, the arthritic bone at the base of the thumb may be necessary.

A special procedure called ligament reconstruction with tendon interposition (LRTI) may be done. In this operation, a tendon is split in half. One half is rolled up and used to fill in the space where the bone was taken out. The other half is used like a ligament to stabilize the joint. LRTI has been shown to be a very good way to restore a stable thumb that can then be used for daily tasks without pain.

Attempts have been made to replace the joint with an implant. Silicone and titanium implants have been used with mixed results. Silicone implants fell out of favor because of implant instability. Wear and tear caused silicone synovitis. Titanium has been used but with a high failure rate. Until better implant design is successful, the LRTI remains the surgery of choice for this condition.

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