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Five years ago I had reconstructive surgery on my left thumb. The arthritis was so bad, they took out one of the bones at the base of the thumb. The X-rays show everything is okay, but I'm starting to have more pain and discomfort now. What could be causing this?

Your experience is typical of many patients who have basal joint osteoarthritis (OA). Basal joint refers to the joint of the thumb where it attaches to the wrist. It is also known as the carpometacarpal (CMC) joint of the thumb.

Arthritis of the CMC is fairly common, especially among post-menopausal women. In fact, it is the place in the hand most often affected by OA for both men and women. Conservative care with physical therapy, exercises, and splinting can often manage the problem.

But surgery is needed when nonoperative care fails to relieve painful symptoms or improve function. Long-term studies of the outcomes of these operations show good results. Pinch and grip strength seem to be restored early on. Pain relief isn't always so successful.

In terms of X-ray results, many patients do have what are considered normal radiographs. No progression of disease is seen. But about 66 per cent of patients have gradually increasing symptoms between five and 15 years postop.

The reasons for this aren't clear. Experts say that there are up to 16 ligaments that stabilize the basal joint. Some ligaments allow for motion while others hold the joint steady and keep it from moving. Anything that affects one of those ligaments could disrupt the stability of the joint leading to pain.

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