Thumb Basal Joint (Carpometacarpal Joint) Arthroscopy

Dr Jacqueline Tan

Senior Consultant Hand Surgeon

MBBS (SG) | MRCS (Edin) | MMed (Surgery) | FAMS (Hand Surgery)

Thumb basal joint arthroscopy is a minimally invasive surgical procedure that examines and treats conditions affecting the carpometacarpal (CMC) joint of the thumb. This technique uses small incisions and specialised instruments to visualise the joint space through a tiny camera, allowing surgeons to diagnose and address various pathologies while preserving surrounding tissues.

Indications Benefits Techniques Preparation Procedure Recovery Risks FAQ

Indications for Carpometacarpal Joint Arthroscopy

Carpometacarpal (CMC) joint arthroscopy is considered when non-surgical treatments fail to provide sufficient relief. Common conditions that may benefit from this procedure include:

Osteoarthritis: Progressive degeneration of joint cartilage, leading to pain, stiffness, and impaired thumb function, especially during pinching or gripping.
Synovitis: Chronic inflammation of the joint lining, characterised by pain, swelling, and limited motion, affecting daily tasks.
Joint Instability: Weakness or injury to ligaments causing compromised joint stability and reduced thumb strength or control.
Diagnostic Uncertainty: Situations where physical examinations and imaging are inconclusive, and arthroscopy aids in identifying the source of thumb pain or dysfunction.

Benefits of Carpometacarpal Joint Arthroscopy

Arthroscopic treatment of the thumb CMC joint provides several advantages over traditional open surgery, including:

Minimal Tissue Disruption: Small incisions limit damage to surrounding soft tissues, promoting faster healing and reducing post-operative scarring.
Enhanced Visualisation: High-definition magnified views of the joint enable accurate identification and targeted treatment of underlying issues.
Faster Recovery: The minimally invasive approach results in less surgical trauma, often shortening rehabilitation time and facilitating an earlier return to daily activities.
Preservation of Future Options: The procedure does not compromise the possibility of additional surgical interventions should further treatment be required.

Surgical Techniques

The specific approach to thumb CMC arthroscopy varies based on the underlying pathology and surgical objectives.

Diagnostic Arthroscopy

This minimally invasive technique involves examining the joint through one or two small incisions. The surgeon evaluates the cartilage surfaces, joint lining, and ligaments while recording their observations. The procedure may also include flushing the joint (lavage) and removing damaged tissue (debridement) if needed.

Synovectomy

The procedure involves removing inflamed synovial tissue through arthroscopic instruments. The surgeon systematically addresses affected areas while preserving healthy tissue and maintaining joint mobility. This technique may include additional steps such as capsular shrinkage.

Ligament Reconstruction

This technique combines arthroscopic evaluation with ligament repair or reconstruction. The surgeon identifies torn or damaged ligaments arthroscopically, and then proceeds with repair through small incisions. This may involve using suture anchors or other fixation methods.

Surgery Preparation

Medical Assessment

A comprehensive evaluation includes a physical examination, imaging studies, and a review of medical history. Blood tests and cardiac assessments may be required based on age and health status. The surgeon reviews all findings to finalise the surgical plan.

Medication Review

Blood-thinning medications require adjustment or temporary cessation prior to surgery. Patients should provide a complete list of current medications, including supplements.

Fasting Guidelines

Avoid all food and drink for at least 8 hours before surgery. Approved medications may be taken with a small sip of water if instructed by your surgeon.

Step-by-Step Procedure

Anaesthesia Administration

Regional anaesthesia with a brachial plexus block is typically used. The surgeon monitors vital signs throughout the procedure. A tourniquet may be applied to the upper arm for better visualisation.

Portal Placement

The surgeon creates two small portals for instrument access. These locations are carefully selected to avoid nerve injury and optimise joint access. Portal placement may be confirmed with fluoroscopy.

Joint Examination

Systematic evaluation of the joint surfaces begins with the introduction of the arthroscope. The surgeon evaluates the condition of the articular cartilage, synovium, and ligaments. Probing instruments are used to examine the structures and assess tissue integrity.

Therapeutic Intervention

The surgeon addresses identified issues by performing treatments such as debridement, synovectomy, or ligament repair. Continuous irrigation is used to maintain a clear view of the joint throughout the procedure.

Incision Closure

The surgeon carefully removes the instruments and closes the small portal incisions with sutures. A sterile dressing is applied, followed by a thumb spica splint to support the joint. The tourniquet is then released, and proper blood circulation is confirmed before completing the procedure.

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Post-Surgical Care and Recovery

Immediate Post-operative Care

The affected hand remains elevated above heart level for 24-48 hours. Pain medication and ice therapy help manage discomfort and patients may begin gentle finger movements as directed.

Early Recovery Phase

A protective splint is worn for 2–3 weeks to support healing. During this time, patients begin hand therapy sessions to learn gentle exercises that promote mobility and strength. Activities are gradually reintroduced in accordance with healing progress and the surgeon’s guidelines.

Long-term Recovery

Most patients resume daily activities within 6–12 weeks, depending on individual healing. Strengthening exercises are ongoing, guided by a hand therapist to restore full function. Regular follow-up appointments ensure progress is on track.

Potential Risks and Complications

Thumb CMC arthroscopy carries risks including infection, nerve injury, bleeding, and portal site problems. Complex regional pain syndrome may develop in rare cases. Some patients may experience temporary joint stiffness or ongoing pain. Technical challenges may necessitate conversion to an open procedure. Portal placement can damage surrounding structures if not precisely executed.

Frequently Asked Questions

How long does the procedure take?

The surgery typically lasts 45-90 minutes, depending on the complexity of the case and additional procedures required. If significant issues are identified during the joint examination, the operating time may be extended.

When can I expect to regain pinch strength?

Pinch strength gradually improves over 3-6 months post-surgery. Recovery varies among patients based on pre-operative condition and compliance with rehabilitation protocols.

Will I need additional surgery in the future?

Some patients may require further intervention if arthritis progresses or new problems develop. The arthroscopic procedure does not prevent future joint deterioration but may delay the need for more extensive surgery.

Dr Jacqueline Tan

Senior Consultant Hand Surgeon

MBBS (SG)

MRCS (Edin)

MMed (Surgery)

FAMS (Hand Surgery)

Dr. Jacqueline Tan is a hand surgeon in Singapore with over 18 years of experience in managing hand, wrist, and nerve conditions. Formerly the Head of Department of Hand and Reconstructive Microsurgery at Singapore General Hospital, she has continued to contribute significantly to her profession.

Director of Micro-Reconstruction Service and the Director of Peripheral Nerve and Paralytic Upper Limb Service
Upon the completion of her training as a hand surgeon in Singapore, Dr Tan was awarded the prestigious Health Manpower Development Plan scholarship by the Ministry of Health (MOH).
Completed a one-year advanced fellowship in Taiwan under the tutelage of internationally-acclaimed Hand and Orthopedic Microsurgeon – Professor Yuan-Kun Tu
Dr Tan’s field of expertise is in early and late brachial plexus reconstruction, peripheral nerve disorders, reconstructive microsurgery of the extremities and wrist disorders.

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