Westminster, Md. – Carroll County General Hospital is one of only two sites in the country to offer a revolutionary procedure to repair an arthritic joint at the base of the thumb. The minimally-invasive surgery, known as capsulorrhaphy, is designed to create space within the joint, rather than reconstruct it using conventional techniques such as arthroplasty with interpositional grafting, carpometacarpal fusion or a prosthetic.

The procedure also is performed at the Philadelphia Hand Center.

The joint at the base of the thumb (known as the basal joint), near the wrist and at the fleshy part of the thumb, consists of the metacarpal bone of the thumb and the trapezium bone of the wrist. The basal joint is shaped like a saddle and allows the thumb to swivel, pivot and pinch so you can grip things in your hand. Over time, wear and tear on the joint can cause a breakdown in cartilage, resulting in bone rubbing against bone.

“The components of the procedure are primarily removing the arthritic surfaces, so that bone is not rubbing against bone, and stabilizing the joint,” said Stacey Berner, M.D., orthopaedic surgeon at Carroll County General Hospital. “With the new procedure, patients are able to maintain flexibility of the thumb.”

Patients with inflammatory arthritis and those with arthritis in the adjacent joint are not suited for arthroscopic CMC joint arthroplasty, Berner said.

In many cases, arthritis of the base of the thumb is treated using Ligament Reconstruction Tendon Interposition (LRTI), an extensive surgery during which the diseased joint is removed and reconstructed with tendons from the arm or wrist. Although LRTI has proven to be successful, it’s a lengthy surgery that involves significant bone loss and requires three months of recovery. The new procedure cuts recovery time by almost five weeks, involves only two small incisions and is performed in under two hours.

“Patients have been quite happy and they get back to work in a hurry,” said Berner. “The new procedure allows you to arthroscopically do almost all of what is done during ligament reconstruction using a tendon graft.”

Berner added that CMC joint arthroplasty also allows surgeons to resort to conventional surgery if arthritis recurs at the base of the thumb.

“When replacing and resurfacing joints in younger people, you always run the risk of having the reconstruction wear down over time,” he said. “But this new procedure gives us an adequate, at the very least, temporary measure until they get much older and maybe need another repair.”

Because capsulorrhaphy is not widely performed, research on the long-term effects, such as grip strength and durability, is preliminary. Still, early results show the new procedure as a viable option to restore function to the basal joint compared to traditional approaches, said Berner.

Arthritis is a condition that irritates or destroys joints. While there are several forms of arthritis, the one that most affects the joint at the base of the thumb is osteoarthritis, or degenerative, wear-and-tear arthritis. Osteoarthritis occurs when the cartilage that covers the ends of bones begins to deteriorate, causing bone to rub against bone.

The cause of osteoarthritis is unknown and usually occurs after the age of 40. Middle-aged women and older men are most affected by arthritis of the base of the thumb. Common symptoms include pain and loss of strength with gripping and pinching activities, such as opening a door, turning a key, or snapping fingers; swelling at the base of the thumb; aching discomfort after prolonged use and development of a bony bump over the joint.

Founded in 1961, Carroll County General Hospital is a nonprofit, acute care facility offering a continuum of services, including comprehensive inpatient, outpatient and community programs.

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