Arthroscopic management of thumb base arthritis

Thumb base arthritis is a common condition. Arthroscopic or arthroscopic assisted procedures offer better visualisation, less invasiveness, faster recovery, and help to guide the treatment decision.

From Apr 2002 to Aug 2013, 76 thumb base arthroscopic debridement & synovectomy was performed in 65 patients (female 51, male 14) at the average age of 56. All patients failed nonoperative care for 6 months. They were follow-up on average of 59 months. Thirty-eight cases were Eaton & Littler stage II, 36 stage III, I stage IV and I stage I. The operation was done under local or regional anaesthesia. Synovectomy, debridement of frayed capsule and radio-frequency ablation were done in all, loose bodies were removed in 25, and thermal shrinkage was done in 30 cases. Post-thermal shrinkage immobilisation was given for 3–6 weeks. Twelve cases had smoothening of the bony surface & prominent osteophytes.

Sixty-nine cases experienced pain relief after the operation. Twenty scored excellent while 14 good results. Mean grip strength of 88.3% of the contralateral side while pinch power of 81.7%. Kapandji index was 8. DASH score was 26.5. Patient satisfaction was 77/100. There was no complication encountered. Seven patients requested the same operation on the other thumb after the operation. Three requested repeating the same operation on the same thumb as pain relief lasted only for 1–3 years. Better outcomes were found to be statistically related to bone surface smoothening, or thermal shrinkage and immobilisation for ≥ 4 weeks. Arthroscopic surgery on thumb base arthritis is a safe, easy and feasible buy time surgery.

Long-term results of arthroscopic debridement and synovectomy, the surgical techniques, and the examples of arthroscopic assisted procedures at the thumb base were also demonstrated and discussed.