THUMB BASE CONDITIONS & SURGICAL REPAIR
Pain, instability or stiffness at the base of the thumb often has a specific cause, and the surgery is chosen to match it. The right diagnosis leads to the right operation and a planned return to grip and function.
THE JOINT AT THE BASE OF YOUR THUMB
The base of the thumb is home to the carpometacarpal (CMC) joint, the most mobile joint in the hand. It allows the thumb to move in multiple planes, giving you the ability to grip, pinch, turn a key and open a jar. Pain, swelling, instability or a grinding sensation in this area are not symptoms to ignore. They indicate a specific structural problem that, left untreated, typically worsens.
The most common reasons for thumb base surgery are arthritis of the CMC joint, ligament injuries (including gamekeeper’s and skier’s thumb), and fractures at the base of the thumb metacarpal such as Bennett’s or Rolando fractures. Each condition requires a different surgical approach: arthritis may be treated by removing the arthritic joint surfaces; ligament injuries by repair or reconstruction; fractures by fixation with screws, pins or plates.
The right operation depends on the diagnosis. The thumb accounts for approximately 50 percent of hand function, and getting the diagnosis, technique and aftercare right determines the long-term outcome far more than it does for most other hand procedures. Post-operative splinting and physiotherapy are both critical to a good result.
THREE DISTINCT CONDITIONS, THREE DIFFERENT OPERATIONS
Similar symptoms can have very different causes. Correct diagnosis is what determines the right surgical approach.
CMC ARTHRITIS
Wear of the cartilage at the joint between the thumb metacarpal and the trapezium bone. The most common cause of thumb base pain. Presents with pain during pinch and grip, a grinding sensation, and a squared-off appearance at the base of the thumb. Treated surgically by trapeziectomy (removal of the arthritic trapezium bone), often with ligament reconstruction.
LIGAMENT INJURIES
Tears of the ulnar collateral ligament (UCL), known as skier’s or gamekeeper’s thumb, or the radial collateral ligament (RCL) cause instability at the thumb MCP joint. Caused by forced hyperabduction, common in ski falls and ball sport. Partial tears may be splinted; complete tears or Stener lesions require surgical repair or reconstruction for lasting stability.
FRACTURES & INSTABILITY
Fractures at the base of the thumb metacarpal involving the CMC joint. Bennett’s fracture is a two-part intra-articular fracture; Rolando is a comminuted three-part variant. Both require accurate surgical reduction and fixation with screws or K-wires to restore joint congruity and prevent post-traumatic arthritis.
PROCEDURE OVERVIEW
Approach and splinting duration vary by condition. The procedure is typically completed within ninety minutes.
Surgery Time
Anaesthesia
Hospital Stay
Drains
Splint Duration
The exact surgical approach is determined at consultation, after an examination and a discussion of the options.
YOUR RECOVERY ROAD MAP
Week 1
The thumb is held in a custom splint or cast immediately after surgery. A follow-up at one week reviews wound healing and confirms the operative position on X-ray where relevant.
Weeks 2–6
The splint continues for four to eight weeks depending on the procedure. For ligament repairs and arthritis surgery, strict immobilisation in this phase protects the repair while initial healing occurs.
Weeks 6–8
Once the splint is safely discontinued, physiotherapy begins to restore range of motion, pinch strength and grip. Exercises are progressive and guided by your physiotherapist’s assessment at each session.
Weeks 8–12
Return to light and moderate work is typically achievable at six to twelve weeks depending on the procedure. Full functional recovery of grip and pinch strength progresses with physiotherapy into three months and beyond.
WHAT SURGERY ACHIEVES
With accurate diagnosis, the correct surgical technique and structured rehabilitation, the majority of patients achieve a substantial and lasting improvement in thumb function.
WHY SPECIALIST CARE MATTERS HERE
Thumb base symptoms are non-specific. Arthritis, a ligament tear and a fracture can all present similarly. Clinical examination combined with targeted imaging establishes the diagnosis, which decides the surgical approach.
There is no single thumb base operation. The technique (trapeziectomy for arthritis, ligament reconstruction or fracture fixation) is chosen specifically for your condition and the extent of the damage found at assessment.
The thumb base sits adjacent to important tendons, sensory nerves and the radial artery. Surgery in this region needs careful dissection to preserve normal anatomy while correcting the problem.
Physiotherapy is part of the treatment plan from the outset. A structured programme of progressive exercises restores pinch and grip strength and prevents the stiffness that can follow any joint surgery.
THE THUMB IS HALF YOUR HAND
The thumb contributes approximately 50 percent of hand function. That figure reflects just how many everyday tasks, from holding a cup to typing a message, depend on a pain-free, stable thumb base. When arthritis, a ligament tear or a fracture compromises that joint, it is not a minor inconvenience. It is a significant functional loss that typically worsens without treatment.
Common activities that become painful or impossible with thumb base conditions are listed below. If several of these apply to you, a specialist assessment is worth arranging sooner rather than later.
IS SURGERY RIGHT FOR YOU?
Thumb base surgery is typically recommended when non-surgical treatments such as splinting, steroid injections and physiotherapy have not provided adequate or lasting relief, or when the injury demands surgical correction from the outset. Common indicators include:
THE WORK AFTER SURGERY
Following thumb base surgery, the joint capsule, tendons and surrounding soft tissue all need time to heal before active rehabilitation can begin. The splint provides this protected window. Once it is removed, physiotherapy has a precise job to do: restore movement, rebuild pinch strength and retrain the neuromuscular patterns that govern thumb stability.
The programme is led by a specialist hand physiotherapist working alongside Professor Hindocha. Sessions are planned around the specific procedure performed and to your occupational and lifestyle requirements. Recovery of function is usually better when rehabilitation is approached with the same rigour as the surgery itself.
ALSO TREATED BY PROF. HINDOCHA
Related hand and wrist conditions managed at the same clinic.
HAND SURGERY
Surgical fixation of displaced and unstable fractures of the hand and finger bones including Bennett's and Rolando fractures.
HAND SURGERY
Tendon sheath inflammation causing the finger or thumb to click, catch or lock when flexed.
HAND SURGERY
Compression of the median nerve at the wrist causing numbness, tingling and weakness in the thumb and fingers.
Verified patient reviews
Independently published reviews from patients of Prof. Hindocha, quoted in full and exactly as written. Every one links back to its source.
★★★★★
After years of being unhappy with my breasts after breastfeeding, I'm so glad I trusted my instincts and waited until I found the right surgeon. From my first consultation, Professor Hindocha made me feel completely at ease and I knew I could trust him. I'm only a week post-op and already love my results. I feel incredibly lucky to have found him and truly believe I found the best surgeon.
K.N.
Breast surgery patient
★★★★★
Amazing experience and surgeon. So incredibly thorough, precise and professional. Went above and beyond to explain every last detail to me, he put me at ease, didn't mind a family member being there, very down to earth, can't praise him enough. Would only use this surgeon now.
L.O.
Consultation and surgery
★★★★★
I cannot recommend prof Hindocha enough, from consultation to aftercare he has amazing as have his team. Very professional , I felt very reassured through every step of the process. Thank you Prof Hindocha and team for your kind and professional care.
D.T.
Consultation to aftercare
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Patient stories describe individual experiences. Results vary from person to person, and the risks, limitations and likely outcome of any procedure are discussed with you at consultation.
GET THE RIGHT DIAGNOSIS
Accurate assessment. The precise operation for your condition.
Thumb base symptoms are common but the underlying cause matters. A consultation with Professor Hindocha will establish what is driving your pain or instability, confirm the diagnosis with appropriate imaging, and set out the treatment options, surgical or otherwise. Many patients wait years before seeking specialist assessment. It is rarely necessary to wait.
FREQUENTLY ASKED QUESTIONS
The questions patients most commonly ask us about this procedure.
