THUMB BASE CONDITIONS & SURGICAL REPAIR
Pain, instability or stiffness at the base of the thumb often has a precise underlying cause — and a precise surgical solution. The right diagnosis leads to the right operation and a predictable return to full grip.
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.
A tailored surgical approach is essential. The thumb accounts for approximately 50 percent of hand function, and getting the surgery right — the correct diagnosis, correct technique, correct post-operative management — 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 — often with ligament reconstruction.
LIGAMENT INJURIES
Tears of the ulnar collateral ligament (UCL) — called 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 — augmentation, reduction, lift or combination — is determined at consultation based on your individual anatomy and goals.
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 correct diagnosis — and therefore the correct surgical approach.
There is no single thumb base operation. The technique — trapeziectomy for arthritis, ligament reconstruction, 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 demands meticulous 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.
“
The arthritis at the base of my thumb had been getting worse for three years. Since the surgery and physio I can open bottles, cut food and use my phone without pain. Life-changing.
“
I tore the ligament skiing. Professor Hindocha repaired it surgically and after eight weeks of physio my thumb is completely stable and I’m back on the slopes.
“
I had a Bennett’s fracture from a fall. The fixation was precise, the recovery predictable and I was back at work as a carpenter at eleven weeks. Excellent outcome.
IS SURGERY RIGHT FOR YOU?
Thumb base surgery is typically recommended when non-surgical treatments — splinting, steroid injections, 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 tailored to the specific procedure performed and to your occupational and lifestyle requirements. Most patients are surprised by how much functional recovery is possible 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.
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 most effective treatment — 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.
