For years the painful, nonarthritic thumb basal joint has been an elusive diagnosis. It is not uncommon to see patients who have had prior operations for tendonitis only to find no relief. The basal joint can, however, be a source of pain even when xrays are normal. Subtle hypermobility can cause pain with grip and pinch. For many years a ligament reconstruction using a strip of wrist flexor tendon was the only option until experimental biomechanical data indicated that forces might be redirected by the use of a thin resection of bone from the metacarpal. I published the first clinical outcome paper in the Journal of Hand Surgery in 2000 and reported very favarable results--pain relief and restoration of strength. Since then I have instructed numerous surgeons around the country on its merits, and continue to recommend the procedure in selected cases. Ligament reconstruction still has a role, as does a relatively new technique utilizing thumb CMC joint arthroscopy, but in my experience, a quicker recovery and its reliability make Thumb extension osteotomy a wonderful option for early stage disease.

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