Complaints about weakness of grip are common in my office, and the offending problem may be nothing more than a painful trigger finger, 1st extensor compartment tendonitis (De Quervain’s disease) or carpal tunnel syndrome. But, it might be arthritis of the thumb’s “basal joint”. The trapezio-metacarpal joint is a bi-concave-convex “saddle joint” which affords unusual motion, but which requires ligamentous restraint.

As we age, those ligaments wear out and increased shear stress at the base of the thumb results in cartilage wear, and ultimately, osteoarthritis. Though a cortisone shot may bring temporary relief often, ongoing pain and weakness, particularly with pinch and grip, prevail. I have been quite involved in establishing the current “preferred treatment” throughout the U.S. –trapezium excision and ligament reconstruction. The arthritic joint between the base of the thumb metacarpal and the trapezium is treated by resection of the trapezium and reconstruction of the “beak” ligament. This affords a restraint to so-called “cantilever bending forces” which may result in long-term collapse of the thumb ray and weakness in the absence, thereof.
 
The operation has undergone iterations over the past 2 decades, and now is performed as an outpatient in under 35 minutes. The results are very successful—in fact I believe that it is the single most successful operation we perform for arthritis in the hand. Postoperative rehabilitation involves 6 weeks of immobilization in a splint, and 4-6 weeks of hand therapy thereafter.  Grip and pinch strength improve and, most importantly, pain relief is the expected outcome in 95% of patients. There are numerous videos of the LRTI procedure online. I have attached a video below. Although my technique is slightly different, it will provide a general idea of the technical aspects of the procedure.

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