This 2000 review by Barron, Glickel, and Eaton covers the diagnosis, staging, and surgical treatment of thumb basal joint arthritis. The Eaton-Glickel 4-stage radiographic classification guides operative decision-making from ligament reconstruction in early disease to trapeziectomy with tendon interposition in advanced stages. A key secondary question — whether to address MP joint hyperextension at the same sitting — is answered with a clear 30-degree threshold.
Radial-sided hand pain in a 50–70-year-old woman is basal joint arthritis until proven otherwise — but the radiographic stage does not dictate symptoms, so exam drives the decision.
When you see a patient failing 6 weeks of splinting with Stage I or early Stage II disease, volar ligament reconstruction with FCR strip is the appropriate next step. For Stages II–III with established cartilage loss, LRTI arthroplasty (Burton-Pellegrini) or suspensionplasty is the workhorse. Stage IV with ST joint involvement requires either complete trapeziectomy or double interposition to address both diseased articulations.
Before any basal joint reconstruction, measure MP joint hyperextension actively during pinch. If it exceeds 30 degrees, plan for arthrodesis or capsulodesis at the same sitting. This is a well-documented cause of failed basal joint surgery when overlooked.
For the boards: the 2 mm osteophyte threshold separates Stage II from Stage III, and Stage IV is defined by ST joint involvement, not osteophyte size.
This 2000 review by Barron, Glickel, and Eaton covers the diagnosis, staging, and surgical treatment of thumb basal joint arthritis. The Eaton-Glickel 4-stage radiographic classification guides operative decision-making from ligament reconstruction in early disease to trapeziectomy with tendon interposition in advanced stages. A key secondary question — whether to address MP joint hyperextension at the same sitting — is answered with a clear 30-degree threshold.
Radial-sided hand pain in a 50–70-year-old woman is basal joint arthritis until proven otherwise — but the radiographic stage does not dictate symptoms, so exam drives the decision.
When you see a patient failing 6 weeks of splinting with Stage I or early Stage II disease, volar ligament reconstruction with FCR strip is the appropriate next step. For Stages II–III with established cartilage loss, LRTI arthroplasty (Burton-Pellegrini) or suspensionplasty is the workhorse. Stage IV with ST joint involvement requires either complete trapeziectomy or double interposition to address both diseased articulations.
Before any basal joint reconstruction, measure MP joint hyperextension actively during pinch. If it exceeds 30 degrees, plan for arthrodesis or capsulodesis at the same sitting. This is a well-documented cause of failed basal joint surgery when overlooked.
For the boards: the 2 mm osteophyte threshold separates Stage II from Stage III, and Stage IV is defined by ST joint involvement, not osteophyte size.