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The Thumb base osteoarthritis is wear of the thumb saddle joint (carpometacarpal joint I) with progressive cartilage damage and irritation of the surrounding joint structures.
Typical symptoms are pain at the ball of the thumb when gripping, turning, and clutching, as well as diminishing strength.
At the reference centre for Axomera therapy, you are treated by a medical team led by Prof. Molsberger.
From our patient consultations and the medical reports submitted.
Almost always in this order.
At the beginning is the conservative basis: relieve the thumb saddle joint in everyday life, adapt strenuous gripping and turning movements, and support the joint with an orthosis — a supportive thumb brace — stabilise. Supplement with exercises for strength and mobility. European professional recommendations (EULAR 2018) explicitly place these non-pharmacological measures — education, aids, exercises, orthoses — at the start of every treatment.
If relief is insufficient, anti-inflammatory painkillers are added. According to EULAR, topically applied antirheumatics (topical NSAIDs, such as gel) are the first-line treatment because they place less strain on the body than tablets. Oral NSAIDs are used for a limited time for symptom relief; chondroitin sulphate may be considered for relief. Important: These agents alleviate symptoms — they do not stop the wear itself.
In cases of thumb base osteoarthritis, cortisone is often injected directly into the joint. The controlled evidence for this is sobering. In the most significant randomised double-blind study to date (Meenagh et al. 2004, 40 patients with moderate to severe thumb base osteoarthritis), a cortisone injection (triamcinolone) compared to a saline placebo injection over 24 weeks showed no measurable benefit regarding pain, stiffness, or function.
Professional recommendations are correspondingly cautious: EULAR 2018 generally advises against cortisone injections for hand osteoarthritis — it can only be considered in individual cases for joints with significant inflammatory activity. Short-term relief during an acute flare-up is possible; a lasting or reproducibly proven benefit is not.
If pronounced symptoms persist despite consistent conservative treatment, surgery may become appropriate. Three questions are worth asking beforehand.
When? Usually in cases of advanced joint wear (Stage III–IV according to Eaton/Littler) with persistent pain and loss of function — and only after relief, bracing, and medication have not helped sufficiently over several months. The declared goal of the intervention is pain relief, not the restoration of the original mobility (as per the EULAR recommendation).
Which method? The most widely used and established reference is the trapeziectomy — the removal of the trapezium bone at the base of the thumb. It is performed either alone or supplemented with additional ligament and tendon reconstruction (in technical terms, LRTI, “ligament reconstruction and tendon interposition”) or with a suspensionplasty, in which a strip of the patient's own tendon supports the thumb. In addition, there is fusion (arthrodesis) and joint replacement (prosthesis).
How well evidenced? Surprisingly thin. The authoritative Cochrane review (Wajon et al. 2015) summarised 11 randomised studies with 670 operated individuals. Their result: No surgical method was superior to another regarding pain and function; the simple trapeziectomy had fewer complications than the more complex variant with ligament and tendon reconstruction. The quality of the studies was low overall. Especially remarkable is what is missing: there are practically no randomised studies comparing surgery directly with non-operative treatment. Whether and from when surgery is superior to further conservative treatment has therefore not been answered to this day by high-quality studies. Recovery after the procedure extends over months.
Kloppenburg M et al. 2018 update of the EULAR recommendations for hand osteoarthritis. Ann Rheum Dis 2019;78(1):16–24. PMID 30154087. — Meenagh GK et al. RCT intra-articular corticosteroid injection thumb CMC, n=40, 24-week follow-up. Ann Rheum Dis 2004;63(10):1260–1263. PMID 15361383. — Wajon A et al. Surgery for thumb (trapeziometacarpal joint) osteoarthritis. Cochrane Database Syst Rev 2015;(2):CD004631. PMID 25702783. — Eaton RG, Glickel SZ. Trapeziometacarpal osteoarthritis staging. Hand Clin 1987;3(4):455–471. — Eaton RG, Littler JW. Ligament reconstruction for painful thumb CMC. J Bone Joint Surg Am 1973;55(8):1655–1666.
Braces, anti-inflammatory ointments and cortisone injections often only temporarily relieve the pain at the thumb saddle joint; repeated injections can further weaken the cartilage, and in the end, when symptoms persist, the question of surgery usually arises.
At the thumb saddle joint (carpometacarpal joint I), as cartilage wear progresses, bone increasingly rubs on bone; the joint capsule and surrounding soft tissue react with chronic inflammation, which creates the actual pain upon movement during gripping and turning. Because this joint lies directly under the skin at the thumb base, the capsule and ligament region is very precisely accessible from the outside.
Axomera starts precisely in this region: computer-controlled electrical signals in the dimension of cellular electrical fields are placed millimetre-precisely at the capsule and ligament attachments of the thumb saddle joint. The goal is to shift the inflammation-regeneration balance back in favour of healing — not to reverse the cartilage wear itself. In favourable courses, pain relief can last for months to years and delay a surgical intervention. This neurophysiological hypothesis is also empirically grounded by many patient courses (real-world data), not by controlled studies; as with other indications, around 20–30% of those treated do not respond.
How inflammation and pain are connected →We treat one level deeper — where the body regulates inflammation and healing itself.
Axomera is an internationally patented bioelectrical procedure.
How Axomera therapy works →Every therapy needs its own examination — for us, this includes the Axomera diagnostics and the Axomera therapy.
Goal: reduce painkillers and delay an operation, if it is necessary at all.
For two years, increasingly stronger pain in the thumb, every time I gripped something it hurt. After two Axomera sessions — first improvement after one day — I was able to grip again. Doctor's report: despite polyarthritis, subsequently lasting significantly fewer complaints at the thumb saddle joint.
Patient, 65 — identified individual case from the practice.
Documented individual cases, with patient consent. Individual outcomes differ.
Developer of Axomera therapy · Medical Director
As the developer of Axomera therapy, he oversees the indication and is involved in your treatment personally upon request. His experience in conservative pain medicine informs the planning of your treatment series.
Doctor, orthopaedics & trauma surgery (in specialist training)
Performs your Axomera treatment and accompanies you throughout the entire treatment series. He reviews your findings and assesses whether the procedure is suitable for you. He also participates in the technical development.
Doctor, Specialist in Orthopaedics and Trauma Surgery
Organises your previous findings, performs Axomera diagnostics, and accompanies you throughout the entire treatment series. He reviews your findings and, based on his experience, assesses whether the procedure is suitable for you.
Three ways to reach us, around the clock, directly here on the site. For each, you can upload doctor's letters, findings, and MRI images at the same time — encrypted into your file, reviewed by a doctor before we speak.
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Our practice treats exclusively by prior appointment.
The telephone initial assessment is not a treatment and does not replace an examination. Whether Axomera is suitable for you will be decided after a medical examination.
