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Hypermobility of the first CMC joint may adversely affect hand function and may lead to osteoarthritis later in life. It presents more commonly in younger women with generalized joint hypermobility or postmenopausal women with early stages of arthritis. It may follow trauma and deletive surgical interventions. Clinically, joint subluxation manifests with a prominent and unstable thumb base, and is radiographically confirmed by stress views. A variety of ligament reconstruction techniques are available to stabilize the CMC joint including open ligament reconstruction with or without temporary Kirschner-wire fixation, arthroscopic debridement with capsular shrinkage, metacarpal extension osteotomy, internal proprietary anchors, and arthrodesis.