Proposal Basal joint arthroscopy is one of the more recent advancements of small joint arthroscopy. We demonstrate the technique, feasibility, and safety of using a novel 2-mm needle arthroscope for operative arthroscopy of the trapeziometacarpal joint of the thumb. Case Overview The patient is a 42-year-old, right-hand–dominant woman with several months of atraumatic pain at the base of the left thumb, which grows worse with gripping and pinching activities. Examination findings are notable for painiful carpometacarpal grind, pain with pinching, and a stable thumb ray. Imaging findings are notable for very early arthritic changes with subtle joint space widening, Eaton-Littler stage I osteoarthritis of the thumb trapeziometacarpal joint. Her pain was persisted despite nonsurgical treatment (NSAIDs, corticosteroid injection, splinting, and therapy). She was indicated for arthroscopic débridement of the thumb basal joint. Method/Technique The procedure is performed under a regional anesthetic, using an arm tourniquet. Ten pounds of axial traction are applied to the thumb with an arthroscopy traction tower. The basal joint is localized via palpation and confirmed with a needle and fluoroscopy; then 1R (just radial to the abductor pollicis longus) and 1U (just ulnar to the extensor pollicis brevis) portals are created. Instead of a conventional 2.7-mm small joint arthroscope, the Arthrex NanoScope (Naples, FL) is used. This is a a 2-mm, single-use, 0&[deg] fiberoptic arthroscopy system. The arthroscopic examination findings are notable for grade 1 and 2 chondral changes along the ulnar aspect of the first metacarpal base, moderate synovitis, and a 1-mm chondral loose body. Arthroscopic synovectomy and removal of loose body are performed. Results Excellent visualization of the trapeziometacarpal joint was noted intraoperatively. The patient's pain had improved considerably at her most recent follow-up. Summary Use of a 2-mm needle arthroscopy system is an effective and safe tool that can be used in small-joint arthroscopy, including for the basal joint of the thumb. Visualization is excellent, and the smaller arthroscope allows for more atraumatic use in small joint spaces.