Thumb Base Arthritis
What is Thumb Base Arthritis?
-
It occurs when the cartilage at the base of the thumbs wears out.
-
Eventually ‘bone on bone’ articulation occurs and bone spurs develop.
-
It is more common in females
-
and runs in families
How does it present?
-
There is usually some prominence at the base of the thumb
-
The areas aches, especially when a pinch grip is exerted.
-
A ‘thumb in palm’ deformity (also called an adduction contracture) can develop
What can be done?
-
Avoid activities that hurt and find other ways to do them
-
Take simple pain relief (such as paracetamol) and consider taking an anti inflammatory.
-
Braces can help for pain and still allow reasonable function.
-
A steroid injection into the worn joint can sometime relieve pain for extended periods
When is surgery needed?
-
When non operative treatment is unsuccessful and
-
pain and weakness in the hand:
-
stop you from doing the ‘things that you have to do’ such as getting dressed, making a meal, driving a car, or getting a good night’s sleep
-
and/or the ‘things that you love to do’ in life such as fishing, riding a bicycle, or holding a book to read.
How does surgery work?
-
This kind of surgery usually requires a General anaesthetic (being ’completely knocked out’)
-
Because it can be quite sore immediately after surgery and because there is a small risk of severe swelling that cuts of blood supply(compartment syndrome) - It is recommended to stay in hospital overnight
-
Antibiotics is usually administered at the time of surgery, but does not have to be continued after surgery.
What do we do in surgery?
-
There are many different surgeries for thumb base arthritis.
-
The technique that I use requires 3 small incisions as drawn in the photos
What do we do in surgery?
-
During surgery the trapezium bone is removed.
-
Half or all of the FCR tendon (marked by the dotted line) is then harvested via a small incision in the forearm
-
The harvested tendon is then used to stabilise the thumb.
After the Surgery
In Hospital
-
The hand is placed in a plaster
-
It is important that the hand remains elevated ‘higher than your heart’ to help limit swelling
-
Do not hesitate to ask for pain killers. It is much better to ‘stay on top of pain’, than ‘to catch’ up when it is severe.
-
If the plaster feels to tight, ask to have the bandages cut and even remove the plaster if pain form a tight cast is severe.
-
It is usual to leave hospital the morning after surgery
At Home
-
Continue to elevate your arm until swelling in your fingers subside.
-
Move your fingers (making a full fist and straightening your fingers out fully about 10-20 times a day).
-
Keep the wound dry covered and clean.
-
Make and appointment with a hand therapist (within a week or 2), to have the cast replaced with a thermoplastic splint.
-
An appointment with hand therapy and your surgeon is usually arranged for about 2 weeks after surgery.
-
Please do not drive before speaking to hand therapy or a doctor.
The recovery
-
A splint is usually worn full time for about 6 weeks
-
From 2-3 weeks on, a hand therapist will show you how to remove the splint for short periods to do gentle range of motion exercises.
-
From 6-12 weeks splint wear can be weaned hand use increased
-
Most moderately heavy activities can usually be achieved by 3-4 months, but scarring around the base of the thumb can take 6 -9months to become completely comfortable
Time frames
-
Self care (washing, dressing, eating) with the operated hand – usually around 2 weeks (a splint is still needed)
-
Driving: when you are able to control a steering wheel with your operated hand and you are not taking strong pain relief anymore (usualy 4-8 weeks post surgery)
-
Golf, fishing, cycling etc.: usually around 3-4 months, but it can be longer (6 months)
What can go wrong?
-
Infection occurs rarely (1% of the time), but can be severe. It may need further operations, weeks in hospital. It can lead to a poor outcome.
-
There may be ongoing pain from other worn out joints in the area, that were not obviously a problem at the time of doing the surgery.
-
It is common to have a bit of numbness next to the scar. Sometimes the scar can be very sensitive for a long time due to damage to small skin nerves.
-
Very rarely (around one in a thousand)a severe pain reaction , (CRPS) can develop, which can be disabling for years.
-
Rarely, the reconstruction can fail, causing ongoing instability and pain at the base of the thumb. This may need further surgery
-
A general anaesthetic can have complications, such as nausea, heart and lung problems. Please discuss it with your anaesthetist before the operation.
What can you expect the final outcome to be?
-
Trapeziectomy with a ligament reconstruction has a high success rate and most patients are very happy.
-
Pain is usually significantly improved, if not cured completely
-
Mobility in the thumb is usually improved compared to before the operation.
-
Strength in the thumb stays at about the same level as it was before the operation