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Thumb Base Arthritis

Thumb Base Arthritis

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  • 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

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  • 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

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  • 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

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  • 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.

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  • 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.

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  • There are many different surgeries for thumb base arthritis.

  • The technique that I use requires 3 small incisions as drawn in the photos

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  • During surgery the trapezium bone is removed.

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  • Half or all of the FCR tendon (marked by the dotted line) is then harvested via a small incision in the forearm

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  • The harvested tendon is then used to stabilise the thumb.

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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

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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.

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  • 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

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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)

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  • 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.

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  • 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

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