Friday, April 12, 2024

New Surgery For Thumb Arthritis

What Is A Joint Fusion When Is It The Best Surgical Option

Thumb Arthritis: New Treatment Options

Fusion of a joint involves removing the joint and surgically fusing the bone ends so that the two bones effectively become one solid bone. This procedure terminates all motion at that joint and thus eliminates the pain. The benefit of fusion is pain relief and the downside is elimination of motion at the fused joint, which can hinder function. This surgical option is reserved for patients with advanced arthritis.

Joint fusion is usually the best surgical option in patients who are younger and very active. Younger patients may not be candidates for joint replacement because of the increased stress demand on the joints which accompany higher activity levels. This increased stress demand can quickly wear out an artificial joint.

Understanding The Structure Of The Hands And Wrists

The hands and wrist tend to work together. A structural problem in the wrist could complicate symptoms of a condition in the hands or could influence the treatment plan needed to address arthritis.

There is a flexor group, found on the inside and the front of your arms. They are largely responsible for controlling how you bend your wrist as well as your fingers. Many of these important flexors pass directly over the front of your wrist. Most are held securely in place by a flexor retinaculum or carpal tunnel ligament which is a durable fibrous band of connective tissue.

Opposing the flexor group is the extensors, which are located on the outside or back of your forearm. It helps to open your hand. They work in tandem with a series of small muscles in your hand, which are known as the lumbricals and interossei which play an important role in executing fine movements. The tendons in your hands are covered by a layer of synovium as well as a tendon sheath.

At the same time, two main nerves are responsible for your sense of touch. As the name implies, the carpal tunnel nerve or median nerve passes under the carpal tunnel ligament. This nerve provides the primary sense of touch for your thumb to your ring finger. It also plays an important role in how the muscular structure of your thumb operates.

What To Expect During Recovery After Finger Joint Fusion

After surgery, you can expect some bruising, swelling, and pain at the site of operation. You will probably be wearing a cast for a few weeks to stabalize your hand. Dr. Mark will tell you when you can come back in to have your stitches removed . You will be prescribed pain medications to relieve your pain and an antibiotic to prevent infection.

You will need a few weeks to recover and regain the function of your hand and fingers. These will probably include some physiotherapy sessions to aid the healing process.

Arthritis can be a debilitating disease, causing pain and joint deformity. It commonly affects the fingers and the hand which may limit their function. Fortunately, surgical treatment can be useful in managing severe arthritis that fails conventional treatment. Dr. Mark Gittos in Auckland, New Zealand, offers finger joint replacement and joint fusion to treat arthritis. He is a plastic surgeon that specializes in hand surgery and cosmetic surgery. Call us today to set up an appointment and get a full evaluation by Dr. Mark or to learn more about your condition.

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Outpatient Suture Button Suspensionplasty Procedure For Thumb Arthritis Shortens Recovery Time

05.28.2021

Orthopaedic surgeons at Stanford Health Care thrive on the forefront of innovation, seeking out advances that benefit patients. One of these advancements, suture button suspensionplasty , has emerged as an effective technique for thumb carpometacarpal joint osteoarthritis. It is an outpatient procedure notable for its rapid recovery time.

Rehabilitation Following Surgery For Thumb And Digit Arthritis

A new thumb joint? That

Following surgery, a rehabilitation program, often involving a physical therapist may help to regain hand strength and movement. You may need to use a postoperative splint for a while after surgery that helps to protect the hand while it heals. You may need to restrict activities for a minimum of 12 weeks to let the joint reconstruction heal properly. Although recovery is slow, you should be able to resume your normal activities within a few months of surgery.

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Ligament Reconstruction And Tendon Interposition

An LRTI is the most common type of thumb arthritis surgery and involves removing damaged joint surfaces and creating a cushion of other tissues to keep the bones separate.

This procedure involves a trapeziectomy or removal of the trapezium bone. This bone is one of the smaller bones in the wrist and forms the CMC joint with the metacarpal bone in the thumb. Arthritis often causes damage to the trapezium.

The padding is usually part of a nearby tendon, which the surgeon removes, rolls up, and places between the bones of the CMC joint. This procedure is helpful for those with moderate to severe thumb arthritis, especially if they struggle to pinch or grip.

This option can greatly improve certain symptoms, such as pain and reduced mobility. However, it usually requires a long and painful recovery period. It may also decrease pinch strength and result in a noticeably shorter thumb.

Thumb Osteoarthritis Is Caused By Joint Instability Due To Ligaments That Are Weakened Or Damaged By Overuse Or By A Traumatic Injury To Restore A More Natural Movement To The Thumb Joint You Have To Examine And Explore The Repair Of The Thumbs Ligaments

To restore a more natural movement to the thumb joint, you have to examine and explore the repair of the thumbs ligaments. Repairing the thumb ligaments should be the main objective of treatment. We are going to discuss this below.

Research: Thumb osteoarthritis is caused by joint instability due to ligaments that are weakened or damaged by overuse or by a traumatic injury.

This is according to researchers from Indiana University School of Medicine, Tufts University School of Medicine, University of Bristol, Bristol, and the Dutch university researchers who made this statement in their paper: Yet more evidence that osteoarthritis is not a cartilage disease, published in the British Medical Journal.

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What Does Surgery To Treat Thumb Basal Joint Arthritis Involve

If your symptoms have not responded to bracing, steroid injections, oral anti-inflammatories, or diet and activity modifications, you may be a candidate for surgical treatment.

The most reliable and successful surgical option for thumb basal joint arthritis has been given several names, the most common being suspensionplasty or LRTI . This is an outpatient procedure performed with light general anesthesia and regional anesthesia, also referred to as a block, which temporarily numbs the arm to allow for painless surgery. The block also reduces and delays the need to take narcotic medication, thereby reducing the risk of unpleasant side effects of narcotics, including nausea, constipation, and cognitive impairment.

The surgery involves removing a small arthritic bone at the base of your thumb called the trapezium. This is performed through a 3 cm incision on the back of the thumb. I then use a tendon from your forearm to reconstruct the supporting ligaments at the base of the thumb and to serve as a cushion in lieu of the removed bone.

The procedure is often referred to as a suspensionplasty because the thumb looks suspended on the x-ray after surgery .

It takes about one hour to perform the surgery. You can expect to be at the surgery center for 3-4 hours .

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Rapid Recovery Is A Clear Advantage Of The Sbs Technique

Treating Basal Thumb Joint Arthritis – Mayo Clinic

The key benefit to using suture button suspensionplasty is the accelerated pace of recovery. The entire procedure takes about 30 minutes in an outpatient setting under regional anesthesia. Patients remain in a splint for about five days, after which their dressing comes off. They can begin therapy and start using their hand again immediately.

With traditional thumb arthritis surgeries, patients can be in a cast for one month or longer. The majority of Dr. Yaos patients get back to normal activity by the three-month mark, if not sooner. Other surgical methods can have double the recovery time, up to six months in some cases.

Mobility and regaining range of motion happens very quickly and is very predictable with SBS, says Dr. Yao. Same thing with pain relief. Those are the things that are most important for patients. Thats why I adopted this techniquebecause I felt there was room for improvement.

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Demonstration Of Prolotherapy Treatment For The Thumb

This image demonstrates the Prolotherapy injection treatment to the thumb and the carpometacarpal joint. The goal of the treatment is to strengthen and tighten the ligaments of the hand and bring the bones back towards a more natural alignment. This will reduce or alleviate pain and restore better function.

The treatment starts at 1:15 of the video: Ross Hauser, MD comments, and narrates:

  • Treatment begins. This patient has thumb, hand, and finger pain with loss of function
  • Narration summary and thumb injections: When a patient comes in with these problems we always start on the thumb because that is where we often find the most degenerative problems in hand pain.
  • Injections at the base of the thumb and the thumbs metacarpal and interphalangeal joints.

Stem Cell Therapy For Thumb Osteoarthritis

Another more aggressive treatment we may employ is Stem Cell Prolotherapy. This combined treatment of stem cells and Prolotherapy presents the same clinical benefits as PRP Prolotherapy except we are using, bone marrow aspirate concentration or bone marrow-derived stem cells. We want to make it clear that we perform stem cell therapy on very few patients. Why? Because we can usually achieve the patients goal of treatment with simpler procedures. Bone marrow stem cell therapy is usually reserved for the most advanced cases.

Stem cell therapy in an injection of your own harvested stem cells. Stem cell therapy is typically utilized when we need to patch holes in cartilage and stimulate the bone. We explore this option in patients when there is more advanced osteoarthritis and a recommendation for a joint replacement has been made or suggested.

Our published research in the journal Clinical Medicine Insights. Arthritis and Musculoskeletal Disorders demonstrates and documents clinical results in patients receiving bone marrow-derived stem cells and dextrose Prolotherapy.

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Trapeziectomy With Or Without Ligament Reconstruction Is Still Considered The Gold Standard But The Challenges Associated With Treating Its Complications Limit Its Indications

Despite this and other evidence, doctors from the University of Michigan wrote in the journal Plastic and Reconstructive Surgery: With a consistent rise in health care spending, adherence to an evidence-based approach in medicine is more important than ever. Most surgeons continue to perform trapeziectomy with ligament reconstruction and tendon interposition, the most expensive surgical option.

French doctors gave a thorough analysis of the challenges of surgical repair of trapeziometacarpal osteoarthritis. Writing in the journal Hand Surgery and Rehabilitation, they write:

  • The demand for surgical treatment for Trapeziometacarpal osteoarthritis is growing and the patients are becoming younger, adding to the challenge.
  • Surgery can only be proposed after the failure of well-conducted conservative treatment and requires a complete X-ray assessment.
  • In the early stages, conservative surgery measures can be used to stabilize the joint or realign it in cases of dysplasia, but in most cases, patients are seen with more advanced arthritis and a joint replacement must be considered.
  • The ideal arthroplasty technique has yet to be defined. Although many studies have been published on this topic, they do not help define the treatment indications.
  • Trapeziectomy with or without ligament reconstruction is still considered the gold standard, but the challenges associated with treating its complications limit its indications.

What You Should Know About Thumb Joint Surgery

Thumb Arthroplasty: Learn About the Procedure! â Healthsoul

Arthritis is a very common disease of bones. And a common type of arthritis of the hand is of thumb. Each joint is lined with cartilage, which cushions the bones. When the arthritis becomes severe, the cartilage between joints deteriorates, which then hampers the movement of joints. The issue begins when the strong tissues holding the joints become loose, resulting in the bone slipping out. The doctors recommend a thumb joint surgery to put the bone back to its place.

The Procedure of Thumb Joint Surgery

The doctors for a thumb joint surgery removes a tiny bone from the base and rearranges the tendon to create a cushion for the thumb joint. The doctors also remove a damaged ligament and replace it with a piece of wrist tendon. The recovery takes time and is painful, but after the recovery time, most of the people enjoy a painless movement of the thumb.

Who Should Get It Done?

Surgery is not everyones friend. Only those with severe thumb or basal joint arthritis are good candidates for it. The adults who feel difficult doing regular work like pinching and gripping with thumb should prefer getting it done. Thumb arthritis affects women over 50 years 20 times more than men. Therefore, all women who age 50 or above and experience difficulty moving thumb because of arthritis should consult her doctor and seek advice on getting thumb joint surgery.

Aftercare

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When Should I Talk To My Doctor About Joint Surgery

If you have any of the following signs you should talk to your doctor about the possibility of surgery.

  • You have pain that stops you going to sleep at night.
  • Your pain does not improve with rest, medicines, exercise or other treatments.
  • Your affected joint makes it difficult for you to look after yourself and you require help from others for everyday tasks.
  • Your condition makes it difficult for you to work or look after people who require your care.
  • Your pain is keeping you from doing things you enjoy, such as exercising or doing hobbies.

Stopping Medications And Supplements

You may need to take a break from some medications or supplements for a few days before the surgery. That’s because some of them can cause heavy bleeding or interact with the anesthesia.

The requirements for this vary by drug, so talk to your healthcare provider about which drugs and supplements you need to stop taking and for how long. This includes prescription and over-the-counter medications as well as any vitamins and herbal products you may use.

If you need to wean off of a medication, follow your healthcare provider’s directions.

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Surgery For Osteoarthritis Of The Thumb Often Includes Ligament Reconstruction With A Tendon And Bone Removal

Much of the research and attention on surgery for thumb osteoarthritis centers around the removal of the trapezium bone at the base of the thumb. The surgery is called a trapeziectomy.

The trapeziectomy can be performed with variations of the technique. First is the removal of the bone. Some procedures will include a ligament reconstruction to strengthen the compromised anatomy and fill the void left with a forearm tendon. For patients with thumb arthritis being recommended for surgery, the term interpositional arthroplasty or commonly referred to as trapeziectomy with LRTI would likely be recommended as a surgical choice.

In addition to the research above, research from the University of Massachusetts Medical School examined various surgical procedures for thumb osteoarthritis. Here are their findings published in the medical journal Hand.

Can You Have Surgery For Thumb Arthritis

BASAL JOINT ARTHRITIS – CMC SURGERY – Thumb Splints and Braces

Surgery would only be considered as a treatment for thumb arthritis if all other options have been exhausted.

Traditionally, the main options have been joint excision without replacement , or fusion of the joint . While both these operations are excellent at relieving pain, they do come with downsides. Risks include loss of range of motion or strength in your thumb.

Youve probably heard of hip or knee replacement surgery, and it is possible to replace a thumb too. We use similar technology, just on a much smaller scale, to replace thumb joints, as well as other arthritic joints in your fingers.

During joint replacement surgery, the damaged parts of your thumb joint are replaced by an implant , which is designed to match your original joint as closely as possible.

The benefit of a thumb joint replacement is that you should retain much of your movement and strength.

The operation itself is done as a day case procedure and results in just a small scar.

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What Is Arthritis At The Base Of The Thumb

In a normal joint, cartilage covers the ends of the bones and allows them to move smoothly and painlessly against one another. In osteoarthritis , the cartilage layer wears out, resulting in direct contact between the bones. In the hand, the second most common joint to develop osteoarthritis is the joint at the base of the thumb. The thumb basal joint, also known as the carpometacarpal joint, is a specialized saddle-shaped joint that is formed by a small wrist bone and the first of the three bones in the thumb . The specialized shape of this joint allows the thumb its wide range of movementup and down, across the palm, and the ability to pinch with the fingers.

Why Is Trapeziectomy Done

The primary reason to undergo trapeziectomy is to resolve pain at the base of the thumb that becomes worse with movement or activity . If left untreated, the pain may be felt even during inactivity or rest and result in deformity at the base of the thumb.

Other indications for trapeziectomy can be:

  • Tenderness, swelling, and stiffness at the base of the thumb.
  • A thumb that appears crooked with limited range of motion.
  • Difficulty in gripping or grasping objects or in pinching.
  • Feeling of a crunchy sound at the thumb base with certain movements.

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