Tuesday, April 16, 2024

What To Expect After Basal Thumb Surgery

Recovery After Thumb Surgery

BASAL JOINT ARTHRITIS – CMC SURGERY, 3 WEEKS OUT (Are we there yet?!)

Depending on the type of surgical procedure used, full recovery from a thumb joint arthroplasty operation can take a number of months. It will require professional rehabilitation by a physical therapist in order for the surgery to be a success, because otherwise patients tend to use their hand normally again which can cause re-injury and can undo what was done during the surgery.

Initially, the thumb is padded and a splint is applied to immobilize the thumb. This will keep it in a natural position to promote proper healing following surgery.

There may be some discomfort and swelling, but your surgeon will recommend pain medication to help alleviate the symptoms. For the first few days your hand should be kept elevated to reduce pain and swelling. Your surgeon will want to check your hand within five to seven days after the procedure, and the stitches will need to be removed after 10 to 14 days.

Joint reconstruction surgery requires a period of immobilization of the joint followed by physical therapy and occupational therapy, ideally with a certified hand therapist. You therapist will direct your recovery program and will work with you to help you regain motion, strength, and coordination of the thumb joint.

Basal Joint Arthritis: Evaluation Treatment And Postop Expectations

Review the clinical presentation of basal joint arthritis, conservative management strategies, when surgery is indicated, and what patients can expect after surgery.

The basal joint is the second most common location for osteoarthritis in the wrist and hand, and is the most common arthritic condition of the upper extremity to be treated with surgery. Basal joint arthritis is usually seen in patients aged 50 to 70, and occurs more frequently in women than men.

Dont Be Afraid To Ask About Training And Experience

Because thumb arthroscopy is not as common as knee or shoulder arthroscopy, its important that you select a surgeon who has extra training and experience in small joint arthroscopy. Typically, fellowship training in hand surgery is required to safely and effectively perform this technique.

Side note: This is a specific example, but in general you should always feel free and comfortable to ask your doctor anything.

Also, your surgeon may not recommend minimally invasive thumb surgery for you because:

  • The surgeon is not trained on the procedure and does not feel comfortable performing it.
  • The is only median term follow up on the procedure. 6 year follow up has been reported with results similar to open surgery. It is important to know we are essentially performing the same operation that is has been performed with standard open surgery and just through smaller incisions. The data is confirming so far that the results will be very similar to open surgery.
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    Flexor Carpi Radialis Muscle/other Tendon Options

    • O: Medial epicondyle of humerus
    • I: Base of 2nd/3rd MC
    • F: Radial deviation of wrist & wrist flexion

    Figure 7. Location of the muscles, specifically the flexor carpi radialis on the forearm. .

    Here is a little bit more information about the FCR muscle and tendon. The FCR originates at that common flexor origin on the medial epicondyle of the humerus. It is then going to move distally and insert at the base of the second and third metacarpal. Anatomically, this is in a good position to use. Other options for tendon harvesting would be the palmaris longus. I always call the palmaris longus a “spare body part” that we have. This tendon is used for a lot of different tendon transfers. This can either be a full or partial excision of the palmaris longus. Some use the abductor pollicis longus or APL. I even read that the extensor carpi radialis longus tendon was used. Other muscles and tendons can then take over and make up for the loss of the one used in the surgery.

    What Are The Symptoms Of Basal Thumb Arthritis

    Why is my finger locked or clicking? Do I need surgery?

    In the early stages of Basal Thumb Arthritis, pain may be present with activities such as writing, opening a jar, or twisting a doorknob. There may be tenderness and swelling over the carpometacarpal joint. As the condition progresses, the pain may increase in intensity and duration. A bony prominence may form at the carpometacarpal joint as a result of osteophyte formation, swelling and resulting misalignment of the joint. In late stages of the disease, weakness of grip, and inability to abduct or extend the thumb away from the hand are classic findings. Swan neck deformity of the thumb is a late finding.

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    How Can Dr Knight Help You With Basal Thumb Arthritis

    Basal thumb arthritis can be extremely painful, and Dr. Knights primary concern is to relieve you of this pain, as well as the accompanying inflammation, so that you can return to your life and work and continue to go about your daily routine with little or no change in behavior.

    We looking forward to helping you live a more pain free life. Dr. Knight is one of the top hand doctors in Dallas. Contact us online, give us a call at or visit Dr. John Knight at our Southlake hand and wrist center or Dallas office location.

    Suture Button Suspensionplasty For Basal Joint Arthritis

    Dr. Yao collaborated to develop a suture-and-button implant. After years of biomechanical, safety, and durability studies performed in concert with the manufacturer and his peers, Dr. Yao has perfected the SBS technique using this device.

    Surgery begins like all thumb CMC joint arthritis procedures, with the surgeon removing the trapezium bone. But thats where the SBS technique diverges. The remaining thumb metacarpal bone is then suspended or kept in its normal place by using the implant that remains underneath the skin.

    The implant suspends the thumb above the space where the trapezium was, anchoring the thumb and second metacarpal to one another. A button on each of the metacarpals is attached to either end of the suture to secure the bones in the correct position.

    The device stabilizes the joint and helps to avoid any potential sinking or caving. Its like having a boat tethered to a dock, Dr. Yao explains. The suture holds the thumb in place by attaching it to the stable, immovable object which is the adjacent metacarpal. The space previously occupied by the trapezium ultimately fills with scar tissue, which further cushions and supports the thumb metacarpal.

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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 .

    What To Expect From Thumb Surgery

    THUMB ARTHRITIS – BASAL JOINT SURGERY – DON’T DO ALONE!

    LRTI surgery is usually conducted either under general anesthesia or a regional axillary block, a type of anesthetic that affects only a specific region of the body, rather than putting you completely to sleep. Thumb joint replacement is typically a same-day, in-and-out surgical procedure, Dwyer says. Patients typically go home the same day, wearing a splint that immobilizes the wrist and thumb for two weeks. At their follow-up visit, patients are placed into a cast for approximately four weeks, then transitioned into a brace. The length of immobilization time is determined on a case-by-case basis depending on the patient and procedure.

    Chi says keeping the joint immobile for roughly six weeks after surgery is an important component of the healing process that protects the reconstruction. After that period, most patients can begin gentle use and youll likely start physical or occupational therapy to restore range of motion and strength to the joint. Chi says PT typically runs for about five weeks, and most people have normal function of the joint restored within three months of the surgery.

    Once motion is restored and the patient feels better, PT can be tapered off. Nevertheless, its still a good idea to take it easy for a while after this surgery to make sure your joint and tendons heal properly. I recommend avoiding strenuous activity, sports and heavy lifting for approximately three months or until symptoms have resolved, Hays says.

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    What Is The Expected Recovery

    • Patients can expect to have minimal pain at the thumb by three months.
    • Patients can expect to have recovery of their preoperative strength by approximately six months.
    • Each year thereafter, their comfort and their strength will continue to improve. This is one of the only surgeries done where the results keep getting better over time.

    What Is The First

    Early on, non-surgical treatment is trialed. A splint, known as a thumb spica splint is used to stabilize the thumb. Decreasing motion of the thumb during activities can help to reduce the pain of basal thumb arthritis. Patients may also use anti-inflammatories. These can be topical, such as Voltaren gel that can be purchased without a prescription or oral, such as medications known as anti-inflammatories like ibuprofen or Advil.

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    What Is Cmc Joint Arthroplasty

    Joint arthroplasty, or joint replacement surgery, is a surgical procedure in which a portion of damaged and inflamed bone is removed and replaced with metal implants in order to help relieve pain and improve physical functioning for patients with arthritis. While joint arthroplasty is commonly performed in large joints like the hips, knees, and shoulders, joint arthroplasty can also be performed on the thumb joint.

    Thumb arthritis, also known as carpometacarpal joint osteoarthritis, occurs at the carpometacarpal joint at the base of the thumb, between the metacarpal bone and the trapezium. The force to the joint during gripping, pinching, and grasping movements and the decreased strength of supporting ligaments that occur with aging often cause degeneration of the thumb joint over time. Because the thumb is a very mobile joint, it lacks the stability to withstand repetitive stress and easily wears down over time.

    CMC joint arthroplasty typically involves a trapeziectomy, a surgical procedure in which the trapezium bone is removed from the wrist. Once the trapezium is removed, a tendon graft or implant, made from silicone or metal, is then inserted into the missing space to complete the arthroplasty.

    What Can I Expect After Surgery

    Why is my finger locked or clicking? Do I need surgery?

    When you wake up from surgery, you will have a splint that spans your wrist. The end of your thumb will be free but the surgical site at the base will be covered. You will also have a sling to support the arm until you regain control of it as the block wears off, which occurs anywhere for 6 to 24 hours after the surgery. You may stop using the sling as soon as you recover control and feeling of your arm.

    The rebound pain that occurs as the effects of the block wear off can catch one off guard, so best to take a prescribed pain pill as you feel the tingling and return of sensation that signals the end of the block. This pain is strong but only lasts a few hours. Most patients do not require the narcotic medication beyond 72 hours from surgery. Barring any medical contraindication such as heart or kidney disease or gastritis, it is permissible to take over the counter ibuprofen or naproxen as an augment to the pain medication. Do not take Tylenol at the same time as the pain medication, as the prescribed pain medication already contains Tylenol.

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    What Is Basal Thumb Joint Surgery

    What is the basal joint?

    The basal joint is located at the base of the thumb, and allows you to move the thumb toward the palm of your hand. This joint can be weakened due to illness, injury, or repetitive use. These injuries can cause:

    • Weakness in the ligaments that attach bone to bone
    • Wearing away of the slick cushion of cartilage that allows bone to move against each other
    • Pain when grasping or holding items or inability to maintain a hold on something

    The most common type of basal joint surgery is called an arthroplasty. Arthroplasty is a procedure to remove the damaged part of a joint and replace them with artificial parts or with your own soft tissues.

    Arthroplasty may be recommended when other medical treatments no longer relieve joint pain and disability. These treatments include:

    • Anti-inflammatory medicines, such as steroids
    • Pain medicines, such as ibuprofen, aspirin, or naproxen
    • Limiting painful activities
    • Physical therapy

    After arthroplasty, patients usually have improvement in their joint pain, improved ability to perform activities, and better quality of life.

    Surgical options that may be considered include:

    There are pros and cons with each of these surgeries. Talk with your doctor to see which one might be the best fit for you.

    Other Types Of Thumb Surgery

    Chi says the ideal patient for the LRTI procedure is someone with painful arthritis at the thumb basal joint who wants to preserve thumb motion and decrease pain. However, he adds, we do not recommend this for patients younger than 45 who have heavy, manual jobs. Those patients are better off with fusion surgery.

    If LRTI is not a good option for your situation, there are a few other surgical procedures that may be recommended. Here are other surgery options for thumb arthritis:

    • Fusion surgery. Some patients can get significant symptom relief from a fusion procedure, in which the surgeon fuses two of the bones together to prevent movement. Younger patients, those with physical jobs and those with rheumatoid arthritis a form of inflammatory arthritis caused by an autoimmune disorder are most likely to benefit from this approach, the Arthritis Foundation reports. The downside to fusion is that it reduces mobility in the thumb joint that can impact functionality of the hand.
    • Ligament reconstruction. This procedure features the removal of a portion of the damaged ligament and replacement with a piece of the flexor tendon . This procedure does not include removal or repair of the arthritic bone. Patients whose symptoms are caused by lax tendon rather than a loss of cartilage may find this procedure helpful.

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    When Can I Return To Work

    Patients with sedentary jobs may be able to return as early as one week after surgery. Typing will have to be performed with modification. Patients who perform repetitive tasks with their thumb will need closer to 6 weeks off from work, and patients who have to forcefully load the thumb in their jobs will need closer to 12 weeks off from work.

    Five Surgeries For Thumb Arthritis

    BASAL JOINT ARTHRITIS – CMC SURGERY, 2 DAYS AFTER SURGERY

    Learn about five procedures used to treat joint damage and pain caused by thumb arthritis.

    Most activities that involve grasping or pinching are possible because of the thumbs remarkable range of motion. But dexterity comes at a price an increased risk ofosteoarthritis in the first carpometacarpal joint, where the thumb meets the trapezium bone in the wrist. Sometimes the joint becomes so damaged that surgery is necessary.

    How Thumb Arthritis Develops

    Problems often start when the thick ligaments that hold the joint together loosen, allowing it to slip out of place. Over time, the articular cartilage that cushions the ends of the bones wears away, causing pain and limiting movement.Rheumatoid arthritis and other forms of inflammatory arthritis can also damage the CMC joint in the thumb, also known as the trapeziometacarpal joint .

    David S. Ruch, MD, chief of the hand surgery at Duke Health in Durham, North Carolina, says women, especially those older than 50, are 10 to 20 times more likely than men to develop thumb arthritis, though no one is quite sure why. Both women and men respond well, at least initially, to conservative measures such as anti-inflammatory medications, splints, activity modification and limited steroid injections. For some, says Dr. Ruch, these may be the only treatments needed.

    make people feel better, but they dont stop disease progression, and eventually surgery may be necessary, he says.

    Five Types of Thumb Surgery

    Ligament Reconstruction

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    The Traditional Approach To Surgery: Invasive And Open

    Traditional surgeries, that maintain thumb motion, commonly require a large incision where the entire arthritic bone is removed.

    Because open surgery is much more invasive, additional incisions on the hand and forearm are frequently required to gain access to a tendon that is used to stabilize the thumb base, which sacrifices a perfectly good tendon.

    In many cases, a total of three incisions on the hand and forearm arm are needed with open surgery.

    Managing Pain And Swelling

    To help with pain and inflammation after surgery, you’ll be prescribed pain medication. You can also ice and elevate your hand, especially for the first week. This not only makes it feel better, it can help you recover faster, too.

    You can do some things to help your body recover well. They include:

    • Getting enough sleep
    • Eating a healthy diet
    • Maintaining a positive attitude and managing stress
    • Following the exercise program from your physical or occupational therapist
    • Wearing your splint according to your healthcare providerâs instructions

    It’s important to follow all instructions from your healthcare team so you can have the best possible outcome from your trapeziectomy.

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