The dictionary says opposable thumbs allow the digits to grasp and handle objects and are characteristic of primates. The movement of opposition is a rotary movement in which the thumb, swinging about its own axis, comes to face the lower surface of the tips of the fingers.
All that is fine and good, but it doesn’t help much when your thumb hurts!! And arthritis is often the culprit.
For those who suffer the nagging, persistent pain and inconvenience of arthritis at the base of the thumb, treatment by a hand surgeon can include non-surgical treatment during early stages, with the option of surgery as the disease progresses.
For non-surgical treatment, start with icing the joint several times a day, oral or topical anti-inflammatory medications, and various splints to support the joint.
Other non-surgical treatment includes injecting a steroid solution into the joint. The good news is that just one injection can provide relief up to several months, but it’s important to note injections cannot be repeated indefinitely, due to the progressive and degenerative nature of arthritis.
And it’s this degenerative nature that diminishes the initial relief provided through injections, oral medications, and splinting. When this becomes the case – depending on the level of discomfort – patients may wish to consider surgery.
There are several surgical procedures commonly used to address this problem. Each is a same-day surgical procedure done under general anesthesia with a long-acting arm block to control the first 24 hours or pain.
One option involves fusing the bones of the joint together, called arthrodesis. While this procedure may stop pain, it limits the range of motion of the thumb. It holds up well, but is usually reserved for young patients who need a strong pinch.
Another option, called thumb arthroplasty, involves removing part or all of the small bone at the base of the thumb, the trapezium, and reconstructing the joint using an adjacent tendon as a graft. Artificial substances such as Artelon have been used to resurface the joint. Although I had excellent results with this, some reports of late inflammatory reactions have caused this to fall out of favor.
There are some artificial joint replacements available, but their long-term outcomes to this point are not known, so their use is best confined to a few study centers until more results are available.
After surgery, most patients wear a cast for four weeks. They then go into a removable splint, and have sessions with a hand therapist, working on swelling reduction, pain management, range of motion, and strengthening.
It may take several months to make a full recovery following this surgery, but most patients are functional for routine activities in eight to twelve weeks. Don’t try and do too much too soon!
Most patients are glad that they had the surgery. In my experience, I have had several patients come back to have their second hand done once the first one is healed.
Take Care,
David Ostrowski, M.D.