Thumb Base Arthritis
What is Thumb Base Arthritis?
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It occurs when the cartilage at the base of the thumbs wears out.
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Eventually ‘bone on bone’ articulation occurs and bone spurs develop.
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It is more common in females
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and runs in families
How does it present?
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There is usually some prominence at the base of the thumb
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The areas aches, especially when a pinch grip is exerted.
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A ‘thumb in palm’ deformity (also called an adduction contracture) can develop
What can be done?
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Avoid activities that hurt and find other ways to do them
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Take simple pain relief (such as paracetamol) and consider taking an anti inflammatory.
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Braces can help for pain and still allow reasonable function.
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A steroid injection into the worn joint can sometime relieve pain for extended periods
When is surgery needed?
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When non operative treatment is unsuccessful and
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pain and weakness in the hand:
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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
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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?
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This kind of surgery usually requires a General anaesthetic (being ’completely knocked out’)
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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
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Antibiotics is usually administered at the time of surgery, but does not have to be continued after surgery.
What do we do in surgery?
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There are many different surgeries for thumb base arthritis.
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The technique that I use requires 3 small incisions as drawn in the photos
What do we do in surgery?
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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.
After the Surgery
In Hospital
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The hand is placed in a plaster
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It is important that the hand remains elevated ‘higher than your heart’ to help limit swelling
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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.
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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.
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It is usual to leave hospital the morning after surgery
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At Home
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Continue to elevate your arm until swelling in your fingers subside.
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Move your fingers (making a full fist and straightening your fingers out fully about 10-20 times a day).
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Keep the wound dry covered and clean.
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Make and appointment with a hand therapist (within a week or 2), to have the cast replaced with a thermoplastic splint.
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An appointment with hand therapy and your surgeon is usually arranged for about 2 weeks after surgery.
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Please do not drive before speaking to hand therapy or a doctor.
The recovery
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A splint is usually worn full time for about 6 weeks
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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.
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From 6-12 weeks splint wear can be weaned hand use increased
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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
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Self care (washing, dressing, eating) with the operated hand – usually around 2 weeks (a splint is still needed)
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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)
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Golf, fishing, cycling etc.: usually around 3-4 months, but it can be longer (6 months)
What can go wrong?
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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.
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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.
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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.
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Very rarely (around one in a thousand)a severe pain reaction , (CRPS) can develop, which can be disabling for years.
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Rarely, the reconstruction can fail, causing ongoing instability and pain at the base of the thumb. This may need further surgery
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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?
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Trapeziectomy with a ligament reconstruction has a high success rate and most patients are very happy.
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Pain is usually significantly improved, if not cured completely
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Mobility in the thumb is usually improved compared to before the operation.
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Strength in the thumb stays at about the same level as it was before the operation