Anatomy/Symptoms
Arthritis is a condition where the articular cartilage at the ends of the bones becomes worn. The joint commonly affected in the thumb is the carpometacarpal (CMC) joint – also known as the basal joint. This joint allows you to move your thumb across your palm to assist in holding and grabbing things. The bones involved are the metacarpal of the thumb, and the trapezium of the wrist.
As the arthritis progresses, the thumb becomes more painful and stiff, and movement is decreased. Swelling may occur at the base of the thumb and the joint may become unstable and weak.
Non-Operative Treatment
When you first experience symptoms of arthritis in your thumb, analgesics and anti-inflammatories are often prescribed to help reduce the pain. Cortisone injections may also provide some relief from symptoms. Reducing activities that aggravate your thumb, as well as the use of a thumb support during such activities may help with pain.
If the pain and symptoms of the arthritis become disabling, it may be necessary to consider surgery.
Operative Treatment - EXCISION ARTHROPLASTY OF THE THUMB
This surgery involves the (excision) removal of the diseased parts of the CMC joint, and the trapezium. To help hold the first metacarpal of the thumb in place, a reconstruction of the joint is also performed. To do this, the flexor carpi radialis tendon is used to create a sling between the metacarpals of the thumb and index fingers, to support the thumb and prevent the space between the bones collapsing.
This procedure is usually performed as day surgery.
Post-Operative Course
After surgery, your hand and wrist will be wrapped in a padded bandage dressing, with a plaster backslab for support. This will be removed a few days after surgery, when a waterproof dressing will be placed over the wound and a fibreglass cast applied, to stay on for approximately 4-6 weeks.
When the surgery has healed, the cast will be removed and a thumb wrap applied, to be worn to provide support during activity as needed. It takes about three months to regain full strength and function.
Risks/Complications
Possible complications of this surgery include: