shutterstock_98475902What causes thumb pain or thumb base arthritis(CMC arthritis)?

Thumb base arthritis, or carpometacarpal joint arthritis (CMC arthritis), occurs when the cartilage at the base of your thumb between two bones wears away.  There is no padding between the two bones, which results in bone on bone contact, and subsequent pain.  This is a very common condition affecting 1 in 3 women and 1 in 10 men.

What are the symptoms of thumb base arthritis?

Often people complain of an aching thumb pain and sometimes burning pain in the base of the thumb where it meets the wrist.  This thumb arthritis pain is often worse with pinching and gripping activities.  People often have trouble performing tasks such as sewing or opening jars.

How is thumb base arthritis diagnosed?thumb

In our practice thumb arthritis is most often diagnosed by history and physical exam.  Often we will then get X-rays of the wrist to confirm the diagnosis.

What is the treatment for thumb base arthritis?

In most cases, the initial thumb arthritis treatment is nonoperative.  A trial of splinting and non-steroidal anti-inflammatory medications is tried at first.  Supplementation with glucosamine chondroitin is also shown to be of benefit.  If these measures do not improve pain the next step is to perform a steroid injection into the joint.  This often provides long lasting pain relief. If the injections do not work, or only work for a short time, the next option is surgery.

What does thumb arthritis surgery involve?

All techniques of thumb arthritis surgery involve removing one of the diseased bones of the thumb joint called the trapezium.  Once this is removed there are a variety of techniques utilized to reconstruct the joint.  The method utilized by Dr. Graham was developed at the world renowned Kleinert Institute in Louisville.  It involves utilizing a portion of a tendon in the wrist to re-suspend the thumb bones and also to provide a spacer to replace the bone that is removed.

Why should I have Dr. David Graham perform surgery on my thumb?

Dr. Graham is the only fellowship trained hand surgeon in the Victor NY and Canandaigua area.  This training means he spent an extra year of training doing nothing but surgery on the hand.  In this year he evaluated over 4-5000 patients with various hand problems.  Completing his fellowship at the world renowned Kleinert Institute in Louisville, KY, he learned from several experts in the field and has learned the best surgical methods to correct thumb arthritis.

What are the main risks of this surgery?

• Swelling, stiffness, and pain
• Infection
• Nerve Damage
• Residual thumb base pain
• Reduced thumb range of motion and pinch strength

What is the thumb arthritis surgery recovery time

Day 1-14
• Keep splint and dressing clean and dry
• Elevate hand above heart level for next 48 hours to prevent pain and swelling
• Start moving the fingers immediately to prevent stiffness

2-6 weeks
• Your thumb will be immobilized in a splint or a cast during this time
• Continue to utilize the other fingers of the operated hand
• You will likely see a therapist at this time to fabricate a splint and ensure your digits are not getting stiff

6-8 weeks
• You will take off the splint from time to time to begin range of motion activities

8 weeks to 3 months
• You will gradually strengthen thumb and resume prior activities
• It is not uncommon to have residual post-surgical pain beyond this period

Driving?

You may drive when you are off narcotics and feel confident to control the car, even in an emergency.  Most patients are able to drive within a week.

Time off of Work?

This is dependant on the type of work you perform.  Many patients with office jobs only require a few days.  However, I would plan on taking at least a couple weeks off of work.  You will be without full usage of your thumb for at least 3 months.  Patients who perform heavy labor may require several months to recover.

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