Arthritic Thumb Fix
Discussion
Hi,
Just wondering if anyone has any experience of thumb probs and the fixes.
I started last year (age 59) with problems with fingers and thumbs. I'm right handed and my left basal thumb joint started paining in a big way. I had a steroid injection which helped a lot (also had two trigger fingers injected) but the pain on gripping and flexing has come back now.
I'm seeing the consultant on 13th July but I want to research options before then.
Firstly, the thumb joint injection hurt like crazy. I've had many nerve blocks for a spinal problem and these were very deep and nothing like as painful. Apart from the location, the difference was that an injection of local went it first. The thumb joint procedure was to go straight in.
Now, the Nurse Practitioner who referred me asked if I want to try painkillers. I said no 'cos I have some Tikolet gel, which makes hardly any impression. So he set about the referral saying, "Well, if you want to knacker it that way."
Initial researches suggest there are two surgical options...
Thanks.
Just wondering if anyone has any experience of thumb probs and the fixes.
I started last year (age 59) with problems with fingers and thumbs. I'm right handed and my left basal thumb joint started paining in a big way. I had a steroid injection which helped a lot (also had two trigger fingers injected) but the pain on gripping and flexing has come back now.
I'm seeing the consultant on 13th July but I want to research options before then.
Firstly, the thumb joint injection hurt like crazy. I've had many nerve blocks for a spinal problem and these were very deep and nothing like as painful. Apart from the location, the difference was that an injection of local went it first. The thumb joint procedure was to go straight in.
Now, the Nurse Practitioner who referred me asked if I want to try painkillers. I said no 'cos I have some Tikolet gel, which makes hardly any impression. So he set about the referral saying, "Well, if you want to knacker it that way."
Initial researches suggest there are two surgical options...
- Trapeziod bone taken out, then the tendons are 'plaited', with one going through the metacarpal - it's drilled for the purpose. The tendons knit and take over the work of the trapezium.
- Artificial joint.
Thanks.
I had a trapeziectomy in February. It was worn (arthritis) and giving me pain. Had a steroid injection (done in theatre, with X-ray and didn't hurt) which helped for about 3 mnths.
The op was done using a nerve block rather than anaesthetic, lasted 35 mins and I went home a couple of hours later. Now 4 mnths later my thumb is almost back to full strength with no pain.
The op was done using a nerve block rather than anaesthetic, lasted 35 mins and I went home a couple of hours later. Now 4 mnths later my thumb is almost back to full strength with no pain.
Thanks craig1912,
May I follow up with a couple of questions?
May I follow up with a couple of questions?
- Do/did you have visible changes pre-op? My thumb joint has a 'boxy ' appearance but there's little swelling and no nodes to see.
- How were you left post-op? Did they immobilise the thumb with a rod or pin, or was it splinted and dressed?
davhill said:
Thanks craig1912,
May I follow up with a couple of questions?
No visible changes pre-op (really the first thing I knew there was anything wrong was when I woke up in agony. Went to minor injuries clinic and they thought it was tendinitis)May I follow up with a couple of questions?
- Do/did you have visible changes pre-op? My thumb joint has a 'boxy ' appearance but there's little swelling and no nodes to see.
- How were you left post-op? Did they immobilise the thumb with a rod or pin, or was it splinted and dressed?
It was in a plaster cast for 10 days and then neoprene splint (which I could take off for washing etc.)for about four weeks. It's worth seeing a BAHT member Physio as its important that you do the right exercises to recover. Only sign I have had something done is a small 1" scar that will fade and the thumb is fractionally (5mm) shorter.
I have heard recovery can take much longer and both the consultant and Physio commented on the quick progress I had made- but they also said I was quite young (54) to have the condition in the first place.
Great, thanks.
I'm already using a McKenna splint (neoprene former in an elasticated cuff) to keep the thumb in alignment.
It's the kind of pain that's always present in a mild way but gripping or pressing without thinking equals big yow!
It sounds like a t/ectomy could be a solution. I suppose it'd mean slow gearchanges for a while...and use my crossbow for a month or two. I have to pay for shooting my compound bow, and it’s set to only 40lb!
I'm already using a McKenna splint (neoprene former in an elasticated cuff) to keep the thumb in alignment.
It's the kind of pain that's always present in a mild way but gripping or pressing without thinking equals big yow!
It sounds like a t/ectomy could be a solution. I suppose it'd mean slow gearchanges for a while...and use my crossbow for a month or two. I have to pay for shooting my compound bow, and it’s set to only 40lb!
Was told I couldn't drive for 6/8 weeks! Once cast was off it was OK though as I have an auto- might be more difficult with a manual as the grip is very weak at first. Only three weeks ago I struggled playing golf, but four days ago I played and had no pain so I guess its getting stronger all the time.
Update time!
I'm on course for a trapeziectomy sometime in the next eight weeks. Herebaouts, it's a day case job with a general anaesthetic.
The consultant says it's two weeks in a cast, then it's stitches out and another six weeks or so in a cast (no driving).
I expect that as they'll be cutting out my trapeze, I'll have to give up the circus act.
I'm on course for a trapeziectomy sometime in the next eight weeks. Herebaouts, it's a day case job with a general anaesthetic.
The consultant says it's two weeks in a cast, then it's stitches out and another six weeks or so in a cast (no driving).
I expect that as they'll be cutting out my trapeze, I'll have to give up the circus act.
davhill said:
Update time!
I'm on course for a trapeziectomy sometime in the next eight weeks. Herebaouts, it's a day case job with a general anaesthetic.
The consultant says it's two weeks in a cast, then it's stitches out and another six weeks or so in a cast (no driving).
I expect that as they'll be cutting out my trapeze, I'll have to give up the circus act.
I had a nerve block rather than a general- much better imo. I had two weeks in a cast, dissolvable stitches and then just a neoprene support. I know specialists have different opinions but I was doing gentle exercises after two weeks to ensure. I regained movement asap. I was driving (automatic) after three weeks. Now after five months it is completely normal with very little loss of strength.I'm on course for a trapeziectomy sometime in the next eight weeks. Herebaouts, it's a day case job with a general anaesthetic.
The consultant says it's two weeks in a cast, then it's stitches out and another six weeks or so in a cast (no driving).
I expect that as they'll be cutting out my trapeze, I'll have to give up the circus act.
Edited by craig1912 on Wednesday 15th July 09:47
Thanks, craig1912.
I saw the consultant's opportunity and asked about a B block but he said they do a GA, end of. I've had four big ops with general anaesthesia, and a short procedure too. This was also a day case job and I was only out for an hour.
I've been practising thumbless driving in my manual Scirocco and I can operate the gears and grip the wheel fingers/palm style. Being in a semi-rural location with a poor bus service makes driving important.
The doc said they don't cut and thread the tendon. I'm just wondering if I'll be able to continue doing archery. My bow is a compound...40lb pull, 25lb holding draw weight. Just a loose grip is used once the draw starts. The thumb is then the 'peg' the bow sits against.
I saw the consultant's opportunity and asked about a B block but he said they do a GA, end of. I've had four big ops with general anaesthesia, and a short procedure too. This was also a day case job and I was only out for an hour.
I've been practising thumbless driving in my manual Scirocco and I can operate the gears and grip the wheel fingers/palm style. Being in a semi-rural location with a poor bus service makes driving important.
The doc said they don't cut and thread the tendon. I'm just wondering if I'll be able to continue doing archery. My bow is a compound...40lb pull, 25lb holding draw weight. Just a loose grip is used once the draw starts. The thumb is then the 'peg' the bow sits against.
I have no 'proper' advice to offer, except for dont rush into anything. My left thumb has been fused and although it fixed the problem, its a pain. My thumb looks normal, but cant bend at all (its just one solid bone now). The only movement I have is the top joint. You do adapt to it, but easy everyday tasks can be a very awkward and the pain is still there when its cold. My brain always tries to move it (like an itch you cant scratch) even though its been like this for 5 years.
TLDR - Thumbs are very important, my advice is go with the least invasive option.
TLDR - Thumbs are very important, my advice is go with the least invasive option.
davhill said:
Thanks, craig1912.
I saw the consultant's opportunity and asked about a B block but he said they do a GA, end of. I've had four big ops with general anaesthesia, and a short procedure too. This was also a day case job and I was only out for an hour.
I've been practising thumbless driving in my manual Scirocco and I can operate the gears and grip the wheel fingers/palm style. Being in a semi-rural location with a poor bus service makes driving important.
The doc said they don't cut and thread the tendon. I'm just wondering if I'll be able to continue doing archery. My bow is a compound...40lb pull, 25lb holding draw weight. Just a loose grip is used once the draw starts. The thumb is then the 'peg' the bow sits against.
My tendons were left alone also- just the trapezium bone taken out. I reckon you will be OK for archery as I have got back very nearly normal movement and strength. It took about 3/4 months.I saw the consultant's opportunity and asked about a B block but he said they do a GA, end of. I've had four big ops with general anaesthesia, and a short procedure too. This was also a day case job and I was only out for an hour.
I've been practising thumbless driving in my manual Scirocco and I can operate the gears and grip the wheel fingers/palm style. Being in a semi-rural location with a poor bus service makes driving important.
The doc said they don't cut and thread the tendon. I'm just wondering if I'll be able to continue doing archery. My bow is a compound...40lb pull, 25lb holding draw weight. Just a loose grip is used once the draw starts. The thumb is then the 'peg' the bow sits against.
Thanks Dgr90,
While I appreciate your advice, I am going into this with my eyes open. I've been the corticosteroid injection route once already and although this switched off the pain for about 3 months it wasn't a fix and the new X Ray shows the joint has been degenerated further. I also know that man-made replacement joints in this area have a very poor track record.
On the upside, formation of scar tissue is the reason why my previous back surgery failed. After a trapeziectomy, scar tissue takes over the bone's function and I'm good at growing scar tissue!
While I appreciate your advice, I am going into this with my eyes open. I've been the corticosteroid injection route once already and although this switched off the pain for about 3 months it wasn't a fix and the new X Ray shows the joint has been degenerated further. I also know that man-made replacement joints in this area have a very poor track record.
On the upside, formation of scar tissue is the reason why my previous back surgery failed. After a trapeziectomy, scar tissue takes over the bone's function and I'm good at growing scar tissue!
Just a thought, after a bit of web research (and I know a little knowledge is a dangerous thing). The surgeon's oppo told me they'd be doing a trapeziectomy on me but would be doing things with the flexor carpi radialis tendon.
This sounds like a 'traditional trapeziectomy, as opposed to one with LRTI, or one with haematoma distraction arthroplasty (HD). This last is characterised by the temporary inclusion of a wire to support the metacarpal.
The learned articles and studies suggect ther's little difference in outcome, with or without a 'spacer'. I just wondered whether anyone here has experience of a trad approach.
This sounds like a 'traditional trapeziectomy, as opposed to one with LRTI, or one with haematoma distraction arthroplasty (HD). This last is characterised by the temporary inclusion of a wire to support the metacarpal.
The learned articles and studies suggect ther's little difference in outcome, with or without a 'spacer'. I just wondered whether anyone here has experience of a trad approach.
Another update!
I had the trapeziectomy done on Monday. This was with a general anaesthetic and a regional nerve block - and 41 minutes with a tourniquet on, according to the notes. These also reveal the joint was seen to be arthritic (never!) and the trapezium was 'excised in piece meal using osteotome and nibblers', for which read chisel and wire cutters!
It was a day case job as promised and I came out with bandages covering a spica - i.e. half a cast that fully encloses the thumb. Soluble Vicryl stitches inside, Ethilon through the skin.
It's smarting somewhat but Paracetamol is taking the edge off the hurt. I went rifle shooting last night - still managed 93/100. I also had a test drive today - both the hospital and the insurance company are happy for me to drive provided I feel in control.
The follow-up is on 5th Nov - 34 miles away in Lancaster. So for now, it's take it easy and wait for the pain to subside.
I had the trapeziectomy done on Monday. This was with a general anaesthetic and a regional nerve block - and 41 minutes with a tourniquet on, according to the notes. These also reveal the joint was seen to be arthritic (never!) and the trapezium was 'excised in piece meal using osteotome and nibblers', for which read chisel and wire cutters!
It was a day case job as promised and I came out with bandages covering a spica - i.e. half a cast that fully encloses the thumb. Soluble Vicryl stitches inside, Ethilon through the skin.
It's smarting somewhat but Paracetamol is taking the edge off the hurt. I went rifle shooting last night - still managed 93/100. I also had a test drive today - both the hospital and the insurance company are happy for me to drive provided I feel in control.
The follow-up is on 5th Nov - 34 miles away in Lancaster. So for now, it's take it easy and wait for the pain to subside.
Time for another update!
After 16 days encased in this...
My thumb looked like this...
Yes, it's swollen but it's the right colour, warm and healthy. The lady of the plaster pronounced it 'beautiful' and the consultant was happy so the stitches could be removed.
I wasn't surprised the little finger didn't grow back - That's what you get for dropping a Reliant Scimitar on it.
Cue a new resin cast...
Since carbon fibre wasn't an option, I chose black. It's a nice neat job and it's much lighter and less restrictive.; My missing CMC joint is grumbling a bit but that's to be expected.
This should come off in four weeks so watch this space,
After 16 days encased in this...
My thumb looked like this...
Yes, it's swollen but it's the right colour, warm and healthy. The lady of the plaster pronounced it 'beautiful' and the consultant was happy so the stitches could be removed.
I wasn't surprised the little finger didn't grow back - That's what you get for dropping a Reliant Scimitar on it.
Cue a new resin cast...
Since carbon fibre wasn't an option, I chose black. It's a nice neat job and it's much lighter and less restrictive.; My missing CMC joint is grumbling a bit but that's to be expected.
This should come off in four weeks so watch this space,
Final update - for now!
I had the cast removed and the ortho consultant took one look and signed me off instantly.
While awaiting my first physio appointment, about the 3nd week in December, I went to lunch. The starter was soup and a
(soft) bread roll, which I couldn't tear open! The physio tested my grip strength a day or two later. Right (dominant, untouched) hand 13lbs, left 11.5lbs.
Then, it was four weeks of exercises. I got a pet toy, a 1/4 size soft rugby ball with a squeaker inside. I had to squeeze this for 10 x 10 seconds twice a day, which was fine, except when the cat nicked it 'cos she fell in love with it. I also had to pull back on the boneless thumb for 5 x 10 seconds, twice daily.
Today's result was highly satisfactory. Right grip 15lbs, left grip, ditto. Ollie, the physio, pronounced my progress as 'brilliant' and also signed me off.
I've retained good thumb movement and it is only pain deep in the joint that's limiting my use. This will improve as time passes - could be another ten or eleven months. I've been using my crossbow, and shot an 18lb fibreglass bow before Christmas. The plan now is to borrow archery club bows of progressively increasing strength. I'll get back to using my 40lb compound bow - in time.
NHS invaluable as ever, and a great result.
I had the cast removed and the ortho consultant took one look and signed me off instantly.
While awaiting my first physio appointment, about the 3nd week in December, I went to lunch. The starter was soup and a
(soft) bread roll, which I couldn't tear open! The physio tested my grip strength a day or two later. Right (dominant, untouched) hand 13lbs, left 11.5lbs.
Then, it was four weeks of exercises. I got a pet toy, a 1/4 size soft rugby ball with a squeaker inside. I had to squeeze this for 10 x 10 seconds twice a day, which was fine, except when the cat nicked it 'cos she fell in love with it. I also had to pull back on the boneless thumb for 5 x 10 seconds, twice daily.
Today's result was highly satisfactory. Right grip 15lbs, left grip, ditto. Ollie, the physio, pronounced my progress as 'brilliant' and also signed me off.
I've retained good thumb movement and it is only pain deep in the joint that's limiting my use. This will improve as time passes - could be another ten or eleven months. I've been using my crossbow, and shot an 18lb fibreglass bow before Christmas. The plan now is to borrow archery club bows of progressively increasing strength. I'll get back to using my 40lb compound bow - in time.
NHS invaluable as ever, and a great result.
craig1912 said:
Good news- your progress is much the same as mine. I'm nearly a year after the op and its at full strength (slightly weaker than my dominant right)
Good innit? The main point is that the remaining pain is far less than the arthritic pain. The surgery was well worth having.Gassing Station | Health Matters | Top of Page | What's New | My Stuff