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Thumb - Arthritis of basal joint |
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This joint is very commonly involved with arthritis as it is one of the most used joints in the body (like the jaw!). The smooth surfaces of the two bones at the base of the thumb are worn away by the arthritis, causing pain and grating, and as the bone slips out of normal position a lump at the wrist appears and the thumb tends to collapse into the palm of the hand, often resulting in the next thumb joint bending backwards and becoming unstable ( a "Z" deformity develops). Good results can be achieved with surgery, when conservative measures cease to be affective. It is worth trying non operative treatment first such as:
- anti-inflammatory creams.
- anti-inflammatory tablets (NSAID`s).
- splints to rest the joint
- physiotherapy to stretch out contracted joint capsule and strengthen muscles about the joint.
- injection of steroids (cortisone or hydrocortisone)
Surgery
  
Two very small incisions are made; one about 2.5 cms around the base of the thumb and the other about 1 cm on the forearm to split a tendon which is used to reconstruct the joint stability. Through the first incision the bone at the base of the thumb is excised (removed) as it has lost its smooth surface and is causing the pain. The space created is then maintained by holding the bones apart using part of the tendon which is obtained from the small second incision in the forearm and passed back under the skin to be threaded through a tunnel in the long thumb bone thus reconstructing the stability of the thumb on the hand and allowing movement. The operation takes about half to 3/4 of an hour under anaesthetic.
After the operation
- A small plaster splint is placed on your wrist in theatre leaving your fingers free.
- You can go home from hospital either the same day or the following morning with appropriate pain tablets.
- No sling is required and use/movements of the fingers and hand is encouraged as well as keeping it elevated to reduce any swelling.
- On the 3-5th day the occupational therapist will make you a light plastic or fibreglass splint/caste which will allow you to use your hand for daily activities. These can be washed and usually not too uncomfortable. The stitches are removed on this visit.
- After 6 weeks the splint/caste is removed .
- A short course of exercises is then begun to regain movement and strength. This usually only requires about 2 visits to the hand therapist.
- A further visit 4 weeks later is usually all that is required as function is generally very good but strength will continue to improve for up to 12 months.
Benefits
- Smaller incisions mean less scarring.
- No artificial prosthesis is inserted to "go wrong", only your own biological tissue is used.
- Your hand can be used in the caste/splint so you can maintain your own independence throughout.
- Minimal hand therapy is needed to regain effective use of the thumb and hand in general.
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