Joint Arthritis: When To Get Thumb Joint Surgery?

CMC Joint Arthritis

If you still stereotypically believe that Arthritis is something that has to do with the knees then you are mistaken. Arthritis typically occurs due to the wearing down of the flexible tissue that covers and protects the joints and so Arthritis can happen anywhere as far as the joints are concerned. Without the cushioning of the flexible tissue at the end of the bones in the joints grind against each other the joint wears down.

Carpometacarpal (CMC) joint arthritis can be defined as arthritis at the base of your thumb where the thumb and wrist meet. It is named for the bones at the base of the thumb, i.e. the carpal of the wrist and the metacarpal which is the long joint bone of the thumb. CMC joint is the most common place for arthritis to happen in hand and the pain in this kind of arthritis may range from mild to chronic. So it’s always better to treat CMC joint pain early with some simple initial measures.[1]

CMC Joint Arthritis Symptoms

Though pain at the base of the thumb while gripping or pinching an object is the first and foremost sign of thumb arthritis, there are other signs as well that can’t be neglected.

• Discomfort, tenderness, aching at the base of the thumb.
• Swelling and stiffness at the base of the thumb.
• Limited range of motion in the joint.
• Loss of strength in the thumb joint.
• Bony-looking enlarged joint at the base of the thumb.

These symptoms can vary in severity being mild at first and then progressing to worse over time if a person doesn’t seek treatment.

Causes and Risk factors

CMC joint arthritis mainly occurs with ageing but previous trauma or injury to the thumb can also be a cause. When the cushioning tissue of the joint gets worn down, the bones rub against each other resulting in friction that leads to joint damage. This damage can lead to the growth of bone spurs that are new bones along the sides of the existing bones. Bone spurs are noticeable lumps on the thumb joints that cause pain. The risk factors that can increase your risk of thumb arthritis include:

• Age above 40 years.
• Obesity or diabetes.
• Females
• Specific hereditary conditions such as malformed joints and joint ligament laxity.
• Jobs and activities that put high stress on the thumb joint.
• Injuries to your thumb joint, such as sprains and fractures.
• Diseases like Rheumatoid Arthritis that changes the normal function and structure of cartilage.

Diagnosis for CMC Joint Arthritis

Before opting for diagnosing for thumb arthritis, a doctor will most likely examine the patient’s thumb and ask questions about:

• The level of pain.
• Movements that make the pain worse.
• Whether there has been a prior injury.
• Any other symptoms.

Then if necessary, the doctor will also typically perform diverse tests while the person moves the thumb around. They will also feel or listen for clicking or grinding joints or see if the joint is warmer than the surrounding tissue and if the joint is enlarged or tender. The doctor will also test the joint’s range of motion.  If he suspects arthritis, then they may order an X-ray to examine the thumb and will reveal any bone spurs or calcium deposits. The X-ray can also show loss of space of deterioration between the bones.[2]

CMC Joint Arthritis Treatment

Arthritis is a progressive disease, so it will typically get worse over time. The severity of a person’s thumb arthritis is the prime parameter to determine which treatment should be appropriate for the patient. Most of the researchers say that no medication can slow the progression of thumb arthritis, but some treatments may help alleviate the symptoms. Some of the potential treatments include:

• Anti-inflammatory medications.
• Steroid injections.
• Occupational or physical therapies.
• Applying heat or ice to the joints.
• Bracing the thumb.
• Exercises to brace up the muscles around the thumb.
• Avoiding activities that put pressure on the thumb.
• Ergonomic activities.

If these treatments fail in one way or the other, a person may require surgery. A person requires surgery only when the symptoms are severe, and other treatment options do not work. The surgical options include:

• Joint Fusion or arthrodesis in which the bones in the affected joints are permanently fused so that they can bear weight without pain. But the problem with this type of surgery is that the joint loses flexibility permanently.
• Trapeziectomy in which one of the bones in the thumb joint or trapezium is removed.
• Osteotomy where the bones in the affected joints are responsible help correct deformities.
• Arthroplasty or Joint replacement that involves the replacement of a part of the affected joint or the entire joint with a graft from your tendons.

These were the essential surgeries that can be performed for the treatment of CMC arthritis which is the most common type for arthritis in hands. But the fact that all these surgeries are done on an outpatient basis can’t also be ignored as well. But you should always try to consult a doctor in the initial stages to avoid surgery because it is a painful process and requires quite a lot of time to recover. You can also try Everyday Medical's CMC thumb brace that delivers essential support to your thumb and allowing you to go on with your daily activities

Complications Involved

Undoubtedly surgeries are excellent and rewarding methods to correct thumb arthritis hence serving as an impeccable method of pain relief and restoration of thumb function. Due to the improvised range of motion and successful alleviation of pain, the satisfaction rates for thumb arthritis surgery are extremely high. Complications are through rare in the process as compared to any other surgical procedure, but still; there are some general complications like:

• Stiffness.
• Skin/Wound infection.
• Hypertrophic Scarring.
• Adverse reaction to the general anaesthetic during the surgery.
• Reflex Sympathetic Dystrophy that can occur for any hand surgery starting from the minor one to the complex reconstruction procedure.

Also, there can also be many specific complications like:

• Joint infection.
• Implant dislocation.
• Thumb weakness.
• Nerve injury that may result in Neuroma that can be otherwise known as the painful nerve lump that is extremely sensitive to touch.

You need to look out for disproportionate swelling as well as pain in your hand and increased the temperature in the area. Also look for signs or infections in the vicinity of the operated area and grazing of the skin. If you notice any of these symptoms, then feel free to contact a skilled doctor so that the situation doesn’t get complicated any further. To get relieve from pain in your hand, you should wear CMC thumb splint. Thumb splints can help in improving blood circulation and accelerate healing time.

Recovering from Surgery

Post surgery, your hand will be placed in a bulky dressing made up of plaster of Paris for protection and restriction of movement on the operated site. It’s obvious that the patient can go home soon after the surgery on the same day, but it is strictly advised to restrict pressure on the operated part. There will be numbness as well as some minor bruising and swelling and elevation is necessary to prevent stiffness and swelling.[3]

This is the reason why patients are advised to bend and straighten their fingers from day one gently. The plaster is exchanged within a week, and the wound is redressed to prevent infection. You can always consult a therapist to guide you with different therapies that will help you to regain the mobility as well as the strength of the thumb and speed up the recovery process as well.

You should protect your thumb from external pressure and will strictly need to avoid activities like driving a car unless and until you are comfortable and have regained full movements. Depending on occupation, return to work is variable as per the job duties, hand dominance etc. It can take anywhere from eight weeks to one year to recover from thumb surgery.

During that period a person may receive rehabilitation services from physical or occupational therapists to speed up the recovery process. After surgery, you can always wear a thumb splint or a cast over your wrist and thumb to help you regain movement and strength. To ease the pain and improve joint mobility, there are several things that you can consider. Some of these are mentioned below:

Heat is also considered effective in relieving pain. Even icing the joints for a good period of 15 minutes several times in a day can help relieve pain and swelling.

After your surgery, consider purchasing adaptive equipment such as key turners, jar openers, and larger zip pulls so that much pressure isn’t applied on your already weakened joint. There are many types of equipment that are designed for people with limited hand strength like you can replace the traditional door handles with levers so that you don’t have to put much effort on the grasp.

References

1..https://www.ohmyarthritis.com/CMC-thumb-arthritis.html

2..https://www.regenexx.com/blog/archive/thumb-arthritis-surgery-recovery-what-a-mess/

3..https://www.arthritis.org/living-with-arthritis/treatments/joint-surgery/types/other/new-thumb-surgery-options.php