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basal joint surgery of the thumb

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Posted 11/4/2011 4:21 AM (GMT 0)
The basal joint of the thumb, or carpometacarpal joint, is made up of a carpal or wrist bone (trapezium) and the first or metacarpal bone of the thumb. This joint is very near the wrist and under the fleshy part of the thumb. It is subjected to an unusual amount of stress, as the thumb must be strong enough to counteract the force of four fingers put together. It has been calculated that one pound of pinch between the thumb and index finger will produce six-to-nine pounds of pressure at the basal joint of the thumb. rolleyes skull turn

Please remove the links from your signature line - they are promoting a clinic and surgeon.

Thank you for your understanding.

Kitt

Post Edited By Moderator (stkitt) : 11/6/2011 10:40:41 AM (GMT-7)

Posted 4/20/2012 3:45 PM (GMT 0)

Hello,

I am a dental hygienist who has just joined this forum. My right CMC joint is at the point where working with the pain is becoming impossible. I have had a diagnosis of "bone on bone" osteoarthritis for approx 2 years now. Is there anyone out there with a similar profession that has had the surgery and was able to return to work? I recently acquired a soft splint that I am able to wear under my gloves. Any and all comments are appreciated.

Posted 4/20/2012 9:38 PM (GMT 0)
Hi Dentalthumb,

I had CMC joint surgery and carpal tunnel surgery combined on February 15, 2012.   I was in a surgical cast for two weeks, a plaster cast for 2 more weeks and a spica gauntlet for an additional 4 weeks.  At my 8 week appointment I was approved for Physical Therapy.  I have been to 3 PT appointments and I am nowhere near ready to be using my hand.  In fact, at my appointment yesterday (9 weeks post op) the PT said the surgery area was still very fragile and to treat it as such.  No lifting, no strain of any kind.  He says at 9 weeks I am right where I should be as far as progress.  I belong to another healthboard forum and there are several of us who have had surgery this year and log on every few days to post an update.  It's under arthritis and is 'basal joint surgery, my story'.  There are over 300 posts.

Good luck with your surgery. 

Posted 4/21/2012 12:08 PM (GMT 0)
Dear Plain Vanilla,

Many thanks for your response. I visited the orthopedic surgeons office yesterday and received a cortisone injection and a new rigid splint. I will not take the splint off for the next several days as I am hoping to prolong the benefit of this injection for as long as I can.

I am going to look for the other forum you mentioned right now. Your info was very timely and helpful, and I greatly appreciate it. Hope your recovery continues in the right direction.

Just as an aside for now, I was met with a blank stare when I asked if I should continue working full time given that my pain level while working as a dental hygienist has increased dramatically. Is it something about arthritis that makes a practitioner suspicious that one is just looking for a way out of work? I realize that there is no one answer for this, just interested in other people's experiences. I have a sense that this is the beginning of a long journey for me. The one decision I have definitely made is to seek a second opinion at a "hand center" before proceeding with surgery.
Posted 4/21/2012 7:24 PM (GMT 0)
Dear Dentalthumb,

I hope you were able to find the other board.....I don't think I can post the web site on here.

The active names you will see are Haydena, Janet20, Gingertea and more.

I don't think people understand what they cannot see.  Even my doctor seemed reluctant

to refer me for a nerve conduction study on my carpal tunnel.  I'm all in favor of second opinions!  The first surgeon wanted to do  4 separate surgeries, bilateral carpal tunnel and bilateral CMC joint surgery.  He never took an x-ray, just read the nerve conduction study and sent in his scheduler to make surgery appointments.  That scared me away from that group of orthopedic surgeons!  I researched the internet to find another orthopedic group in a nearby city.  I found one with many good reviews.  I wrote them an introductory letter and sent them a copy of my test results.  Two days later they called and set an appointment with their hand surgeon.  When I saw the hand surgeon the first thing he did was order x-rays.  When he saw the condition of my hands he referred me to another surgeon in the practice that had more experience.   When that surgeon saw my x-rays he couldn't believe I hadn't been in much earlier.  Both thumb joints were out of place and crumbling because there was no cushion between the bones.  Both hands were loaded with bone spurs.  He also said he would do the carpal tunnel release the same time as the CMC surgery, saving me 2 extra surgeries.  My husband was with me and the surgeon took the time to go through the x-rays and how the surgery would be done with both of us.  They had their own surgery center in the building and we saw that.  I felt comfortable enough to schedule the surgery.  Because of the length of the surgery  (2 hours) I needed general anesthesia.  During surgery the doctor found many more bone spurs he had to remove so it was closer to three hours.

Recovery from this surgery is not 3 months as most websites will tell you.  After 3 months you are out of the casts and braces, but your hand is in no shape to do any work.  PT is a must.  I've had three one hour appointments in 10 days, and the PT says the area is very fragile.  I'm not supposed to lift anything heavier than a coffee cup, and I need to wear my gauntlet brace when I do any kind of activity.

People are skeptical, and look at you like you are faking it.  I'm glad my husband was with me when I saw the surgeon.  He was forewarned that he would be in charge of most everything because I would not have any use of my hand.  The ladies on the website have been most helpful.  It's a very frustrating experience, and some days you just need to vent!

Posted 8/26/2012 1:10 AM (GMT 0)
Hello

New member here..just recovering (5 weeks post op) rt. basal thumb joint replacement and I'm rt. hand dominant. I've had the left one replaced 5 years ago and that went (as much as you could say) smooth sailing. This one, however, was totally different! I had a bier block which I hated as it felt like a thousand ant bites stinging me which i've never felt before. Had the hard/plaster cast for the first 10 days and on day 7 of day 10 I noticed something not right. I could see down inside the plaster cast as it was just one thin strip hugging my thumb and down the inside of my forearm protecting the incision for the tendon harvest. I was itching and I also noticed water and blood blisters forming around the incision around the incision on the forearm. Called the Doc, they got me in and they took out the stitches 3 days early and the dx was I was allergic to the plaster! It looked just like a poison ivy rash all under my cast. I was placed in a small 'boxers' cast for the next 4 weeks which was a nice change until I couldn't handle it any longer. It was so tight it was rubbing in 4 spots. This last week they put me in a splint that I'm using as a cast which I haven't taken off. Wednesday is the day I get to take it off for good! Thank god I have no more thumbs to go through this again. I never knew how difficult it would be to become left handed when it did 't come natural but on the flip side.. somethings are becoming natural to me now with my left hand. good luck to everyone going through this.
Posted 8/26/2012 1:37 AM (GMT 0)
Amazing what we can re-learn when we have to. My left hand used to be a paper weight. Then I got osteonecrosis in my shoulder and couldn't use the mouse with it. I've since had surgery which partially corrected the problem, but I still mouse left-handed all the time.

Glad to hear you're doing better now.
Posted 9/9/2012 5:51 AM (GMT 0)
I had the surgery where they take out the bone and basically replace it with the palmaris longus tendon, the one that sticks up in the middle of the underside of the wrist. We don't need it anymore. I expected hideous pain but never had it. As I woke up I had some and asked for something for it and that was the end of it. Since I don't tolerate codeine well, the doctor gave me tramadol. I took it for a week and ½ and NEVER had severe pain. I kept it elevated and iced from as soon as I got home and for several days. My fingers and end of thumb were swollen but, like the doc said, I kept wiggling them. After 2 weeks he took the stitches and pin out and sent me to a PT to have a splint made. The Doc told be not to move my thumb but to take the splint off while sitting around and move by wrist. After a few days it was moving pretty well. 3 more weeks later he told me to move my thumb out and also down toward my palm under the pinky. It moved pretty well w/o a lot of discomfort. In 2 more weeks he told me I didn't need the splint and to do strengthing . Do anything that didn't hurt. I'm now 8 weeks post op and can do lots of things without pain. The thumb is weak as is my wrist and fingers but the thumb joint is no longer in constant pain as it was before surgery. Its my right hand so it has been a challenge well worth it! Its been nice since surgery to only have pain in one thumb... the one that still needs surgery. I didn't wait until my thumb was totally debilitated to get the surgery. My hand was still pretty strong. I work outside in a pretty demanding job that was getting too hard to do because of the pain and loss of pinch. strength. I worked one day and had surgery the next. Be sure to go to a hand doctor. My doc has been doing this surgery since 1980... he knows his stuff. There's no glory in suffering through until you can barely do anything! Once the joint is ruined get it fixed before you become crippled. The recovery is easier! Also, prepare for being one handed for a few weeks: elastic wastebands, no buttons, slide on shoes, keep your bra snapped and slide over. And wriggle up, frozen dinners, big pile of pillows, frozen 2 litre bottles of water with a little bend in the middle, doggie piddle pads to insulate from freezing your skin and. keeping the splint dry, tape hour deodorant on a length of pvc pipe so you can apply under your good arm, a vice to hold cans with easy open tops
(especially necessary to feed cats), a plastic bag and velcro strap to wrap rhe bandage in for showers. Go places, socialize. Don't stay home all the time! It can get depressing. Enjoy the down time and relax. You got a lemon... make lemonade out of it! If you know an artist have her decorate your sling. Mine also decorated my purple splint. Oh, if its your dominate hand, sign a bunch of checks and keep them in a safe place, you'll be glad. And be sure you have those little flossers, mo way you can floss otherwise. Don't be afraid but look forward to a good thumb in a few months... it will all be worth it. Good luck.
Posted 5/30/2013 8:34 AM (GMT 0)
hello! anyone here been diagnosed with "pantrapezial arthritis"? thx in advance!
Posted 10/12/2013 1:58 AM (GMT 0)
I had Basal Joint surgery 04/04/2013. Besides the Basal Joint surgery, I had the next joint pinned because of it being hyper extended. When I was placed in the cast the person did not pad the pin area enough so I had pain/burning the six weeks I was in the cast. Because of the irritation of the pin area, when the pin was removed, it hurt like )^&^. After being out of the cast I was doing fine for 4 months then I started to hurt again. I was in so much pain that I went back on 10/09/2013 and the xrays showed what I feared; I was bone on bone again and the separation that the inserted tendon was supposed to supply was not there. My only option is for the surgery again but I am going to research having the thumb fused because I do not want this as a repeat issue. I'm now on ibuprofen and in my thumb brace. Anyone have this issue????

This is a link to a picture of post surgery before casting.

https://www.facebook.com/photo.php?fbid=10151389698274716&set=a.10151389698149716.1073741827.621219715&type=3&theater

Post Edited (audiome) : 10/11/2013 8:03:22 PM (GMT-6)

Posted 10/14/2013 9:54 PM (GMT 0)
I had the same Basal Joint Surgery in 2008 on my right hand and just last year on my left. The result for both were wonderful until I had an accident at work (I am a nurse and I had an aggressive patient grab my hand). I am now facing a repeat surgery of my left hand as the separation that was inserted has now travelled and I am back to having the same pain that I previously had. I am thinking about fusion, but I am unsure of what my range of motion will be. I am not concerned with the recovery time, just my future limitations. My job is really physical with alot of fine motor functions, so does anyone have any information on options. I value any opinions that anyone might have, good or bad.
Posted 5/6/2014 3:07 PM (GMT 0)
Hi everyone,
I am scheduled to have the basal thumb joint replacement with the wrist tendon next Tuesday, and getting nervous. Plus I have not had pain for the last few days. I've gone through all the reasons I am doing this now....In May so I can recover before winter and not be off work too long, health insurance in our area will change greatly at the end of the year and my doctor may not be available to me, and I do drop things, can't open jars, the upper joint in my thumb clicks, and I get a bit of numbness in the upper joint and above.

I am just very nervous, I am not yet 60, should I wait, do these replacements wear out, when will I be able to drive (I don't drive a lot, but occasionally locally for work), how worried should I be about jostling my hand....I have several dogs and cats. I am very appreciative of other posters information and just needing confirmation that folks recover and can manage life....

Thank you!!!
Posted 5/9/2014 1:35 AM (GMT 0)

Dentalthumb said...
Hello,

I am a dental hygienist who has just joined this forum. My right CMC joint is at the point where working with the pain is becoming impossible. I have had a diagnosis of "bone on bone" osteoarthritis for approx 2 years now. Is there anyone out there with a similar profession that has had the surgery and was able to return to work? I recently acquired a soft splint that I am able to wear under my gloves. Any and all comments are appreciated.

I do not wish to jinx myself so I will just tell you that after 4 weeks of special concoction of glucosamine, cetylpure, joint herbs and halyronic acid PLUS restricted use I was seeing incremental and slow results. I was concerned one heavy object would rip up any healing as it was slow and fragile and still painful.

Now I took something for my Ulcerative Colitis that was laying around in my Pantry because it was supposed to aid sleep also.

BAM! The constant pain you speak of is diminished and I find myself using it for all sorts of things again. Simply pulling my underwear or sweat pants up was unbearable or putting on rubber kitchen gloves - but NOW I am bench pressing and not feeling pain when gripping, grabbing heavy objects and doing more and more.

It is healing fast and in 2 more weeks if it continues I will not need the surgery the Doctor said I surely would after x-ray revealed all cartilage worn away and bone out of 'saddle' etc.

I want to be sure it is the ingredient and nothing else, what I am certain of is a night and day difference.
Posted 5/18/2014 4:52 PM (GMT 0)
L-Threonine ( not l-theonine ) every night before bed put me back in the game.

I of course modified my behavior and only carefully take it to a new personal thumb-best each day. It will also take a few months more to be 100% again. Miracle for me as it was unusable and doc said cartilage was gone and bone out of place due to stretched/damaged ligaments/tendons.

Healing naturally is the goal now ( and FREE )
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