What is Osteoarthritis?
Osteoarthritis (OA) in the base of the thumb is the most common cause of pain in this area. It is the degeneration of the protective surface of the bones in the joint over time, usually through overuse or damage. Initially pain occurs during movement or activity i.e. turning a key, opening jars or gripping objects. As the arthritis progresses pain can be evident at rest also.
Early OA can be effectively managed using non-surgical treatments to reduce pain, inflammation and swelling:
- Medications and steroid injections may be suggested
- Referral to Hand Therapy for any splinting, advice on joint protection and suitable exercises.
- Surgical management to be discussed with your consultant or GP
For the majority of patients the option of surgery can give the best relief for pain and there are different techniques which the consultant can discuss with you. At the base of the thumb is a small bone called the trapezium which, together with the metacarpal bone above, forms a joint called the carpometacarpal joint (CMCJ). Removal of the trapezium bone can reduce the pain and allow easier use of the thumb.
Remove all jewellery from the hand before the day of surgery. Tight rings may need the help of a jeweller to remove. Ensure that your hand is clean including your nails and any acrylic mails or varnish are removed.
Surgery is usually performed under general or regional anaesthetic. General anaesthetic means being asleep and is usually safe for most patients. Regional anaesthetic involves an injection of local anaesthetic around the nerves in the shoulder to make the whole arm numb. This may be safer for some patients and the preferred option of others. The surgery is the same with both approaches. If you would prefer a regional anaesthetic please let us know when booking your operation as we may need to make arrangements for this. We need to prepare as if for general anaesthetic as the regional is occasionally not effective and this is determined before surgery begins.
An incision is usually made on the back of the thumb base over the site of your pain. The joint is then opened and the trapezium is excised. Occasionally the joint next to the trapezium (the scaphotrapeziod joint) is also arthritic and excision of a small part of this is performed to prevent residual arthritis here being a potential source of persistent pain after the operation. The joint lining is then closed and the skin is closed with absorbable sutures. A temporary plaster is applied for comfort.
For a sling procedure the trapezium bone is removed and the base of the 1st metacarpal is trimmed. A soft tissue spacer is made from part of a tendon taken from your wrist and put into this space, this is tied to the 1st metacarpal base and rolled as a spacer. The joint capsule is then closed and temporary plaster applied.
All surgery has risks and these may very with your individual circumstances, but the following is a general guide:
- Stiffness and swelling– This is common to a degree and can be reduced by elevation of the hand and moving fingers
- Infection– This is rare after hand surgery (less than one per cent of cases), but can be serious.
- Nerve injury– This is rare (less than one per cent of cases), but may cause numbness or pain.
- Bleeding– Some blood on the dressing is common, but significant bleeding is rare.
- Persistent symptoms– Most patients feel more comfortable after surgery, but some may not get full pain relief and occasionally it may not settle.
- Instability– This is an uncommon problem, but further surgery may occasionally be needed.
- Grip Strength– This is usually better than before surgery due to the improvement in pain, but it may not be as good as before the arthritis.
- Complex Regional Pain Syndrome– This is an abnormal reaction to surgery which can lead to long standing pain stiffness and swelling. Severe CRPS is rare but can make you feel worse than before surgery and be difficult to treat.
The local anaesthetic will wear off a few hours after surgery. Simple pain killers are usually all that is required and it is advisable to take these regularly at first. Severe continuous pain should be reported to your doctor. Please report any signs of infection quickly, these include an increase in pain not related to exercise, increased swelling, pain in the arm and ‘flu’ type symptoms.
In the initial stages it is important to keep your hand elevated to minimise swelling and improve your comfort. Use the sling provided to keep your hand above your heart for the initial two days after surgery. When lying or sitting support your hand on pillows at heart height. Remove your sling regularly to stretch your arm above your head and bend and straighten your elbow. Swelling can take several weeks to subside but once reduced you can leave your hand down. If you experience excessive swelling and the plaster becomes too tight please contact the plaster room.
Immediately after your operation your hand and wrist will be placed in either a bulky dressing or in a plaster of Paris backslab.
An appointment will be arranged at 10-14 days with the Hand Therapist in the Therapy Department at Yeovil Hospital, to replace the backslab with a lighter dressing, to remove your sutures and to make a splint.
After the operation all dressings and splint should be kept clean and dry and it is advisable to use a large rubber sized glove or a plastic bag when showering or bathing.
When will my stitches be removed?
Your stitches will be removed 10-14 days after surgery, either at your Hand Therapy appointment or at your GP surgery. Once the wound is fully healed you will be able to wash your hand and start massaging the scar with an aqueous non-perfumed moisturising cream.
When can I use my hand?
From four weeks you will gradually come out of the splint during the day to use your hand for light activities but this may be sooner depending on your progress and pain levels and you will be advised accordingly. You should avoid tasks that cause pain or are heavy. MCPJ fusion and sling procedure surgery delay until six weeks.
When can I return to driving and go back to work?
From six to eight weeks you can return to driving as long as you are comfortable and have enough strength and control to drive safely. How quickly you return to work depends on your job. Generally light activity/secretarial work will be at about 4 weeks and heavier activity at six to eight weeks. Your hand therapist/consultant will advise you.
The Therapy Department is available Monday to Friday, 8.30am-5pm.
If you have any questions or require further information or advice during these hours please contact:
Therapy Department: 01935 384 358
If you have any serious concerns outside of these hours please contact your GP, the NHS 111 service or Accident and Emergency.