What to know about thumb arthritis surgery

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Arthritis describes discomfort in a joint. It can affect joints all over the body, including those within the thumb. Most cases of thumb arthritis occur due to osteoarthritis, which refers to the gradual loss of joint cartilage.

Thumb arthritis is the second most common type of arthritis of the hand and is more common in adults over 50 years of age. Individuals with injuries to the thumb joint, such as fractures, are also more likely to develop thumb arthritis.

Doctors may refer to the thumb joint as the carpometacarpal or CMC joint. This joint is at the base of the thumb, near where the wrist and fleshy part of the thumb meet. It is responsible for enabling the thumb to swivel, pivot, and pinch, which allows people to grip things in their hands.

In some cases of joint damage, a doctor may recommend surgery. Different surgical options are available to help treat joint damage and pain due to thumb arthritis.

Ligament reconstruction is a procedure that aims to stabilize the CMC joint. Surgeons remove some of the damaged ligament within that joint and replace it with some of the individual’s wrist tendon.

This procedure is helpful for people who have damaged ligaments but who do not have any damaged cartilage. Ligament reconstruction can provide significant pain relief in people with early thumb arthritis and may also help to slow the progression of the condition. However, it is unable to fix any damaged bone or cartilage.

An LRTI is the most common type of thumb arthritis surgery and involves removing damaged joint surfaces and creating a cushion of other tissues to keep the bones separate.

This procedure involves a trapeziectomy or removal of the trapezium bone. This bone is one of the smaller bones in the wrist and forms the CMC joint with the metacarpal bone in the thumb. Arthritis often causes damage to the trapezium.

The padding is usually part of a nearby tendon, which the surgeon removes, rolls up, and places between the bones of the CMC joint. This procedure is helpful for those with moderate to severe thumb arthritis, especially if they struggle to pinch or grip.

This option can greatly improve certain symptoms, such as pain and reduced mobility. However, it usually requires a long and painful recovery period. It may also decrease pinch strength and result in a noticeably shorter thumb.

Also known as thumb arthroplasty, this option refers to the total replacement of a damaged thumb joint. Surgeons remove the joint before installing metal or pyrocarbon prostheses. They may also add synthetic cushioning spacers between the prostheses.

Metal prostheses are better suited to people who are less active, as these can fail with heavier use. In more active individuals, spacers may be necessary, but they have higher complication rates.

Typically, thumb arthroplasties have shorter recovery periods than other options and preserve healthy tissue. However, spacers may result in pain, inflammation, and bone damage. They also may not be as reliable or durable as other options.

This procedure may also involve the removal of the trapezium bone, but differs as it uses a wire to temporarily immobilize the thumb. Surgeons will remove the wire 6 weeks later. Without the constant friction in the joint, the body may be able to heal itself.

This option may benefit people with moderate to severe arthritis who want a simpler surgery. Older individuals may also find this procedure useful, alongside those with a failed reconstruction surgery.

However, hematoma and distraction arthroplasty is a controversial surgical option with debatable benefits. While it may help reduce pain, it can impact grip strength and result in thumb shortening.

Also known as arthrodesis, this option involves fusing the bones in a damaged joint. Surgeons accomplish this by trimming the bones so that they fit together. They then insert a metal pin into those bones, holding them in position.

This option may benefit active people, especially those with physically demanding jobs or post-traumatic arthritis. People with rheumatoid arthritis might also benefit from arthrodesis.

This procedure can help reduce thumb pain and increase thumb functionality. However, arthrodesis has a relatively high complication rate. It can result in damage to nearby joints and reduce mobility.

Typically, health experts will initially advise nonsurgical options to treat thumb arthritis, with surgery usually a last resort.

For example, there is evidence to suggest that steroid injections into the joints can be a useful method to reduce symptoms of thumb arthritis. However, these effects are more significant in people with milder forms of the condition and tend to offer only short-term relief. Other options such as using splints or physiotherapy exercises may also help reduce some symptoms of thumb arthritis.

Thumb arthritis refers to painful inflammation of the thumb joint. While a doctor may initially suggest nonsurgical treatment options, surgery may be necessary if these methods are ineffective.

While each type of surgery differs in how they aim to relieve symptoms of thumb arthritis, they typically involve altering the CMC joint at the base of the thumb. A doctor will advise the most suitable type of surgery depending on different factors, such as the person’s age, lifestyle, and the severity of damage to the joint.