What you need to know (and ask about) before your thumb surgery

Posted on: January 21st, 2014 by Dr. Brian J. Bear

Thumb basal joint arthritis is the most common arthritic condition affecting the hands, and it turns routine activities such as opening jars, turning keys, shaking hands, and even buttoning into painful activities; frankly, it’s a debilitating condition, but it’s not something you have to live with forever.

If conservative treatments fail, surgery can correct the condition, alleviating pain and restoring function, and a minimally invasive approach (more on this later) offers so many benefits to those considering thumb surgery.

The traditional approach to surgery: invasive and open

Traditional surgeries, that maintain thumb motion, commonly require a large incision where the entire arthritic bone is removed.

Because open surgery is much more invasive, additional incisions on the hand and forearm are frequently required to gain access to a tendon that is used to stabilize the thumb base, which sacrifices a perfectly good tendon.

In many cases, a total of three incisions on the hand and forearm arm are needed with open surgery.

Minimally invasive thumb surgery: a new, advantageous approach

Arthroscopic minimally invasive surgery has been the standard treatment for many knee, elbow and shoulder conditions because it offers patients so many positives:

  • smaller incisions
  • less scarring
  • less surgical pain
  • faster recovery
  • excellent pain relief
  • restoration of function. 

These same benefits are now available for thumb surgery as well.

Arthroscopic thumb surgery has become a proven minimally invasive option for painful thumb basal joint arthritis.

What you can expect from this procedure

The procedure is preformed through two small portals.  These incisions typically heal with minimal cosmetic scaring and are often barely perceptible to other people.  Because of the smaller incisions, there is only mild surgical pain, and many patients only require oral pain medicine for the first few days after surgery. Because the procedure is minimally invasive, stability of the thumb base is maintained and additional incisions for using your own tendon are not needed. 

Don’t be afraid to ask about training and experience

Because thumb arthroscopy is not as common as knee or shoulder arthroscopy, it’s important that you select a surgeon who has extra training and experience in small joint arthroscopy.  Typically, fellowship training in hand surgery is required to safely and effectively perform this technique.

Side note: This is a specific example, but in general you should always feel free and comfortable to ask your doctor anything.

Also, your surgeon may not recommend minimally invasive thumb surgery for you because:

  1. The surgeon  is not trained on the procedure and does not feel comfortable performing it.
  2. The is only median term follow up on the procedure.  6 year follow up has been reported with results similar to open surgery.  It is important to know we are essentially performing the same operation that is has been performed  with standard open surgery and just through smaller incisions.  The data is confirming so far that the results will be very similar to open surgery.
  3. The procedure cannot be performed for all types of thumb arthritis.  The thumb is connected to the wrist via two joints.  The CMC joint and the STT joint.   In most patients with thumb base arthritis, only  the CMC joint is involved and the arthroscopic procedure can be performed with excellent results.  In severe arthritis of the thumb both the CMC and STT joints can be involved.  The arthroscopic technique is not recommended for the patients who have both the CMC and STT joints involved with arthritis.Also, if there are exceptionally large bone spurs, or if the thumb is completely or partially dislocated from the arthritis, the arthroscopic minimally invasive procedure is not recommended.

Recap: Top five advantages of arthroscopic thumb surgery:

  1. Small barely perceptible incisions with minimal scarring
  2. No need to sacrifice a normal tendon
  3. Minimal post operative pain
  4. Faster recovery
  5. Excellent pain relief and function

(image via)

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