Simple Surgery for Thumb Arthritis Yields Good Results
Osteoarthritis of the thumb can be a very debilitating problem. Without a good, strong, stable thumb, it is difficult to hold a key and turn it in the door or open a jar. Pain and limited motion can make even simple motions like picking up a penny impossible. When conservative (nonoperative) care fails to provide relief from symptoms, the hand surgeon considers the need for surgery.

What can be done for this problem? There are many different types of surgical procedures used for thumb basal joint arthritis. One individual approach has not been found to be the best for everyone. Just as the name suggests, the basal joint is located at the base of the thumb where the thumb meets the wrist. It is the joint that allows you to stick your thumb out as if hitch hiking or touch the pad of the thumb to each finger.

One simple procedure is called a trapeziectomy (removal of the trapezium). The trapezium is a rectangular-shaped bone in the wrist. It is located right where the thumb meets the wrist. Taking the bone out removes the source of the pain but something must fill the hole in order to stabilize the joint.

In the case of this study, 48 patients were treated with a trapeziectomy, interposition of tissue, and soft tissue reconstruction. Interposition refers to using a piece of tendon or ligament folded up to fit into the empty space left by the bone removal. The technique is simple to do, gives the patient relief from the painful symptoms, and restores thumb motion and strength.

The authors (two hand surgeons from well known medical facilities) gave a detailed description and step-by-step drawings of the technique. A piece of the abductor pollicis longus (APL) tendon was woven around the other soft tissues and used to support the tissue placed in the defect left by the trapeziectomy. Before the incision was closed, joint stability was tested. If the joint was not stable when the thumb was moved from side-to-side, the sutures were removed and the slip of tendon used to hold everything together was tightened up.

A full rehab program was followed after surgery. Gentle but active finger motion was started right away. The thumb, hand, wrist, and forearm were placed in a plaster splint then in a short-arm cast (thumb included) a few days later. All of this was done to support and protect the healing surgical site. After six weeks, all protective devices were removed and the patient began gentle active motion and light activities (e.g., brushing teeth, combing hair, picking up objects that are easy-to-lift and hold).

Results of this particular surgical procedure were assessed using before and after measurements of grip and pinch strength. Thumb motion, pain intensity, and space ratio (as seen on x-rays) were also used to gauge outcomes. Patients also rated their satisfaction level from before to after surgery. The surgeons kept track of any complications and reported on these as well.

What were the results? All but four of the 48 patients had good-to-excellent pain relief. Only two of the 48 were not satisfied with the results. Grip and pinch strength improved for everyone. Movement of the thumb away from the hand did not change in a measurable way

What were the complications? Twenty per cent (20%) of the patients had some type of problem either related to the anesthesia or to the hand itself. Most of these were single events (meaning only one patient was reported for each complication). Complications included numbness, infection, persistent pain, and adhesions (scarring). Some of the problems could be treated with antibiotics. Others required an additional surgery.

And how did this technique compare to other (different) surgical procedures performed for the same problem? The authors report results are equal to those reported in other studies using different techniques. The reason they like this technique is because it is easy, doesn't require drilling holes in the bones, and uses only one tendon to support the reconstruction.

Some of the complications that occur with other surgical procedures are eliminated (e.g., no drilling or wires used means fewer infections). The short-term use of splinting and casting also means fewer problems with adhesions and loss of motion. Patients regain motion, strength, and function faster, too.

Long-term results are not yet available so it remains to be seen if these positive short-term results will last. There isn't one particular repair method that is known to work best for persistently painful basal joint arthritis. Surgeons are left to try and find a method that works well for everyone. This one may not be superior to all other methods, but it is equal and does present some positive benefits to consider.
Douglas M. Sammer, MD, and Peter C. Amadio, MD. Description and Outcomes of a New Technique for Thumb Basal Joint Arthroplasty. In The Journal of Hand Surgery. August 2010. Vol. 35-A. No. 7. Pp. 1198-1205.