Thumb

Dr Trussler & Dr. Robison | Austin Hand Surgery Experts | Reconstructive Surgery | Austin, TX

Thumb Arthritis

Arthritis is commonly caused by inflammation in the lining of the joints, which in addition to pain, may result in stiffness, swelling and loss of movement in the affected joints. Arthritis of the thumb, also known as basal joint arthritis, occurs when the cartilage of the thumb joint (carpometacarpal joint) wears away from the bone. This cartilage normally acts as a cushion between the bone and the joint, and when it is worn away, the direct contact and friction between the bones causes pain, swelling, decreased strength and range of motion.

Arthritis of the thumb may cause difficulty in performing simple tasks such as turning doorknobs, opening jars, and pinching or gripping items.

Causes of Thumb Arthritis

The exact cause of arthritis of the thumb is unknown, however prior fractures or injuries to the carpometacarpal joint may make this condition more likely to occur. This joint may also be more susceptible to arthritis because of its frequent use. Arthritis of the thumb is also more common in women than men and often occurs over the age of 40. Some research indicates that it may be a genetic condition.

Treatment of Thumb Arthritis

Arthritis of the thumb is commonly treated with a combination of methods. Splints may be used to support the thumb joint and limit movement. Medication may be used to treat pain and may include:

  • Anti-inflammatory drugs
  • Acetaminophen
  • Prescription pain relievers
  • Corticosteroid injections

Physical therapy may be a successful form of treatment for some patients. Severe cases may require arthroscopic surgery to repair joints or debride damaged tissue, or arthroplasty to fuse, reposition or replace the joint.


Broken Thumb Repair

Repairing a broken (fractured) thumb can be done nonsurgically or surgically. Which method is chosen depends on a number of factors, including the location of the break and how much displacement (movement) of bone has occurred. The thumb comprises two bones: the distal phalange and the proximal phalange. The distal phalange runs from the tip of the thumb to the knuckle; the proximal phalange runs from the knuckle to the base of the thumb. Typical causes of a broken thumb include falling on an outstretched hand, and playing sports that involve either twisting or contracting the muscles of the thumb.

Signs of a Broken Thumb

Signs that a thumb may be broken include the following:

  • Severe pain at the site of the break
  • Swelling at/around the site of the break
  • Extreme tenderness at the site of the break
  • Inability, or limited ability, to move the thumb
  • Thumb looks deformed or misshapen
  • Thumb feels numb and/or cold

People who are calcium-deficient or have bone disease are more prone to thumb fractures.

Treatment of a Broken Thumb

A broken thumb can be repaired nonsurgically or surgically.

Nonsurgical Repair of a Broken Thumb
It is possible that a spica cast, which immobilizes the wrist, palm and thumb, can be used to treat a thumb fracture. A cast is appropriate if the pieces of fractured bone have not moved significantly or can be manipulated back into place, or if the break is in the shaft (middle) of the bone. Typically, the cast remains in place for 4 to 6 weeks, during which time X-rays are taken on a regular basis to make sure that the bone has not slipped out of place.

Surgical Repair of a Broken Thumb
If there is a lot of movement between the broken fragments of bone in the thumb, surgery may be necessary to realign the fragments, which then have to be held in place as the fracture heals. Surgical techniques involve the placement, either internally or externally, of hardware or devices to hold the fragmented pieces of bone together.

Internal fixation uses wire, pins, plates and screws to align the bones properly and hold them together. External fixation uses a device that attaches to the outside of the thumb area. Pins are attached to the fragments from outside of the body, and held in place by the device. A cast or splint is usually work for 2 to 6 weeks post-surgery. When it is removed, physical therapy may be needed to restore the full range of movement to the thumb.

Even after surgery, it is possible that the fragmented bones in the thumb have not healed, or have healed but are misaligned, resulting in pain, and loss of strength and function. If so, a second operation may be needed.


Thumb Basal Joint Reconstruction

Thumb Basal Joint Reconstruction The reconstruction of the thumb's basal joint is a difficult procedure due to the three different ligaments connecting to the degenerating bone. This bone, the trapezium, is removed during the surgery and a replacement cushion is placed in its spot. A donor tissue from elsewhere in the body, normally a piece of tendon, is used to reestablish a connection between the base of the thumb and index finger. This is a direct connection between the two bones and thus will behave slightly differently post-op.

Additionally, some surgeons hold the tissues and bones in place with a steel pin which may be removed later. Upon completion of the procedure, the patient will keep the thumb immobilized for about four to six weeks and may begin a rigorous therapy program for an additional four to six weeks afterwards.

The reconstruction of the thumb's basal joint is a difficult procedure due to the three different ligaments connecting to the degenerating bone. This bone, the trapezium, is removed during the surgery and a replacement cushion is placed in its spot. A donor tissue from elsewhere in the body, normally a piece of tendon, is used to reestablish a connection between the base of the thumb and index finger. This is a direct connection between the two bones and thus will behave slightly differently post-op.

Additionally, some surgeons hold the tissues and bones in place with a steel pin which may be removed later. Upon completion of the procedure, the patient will keep the thumb immobilized for about four to six weeks and may begin a rigorous therapy program for an additional four to six weeks afterwards.



Call 512.450.1077 to speak with Dr. Robison and Dr. Trussler if you have any questions or comments or to learn more about how we can help you.

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