Thumb (CMC Joint) Arthritis

The most common location for arthritis in the hand is due to wear and tear with use of the thumb throughout the patient's years.

There is no cure for arthritis, but there is treatment falling into three categories: no treatment, conservative treatment, and surgical treatment.

Surgery—as the last resort, when conservative treatment has failed—consists of a joint replacement using the patient's normal body tissues and involves excising the arthritic bone and replacing it with a tendon taken from the wrist. The tendon is rolled up into a ball and is used as a spacer, and a portion of it is used to reconstruct the ligament. This is done through a small incision at the base of the thumb and a smaller incision at the base of the wrist to harvest the tendon used for the graft. It is an outpatient procedure performed under axillary block where only the arm goes to sleep. The patient is immobilized in a splint for two weeks, then a thumb spica cast for two weeks, and then uses a removable custom-made splint for two months while he or she is undergoing physical therapy.

The first month is to regain range of motion and the second month to regain strength. This concludes a three-month post-operative rehabilitation protocol. Patients have a very good success rate with this surgery.

Before surgery is considered, conservative treatments are exhausted, which are aimed at alleviating the symptoms of arthritis. This consists of the use of a splint, possible anti-inflammatory medications, possible icing, and occasionally a cortisone injection, which provides effective but temporary relief.

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