Conservative Treatment Options – What Happens First
Once diagnosed with thumb arthritis, your doctor may offer you many different treatment options. They will most likely start with conservative treatments such as anti-inflammatories or cortisone injections. These treatments may alleviate your symptoms and help reduce pain for a short period of time, however in most instances they will not completely resolve the problem. If these treatments do not help your pain your doctor may refer you to a surgeon to discuss your discomfort.
Surgical Treatment Options
Once conservative treatment is no longer effective , your doctor may recommend surgery. Below are the most common surgical procedures used to treat CMC arthritis.
Trapezial Resection with Ligament Reconstruction
Trapezial resection with ligament reconstruction goes by a number of different names, Anchovy, LRTI or TMIA. This procedure involves full or partial removal of the arthritic bone at the base of the CMC joint (the trapezium). A series of small cuts are made in the forearm to split a tendon, which is moved to the base of the thumb to fill in the area from which the trapezium bone was removed. The thumb now rests on a soft tendon pillow, not a hard piece of arthritic bone (which is painful). Immobilization for a LRTI’s is six weeks and mobility after surgery will be limited. The cosmetics of your hand also may be altered. Should this procedure fail, there are not many good treatment options remaining. The only real revision option is to harvest another tendon and try the procedure again.
During a fusion, the two arthritic bones are attached together via a screw or plate. The bones will then grow together, eliminating painful bone-on-bone contact, but also eliminating any motion at that joint. Fusion is frequently unacceptable to many patients because of the loss of movement in the joint. Additionally, fusion often leads to arthritis in adjacent joints as these joints become over used once the thumb joint is fused. After a fusion is completed you will be immobilized for 6 to 8 weeks. You will completely lose mobility and the cosmetics of your hand may also be altered.If a fusion fails, revision options include trapezial resection with ligament reconstruction as well as implant arthroplasty.
A portion of the bone in the base of the thumb metacarpal is removed and the implant is placed in the space from the damaged joint. A new socket that provides a smooth surface for the implant to move in is formed. Your hand is then placed in a cast which keeps the thumb joint in a specific position while your healing begins. You will be in a cast for approximately 3 weeks, depending on your healing. The treatment we are discussing is called an Interpositional Arthroplasty. This procedure has the advantage of maintaining movement and a firm foundation for pinch and grip strength. If implant arthroplasty fails, revision options include trapezial resection with ligament reconstruction as well as fusion.