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Dr. Steinmann describes the treatment for thumb arthritis.
Dr. Steinmann:
There are basically two ways to treat thumb arthritis – the traditional technique involves taking out one of the arthritic bones, which is about the size of a big sugar cube, so to speak. It’s kind of a square bone, and then placing a tendon, for example, that’s taken from the same arm, rolled up into a ball and then securing the ligaments together. That’s sort of the traditional technique. Different balls and incision at the base of the thumb, which isn’t too big and actually it heals up quite nicely. The scar is usually not very unsightly.
About four or five years ago I started using, applying arthroscopy to thumb arthritis. We make two little small holes on either side of the main tendon that goes down to the thumb and that allows us to get into the joint itself through a minimally invasive technique and again, I think operations that we do now-a-days, if they are minimally invasive, if they direct their attention to the arthritic area without disturbing the normal anatomy of the thumb or the shoulder for that matter, and have an intervention that can help and allow minimum recovery time, I think that’s the way we should be shooting for as we look at, as we talk about new procedures anywhere in the body for that matter.
And, when we do this in the thumb, when we arthroscopically get into the thumb we can take out about 2 to 3 mm of the arthritic part of the bone and then we put in a graft as an interposition. So we put artificial material, in some cases it’s collagen graft that comes from different sources. There are many different companies out there that provide graft material so we can cut down and put in to the space between the two arthritic bones to act as, I say, I tell my patients, “It’s a poor man’s cartilage.”
If I was a really good doctor I would be putting cartilage in there, but that, we are still years away from that and there are some attempts to do a cartilage transplant, but if I did that I would turn into a 7-hour procedure as opposed to a 50-minute procedure that works very well, but the technique that we are doing is to provide a false cartilage that allows the thumb to move and decrease the bone-on-bone pain that always comes with arthritis and then the patient slowly gets back into activities.
I caution my patients that even though it’s two little holes and in a position of a collagen graft, as I mentioned there are many different graft choices that the surgeon can use, it still takes at least three months to really heal up that thumb before they feel that they can do normal activities, and in some instances it takes six months to nine months before a patient comes in and says, “My thumb is starting to feel like I can use it before it had arthritis.”
So, I feel that surgery is relatively simple and straightforward and minimally invasive, there’s still a prolonged healing period and we always place patients into a cast or splint for six weeks after surgery, so even though it seems minimally invasive and the way we describe it to the patient they need to know upfront that it actually is a prolonged healing period. But the results are equal, not necessarily better, but equal to the open techniques that we have used in the past.
About Dr. Steinmann, M.D.:
Dr. Scott P. Steinmann, M.D., is on orthopedic surgery at the Mayo Clinic Sports Medicine Center in Minnesota. Dr. Steinmann received his medical training from Cornell University Medical College in New York, completed his residency in orthopedics at New York Orthopedic Hospital and completed a fellowships focusing on the shoulder and hand surgery from Columbia-Presbyterian Medical Center and Mayo Graduate School of Medicine respectively.