Osteoarthritis
What is Osteoarthritis?
Osteoarthritis is the ‘wear and tear’ kind of arthritis. Some people’s cartilage is less hardwearing than others for genetic reasons, and so joints can wear out. In the hand, this commonly affects the finger tip joints and the thumb base joint. It causes pain, stiffness, disability and deformity.
Although the wear and tear continues to gradually get worse, the symptoms usually do not. There is a painful phase, which can last for many months or years, but usually the pain eventually fades leaving stiff and sometimes deformed joints.
Treatment
The pain can often be controlled with non-surgical means using painkillers, splints, physiotherapy and injections. If these measures do not adequately control the symptoms, surgery is sometimes advisable.
The typical operations for arthritis in the hand and wrist are joint fusion or joint replacement surgery. Sometimes, removing the nerves which carry pain messages from the hand to the brain can be successful. The main nerves which provide sensation and movement of the hand are protected, so hand function is not affected by this type of surgery.
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In thumb base arthritis, one of the bones at the base of the thumb can be removed to achieve pain relief. This is called trapeziectomy. The operation is done as a daycase under regional anaesthetic (when the arm is put to sleep by injection but the patient remains awake). Occasionally a general anaesthetic is needed, so any patient planned for a regional anaesthetic needs to be starved for 6 hours before surgery, just in case.
The thumb is put in plaster for 4 weeks afterwards, and then a removable splint so that physiotherapy can commence.
Risks and Recovery
The main risk from surgery is that the symptoms may not fully resolve. However, in the majority of patients it is a successful operation and the risk of complications is low. Other risks from surgery include instability or persistent stiffness in the thumb, recurrence of symptoms and the need for further surgery, infection, bleeding, damage to nerves/vessels/tendons in the area, scarring, and a rare condition (1 in 1000 patients) where the hand can overreact to the operation resulting in pain, stiffness and swelling for many months. Most patients avoid complications and overall the results are good.
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Some patients have made a good recovery within a couple of months, but some take many months for the pain to resolve and good function to return.