Dr. Steven Rueda is one of the most sought after surgeons for thumb arthritis in Palm Beach. Osteoarthritis, commonly known as arthritis, can occur in any of the joints of the thumb but its most common at the base of the thumb near the wrist. It is one of the most common reasons to the hand specialist. The word “arthritis” means inflammation in the joint. A thumb affected by arthritis can limit the function of the hand severely. The thumb is the most important structure in the hand to enable pinching, turning door knobs, texting, buttoning shirts, opening jars, and writing.
Thumb Arthritis Symptoms and Diagnosis
The symptoms arising from thumb arthritis are caused by the bone-on-bone rubbing as well as the inflammation inside the joint. In thumb arthritis, there is also shifting of the bone from its normal position due to the arthritis changes. The most common joint affected with arthritis is the thumb base, also known as the CMC joint; arthritis however can occur at the IP and MCP joints of the thumb as well. Some of the most common symptoms include:
- Pain in the thumb base or wrist with pinching, opening jars, twisting door knobs
- Swollen and puffy thumb joints
- Cracking and popping when moving thumb
- Decreased range of motion of the thumb.
The diagnosis of thumb arthritis is usually performed by clinical examination, history, and xray imaging. Dr. Rueda uses xrays to confirm the diagnosis and verify that there is loss of cartilage and bone-on-bone contact.
WHAT CAUSES Thumb Arthritis?
The cause of arthritis is poorly understood. It is however more common with age and after trauma. The normal joint anatomy consists of the two ends of a bone covered by a cartilage cap or cartilage surface. The space between the two cartilage surfaces is covered in joint fluid that assist in lubrication. In arthritis, the cartilage in the surface wears out leading the bone to be in contact with bone. This rubbing of bone-on-bone leads to the pain and inflammation seen in arthritis. For thumb base arthritis, the bone-in-bone contact is between the base of the thumb metacarpal and the trapezium in the wrist.
Thumb Arthritis Treatment Options
There are three main ways to treat thumb arthritis: braces and splints, steroid injections, and surgery. Modern medicine has not found a cure for arthritis, however, there are excellent ways to manage it. The main goal of arthritis treatment is to control pain, and remains the focus of all interventions. A secondary goal is to increase the range of motion of the joint.
Braces and splints do not cure arthritis but help control pain and inflammation with immobilization of the joint. This minimizes the rubbing and grinding of the bone-to-bone interface. For thumb arthritis, a thumb spica splint is typically recommended to limit the thumb mobility and pain.
Steroid injection reduces the inflammation and improves pain in the joint. It is done in the office setting and is very well tolerated. In some cases, Dr. Rueda uses live fluoroscopic guidance to ensure the injection is precisely placed. In most cases it provides symptom relief from days to months, and in some rare situations even years. The injections can be repeated when symptoms return, but this is not recommended sooner than every 6-8 weeks.
Surgery is indicated for patients who have failed treatment with braces and steroid injections.
Thumb Arthritis Procedure
There are two main types of thumb arthritis surgery: thumb joint fusion, thumb joint arthroplasty. Dr. Rueda is an expert in all of these procedures, and has presented on the subject in national meetings. Some of the differences across the types of surgery are listed below:
• Thumb joint fusion:
Fuses or joins the two raw bones that are rubbing together in the joint using wires, plates, or screws. It avoids pain by eliminating movement at site of the joint.
• Thumb arthroplasty:
Removes the trapezium bone (trapeziectomy) to avoid the bone-in-bone contact that causes pain.
RECOVERY AND DOWNTIME
• Thumb fusion: Outpatient procedure. Patients receive a nerve block to minimize pain after surgery. There is tightness, swelling and bruising for 2-3 weeks after surgery. A cast is worn for 4-6 weeks. The patient begins therapy to gradually increase the movement in the thumb after splint removal. There is no movement at the joint that was fused.
• Thumb Arthroplasty: Outpatient procedure. Patients receive a nerve block to minimize pain after surgery. There is tightness, swelling and bruising for 2-3 weeks after surgery. A removable splint is worn for 4-6 weeks. The patient begins therapy to gradually increase the movement in the thumb after splint removal. Full remains fully mobile.
• Thumb Fusion: Return to work depends on the activity and profession. Those whose labor requires strong manual activity usually return to work for basic tasks in 2 weeks wearing a cast. Hand function is very limited while the cast is in place
• Thumb Arthroplasty: Return to work depends on the activity and profession. Those whose labor requires strong manual activity usually return to work for basic tasks in 2 weeks wearing a removable splint.
Why Choose Precision Hand Center for your Thumb Arthritis Procedure?
Dr. Rueda, a Hand Fellowship trained surgeon who has 7 years and 2,000 procedures of experience will be your safe and best choice for thumb arthritis. Successful results in this procedure requires a surgeon that is experienced and knowledgeable in hand surgery and hand anatomy. Dr. Rueda has published articles in expert peer reviewed journals and his work has been presented in several national conferences. Dr. Rueda’s passion for patient education and custom centered approach will guarantee you feel comfortable every step of the way. Dr. Rueda also believes in treating his patients as if he was treating his own family; you can trust you will enter a trusting and long-term relationship and have some of the best thumb arthritis treatment Palm Beach can offer.
FREQUENTLY ASKED QUESTIONS (FAQ)
Patients with classic history, symptoms, and exam who have failed splinting and steroid injections are good candidates for the procedure.
Fortunately the treatments are all excellent at getting rid of the pain. Most patients feel the arthritis pain “gone” after the procedure while they recover from the different “procedure pain”. In all thumb arthritis procedures there is some decrease in the range of motion of the thumb.
Complications in arthritis surgery are specific to every procedure. Dr. Rueda will discuss these with you personally. Fortunately these procedure are safe and enjoy very high success rates with low complication rates. A very unlikely but significant risk is minor residual pain.