CMC Arthroplasty

I haven’t posted much lately for good reason: I just had surgery on my left thumb. I’ve had arthritis in both thumbs for the last five or so years. It has significantly limited my activities. I had to stop playing guitar, couldn’t use most tools (e.g. pliers, scissors), couldn’t button a shirt, etc. In February I had surgery on my right thumb carpometacarpal (CMC) joint. That’s the one where the thumb bone abuts the wrist bones. That surgery went really well with minimal pain. I was able to get by with only acetaminophen post-surgery and by day nine I could drive again. It’s about 95% back to normal, but there is still some pain with pinching or gripping.

My left hand surgery was 10 days ago and I’m having more pain than the first time. This is the first time I’ve been able to type more than a few words, and most of it is with my right hand. I got my cast off on day 7. I’ll get the stitches out on day 14. I’m using a stiff splint (or spica). The Physicians Assistant (PA) for the right hand told me I was very lucky to do so well with the right hand, so this left-hand experience is more normal. But I’m sure it was worth it. I was able to play guitar again for the first time a few weeks after the first surgery. Of course, I didn’t play well, but I did start to relearn stuff pretty quickly. Now I’ll have to wait a few weeks before I can start up again.

There are several variations on the CMC surgery which is called an arthroplasty. They all start by removing the trapezium bone (a trapeziectomy) . That’s the triangular bone in the wrist at the base of the thumb. The pain originates there where the cartilage has worn away and it’s bone on bone. The standard practiced by most hand surgeons is called the LRTI and uses a piece of ligament taken from your forearm to fill in that gap and the lower thumb bone is attached to the adjacent finger bone in the hand with a rod to give it stability. The newer method is called a suspensionplasty or suspension arthroplasty. It uses fiber to attach those same bones and leaves the gap unfilled, although eventually that gap fills with scar tissue. The advantage is that it’s not necessary to cut your tendon. The fiber may be secured with metal anchors (mini-Tightrope) or only by fiber (FiberTak). The former requires an incision between the forefinger and middle finger bones to place one metal anchor, while the latter can be done with only one incision. If you want details, do some online searches. There are plenty of videos of all these procedures. I recommend the FiberTak that I had after comparing it with the stories from others who had other CMC surgeries. Here’s a picture of my hand taken yesterday.


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