Suspension arthroplasty on CMC joint – patient experience

I’m a man in my 70s who has suffered from osteoarthritis in both thumbs for over five years. For the first three years or so I got good relief from steroid injections, but that stopped working. I was reluctant to have surgery because it wasn’t clear which one would help. The pain was actually centered in my MCP (Metacarpophalangeal) joint, the one most people think of as the base of the thumb, where the webbing is, but the X-rays showed the narrowed bone-on-bone joint to be the CMC (Carpometacarpal) joint, the true base of the thumb where it joins the wrist. I chose the CMC operation for several reasons: 1 my doctor recommended it; 2 it’s surgically simpler with fewer risks and easier recovery; 3 it has a much higher success rate.

Different doctors have different preferences. Mine doesn’t do the “anchovy” operation where a tendon is cut to fill the void where the trapezium bone is removed. Instead he performs the Arthrex CMC suspension arthroplasty where that bone is removed and thumb bone is drilled and lashed to the adjacent finger bone to keep it from slipping into the empty spot, which eventually becomes filled with scar tissue. The operation was one month ago on my right (dominant) hand. I had general anesthesia with a nerve block in the arm and woke up with no pain and my hand in a cast. That night I took one opioid (Hydrocodone) pill for pain on the doctor’s recommendation even though I wasn’t hurting much because they say not to wait for the pain to get bad as the pill takes a while to work. The next morning I took another pill and one in the evening, I had minimal pain that day. The bulky cast meant there were many things I couldn’t do, but my fingertips extended out and I could use the hand to some extent as long as I avoided using the thumb.

The second day I didn’t take the opioid and haven’t since. Acetaminophen has been sufficient to deal with the pain, which has been surprisingly minimal throughout. On day six the doctor watched his P.A. remove the cast and swap it for a brace (aka, spica). The brace is similar to the cast in bulk and coverage, but is more flexible and is removable with Velcro attachment. My doctor was surprised and delighted that my pain was so minimal and I could touch my thumb to each finger easily when the cast and brace were off. I was warned not to pinch or squeeze with that thumb for six weeks and to wear the brace as much as possible, but it’s okay to take it off to shower or when necessary. I wore it to bed the first few nights after that, but found I could sleep more comfortably without it. I even did light chores, like emptying the dishwasher and doing some dishes as long as I didn’t have to scour. My wife did many things for me like cutting my meat and trimming my fingernails.

The next visit was to the P.A. a week later. On day 13 I resumed driving, although only on city streets, nothing high speed and only a few blocks., The doctor wasn’t present as the P.A. removed my stitches. She said I could get it wet and could resume running and exercises as long as I avoid lifting heavy weights, etc. One bad aspect I had not anticipated was that my left hand arthritis pain had gotten much worse right after the operation. I’d asked the doctor about that the last time and he said that was common because I was using it so much more. Although my right hand pain was minimal, that was largely because I was babying it. If I tried to pinch something firmly, e.g. open a ZipLoc bag, or bumped the thumb tip, it hurt a lot. The P.A. told me that I should expect pain until the three-month point. Only then will I begin to feel the pain relief benefits.

It’s now two weeks after that and life has mostly returned to normal. I wear the brace when inactive, e.g. watching TV, reading, etc., but I take it off to eat, brush my teeth, drive, etc. My hand seems pretty flexible to me although I can’t twist my wrist in normal ways. For example, if I’m careful I can brush my teeth with my right hand, but it’s hard to do the right side that way because I can’t bend my wrist for that, so I usually do that side using my left hand. I can use a pencil lightly to do a crossword puzzle, but I hold it wedged low squeezed between thumb and hand, not using my thumb tip and I can’t press hard to write. I can’t sign my name normally yet, so my wife writes any checks needed. I still take acetaminophen daily, but I was doing that for the arthritis before (and still need it for my left hand, too). I don’t know if I will need physical therapy, but I don’t think so. My doctor said not everyone does and seemed very encouraged when he saw me that first visit. I still have a tiny scab at one end of the scar. The skin around the scar has been sensitive, so I roll up my long sleeve on that side when the brace is off as the cuff irritates it, but that seems to be improving. So my next visit is in two weeks; I’m not sure what will be done at that point. Assessment, I assume.

Everyone’s experience is different. Mine is just one data point, so don’t expect yours will be the same. I hope this is helpful. I’ll update this blog when I think enough has changed to warrant it.

One thought on “Suspension arthroplasty on CMC joint – patient experience

  1. Deborah Wyatt

    Excellent write up, I had a cmc joint fusion last march 2023, this march I’m having a silicone replacement for the cmc and mcp fused. This time it’s my dominant hand, so I’m more scared. But reading this has helped a lot


Leave a Reply

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.