Posted 11/19/2017 1:06 PM (GMT -6)
I have had joint pain in my fingers and thumbs for many years; most frequently after working with my hands. The basal joint or thumb CMC (carpometacarpal) specifically has given me the most grief. It started with what felt like an ache in the abductor pollicis brevis muscle after using my hands for some activity like electrical work, skiing, drawing or just life. As life progressed the discomfort localized in the joint at the base of the thumb in the wrist. While that location became the most painful the mmetacarpophalangeal and interphalangeal joints continued to be uncomfortable. I have been treating the symptoms for years with ibuprofen, thumb splints, heat treatments and cortisone injections.
The collapse of the basal joint has been visually apparent in the inability to open my thumb to a full right angle, and the appearance that my thumb is rolling under my palm instead of remaining in the same plane as my fingers and palm.
The swelling and discomfort of this osteoarthritis has additionally caused carpal tunnel syndrome in both of my hands.
Research and consultations with a couple of hand surgeons say that while finger joint replacements are available; they are not very durable, lasting only about 10 years. However there are several procedures specifically for the thumb CMC joint.
The latest x-rays showed that the cartilage around both the left and right trapezium bones was gone. When the surgeon looked at the x-rays her first comment was, “Well, that’s as bad as it gets.” Her recommendation was that I have surgery. The recommendation that is currently the most effective procedure for CMC arthritis is called a trapeziectomy with LRTI (ligament reposition/tendon interposition).
Patients with carpal tunnel syndrome that undergo the trapeziectomy with LRTI surgery frequently experience exacerbated carpal tunnel issues. So, it was decided to perform carpal tunnel release surgery at the same time.
I had both surgeries done on my right hand (my dominant side) on October 26, 2017. My hand was put in a soft cast that immobilized my thumb, and somewhat restricted the use of my fingers. The cast extended up my arm to about 3 inches below my elbow. They also gave me a sling to hold my hand up to minimize swelling.
After 2 weeks I saw the surgeon again. They took off the soft cast, took out the stitches, examined it, washed my arm, and put a new hard cast on. I will wear that cast until the Monday after Thanksgiving.
Having my right hand in a cast has been a real challenge. The soft cast covered quite a bit of my hand making it fairly useless. With the hard cast I have more usage, but I am still fairly restricted in what I can do. My wife has been my right hand, quite literally. She helps me with showering. My right arm is covered in plastic to keep it dry, and there are several steps that require her help to get the plastic on and secured. She also helps wash and dry the places I can’t reach with my left hand. Eating left handed is spastic and messy. I cannot hold a knife or fork in my right hand, so she kindly cuts my food up for me. She buttons my shirts. She thought through all of the issues I have dressing, and has purchased many helpful items: shoes that fasten with Velcro, elastic waist pants, shirts & jackets with big enough sleeves. Having her help me cope with the challenges has been invaluable. I could not have done much that I have without her help. Petting the cats with a cast is not very satisfying for either me or the cat. I cannot hold a pen or pencil, so no writing or drawing.
Aside from the difficulty to perform normal tasks, the cast is uncomfortable. Frequently it itches. A lot. Muscles under the cast twitch and occasionally cramp. Early on the incisions made their locations known with occasional mild pain, but that has subsided. They gave me strong pain killers, but I only took them for a day and a half. Generally the cast is a nuisance, not a devastation.
Ski season has started, and there is no doubt that the recovery process will negatively impact my ability to ski. While the surgeon, himself a former ski instructor, says that I can ski with the cast on; that is somewhat questionable. I must keep the cast dry, falling is contra-indicated, I cannot hold a pole in my right hand, coverings to keep my hand warm are difficult to devise, buckling my boots is challenging, and carrying my skis and one pole to the lift will be awkward at best. It all depends upon how badly I need to ski.
After the cast is removed I lose the protection it provides. Planting the pole impacts the very joint that was the focus of the surgery. No doubt I will have to ease my way back into ripping up the high-speed turbo-corduroy, and finding first tracks.