Unique procedure helps fight thumb arthritis

Doctors are beginning to treat thumb arthritis with a unique procedure, using tendons from the arm to heal the thumb when medication and therapy fall short.

Thumbs are an integral part of daily life, necessary to open jars, send text messages, and open doors. But two out of three postmenopausal women will suffer from arthritis in their thumbs.

Nancy McRay, an avid pianist, remembers playing her first note. “My mother just put music and front of me and sat me in front of the piano,” said McRay.

However, arthritis that developed in her thumb made playing impossible.

Stanford University School of Medicine doctor and surgeon Amy Ladd, versed not only in surgery but piano as well, was aware of how arthritis could cripple a player. “I understand the demands of an octave span and playing precision work,” said Ladd.

The cartilage between the thumb joint and bone was thinning in McRay, leading to the arthritis.

According to the American Academy of Orthopedic Surgeons, women are ten times more likely to develop this type of arthritis than men.

“The majority of postmenopausal women who are Caucasian or Asian will likely get this arthritis,” said Ladd.

If medication and therapy fall short on treating it, surgery was an option, with doctors cutting, fusing, or removing bones in the thumb.

Ladd took a different approach, taking a tendon from McRay’s forearm and putting it between the trapezium and CMC joint in her thumb.

"Basically, creating some sort of natural pillow for that joint to rest upon," said Ladd.

The surgery allowed McRay to take up piano once more.

Experts do not know the reason why post-menopausal women are more at risk for thumb arthritis but do know men and younger women can also get it, although it's much less common.

Ladd believes the next step is to develop implants that can be surgically placed in the thumb.

Research Summary:
REPORT #1753

BACKGROUND: Arthritis is a category of conditions in which the joints of the body are damaged. Over 100 different types of arthritis exist, but the most common type is osteoarthritis. This type involves trauma to, and infection or aging of, the joint. Other types of arthritis include rheumatoid arthritis, psoriatic arthritis, and autoimmune disease, during which the body attacks itself. Arthritis is the most common cause of disability in the U.S., affecting 20 million people who are often severely limited in their daily functionality. Every year, arthritis causes nearly 1,000,000 hospitalizations and close to 45,000,000 outpatient visits to health care centers. The causes of arthritis depend on the form, but can include injury metabolic abnormalities, hereditary factors, the direct and indirect effect of infections and a misdirected immune system with autoimmunity. Symptoms of arthritis include pain, limited function of joints, and inflammation of the joints, which is characterized by joint stiffness, swelling, redness, and warmth. (SOURCE: The Arthritis Foundation)

TREATMENT: The treatment of arthritis is a two-pronged attack, aiming to both relieve the patient of their painful symptoms and improving the functionality of their joints. Patients are often prescribed a combination of medications such as analgesics (pain reliever), counterirritants (pain-relieving preparation creams), nonsteroidal anti-inflammatory drugs (pain and inflammation reliever), disease-modifying antirheumatic drugs (prevent immune system from assaulting the joints), biologics (immune suppressors), and corticosteroids (inflammation reducer and immune suppressor combo). A physical therapy regimen is implemented as well, helping patients build up the muscles around their joints and improve their range of motion. Sometimes, splints or braces are recommended. In certain cases, surgical procedures may be warranted. (SOURCE: Mayo Clinic)

CARE: Those with arthritis are recommended to take it easy on their joints. Obese individuals should try to lose their excess weight, which puts a lot of pressure on their weight-bearing joints. Weight loss can also help arthritis victims to achieve greater mobility and a lower likelihood of subsequent joint injuries. In severe cases, assistive devices such as walkers, canes, and heightened toilet seats can help the patient with daily activity. If possible, exercise is important in keeping the joints limber. Any water activities such as swimming are ideal, because the natural buoyancy of the water relieves the weight-bearing joints of pressure. (SOURCE: Mayo Clinic)

* For More Information, Contact:

Hand and Upper Extremity Clinic
450 Broadway St. Pavilion A, 2nd Fl. Dept A26
Redwood City, CA 94063

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