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Pain after Trapeziectomy (Page 1)

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I had a trapeziectomy {removal of a small bone at the base of the thumb}last Tuesday 8th March. I expected some pain after anaesthetic wore off which Idid experience for a couple of days then all seemed to be well until 1 week after I started having throbbing pains in my palm and at the base of my thumb with pins and needles at times. I now have a constant ache. Neither my thumb or my fingers or thumb are swollen. Can anyone shed any light on this, I am in a heavily padded dressing which wont be removed for another week when stitches are removed. Any advice would be much appreciated. Hospital are useless!
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First Helper User Profile Gaelic
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replied March 16th, 2011
Especially eHealthy
sidarigirl,
A trapezectomy is usually part of an LRTI arthroplasty or some other arthroplasty for basal thumb arthritis. This can be a very significant procedure. It is not uncommon for patients to be in a cast for 6 weeks, followed by a removable splint for several more weeks. Every surgeon is different.
However, you state you still have a heavy surgical dressing on and it will not to be removed for a few more days. With this on, it can not be determined if you have swelling or another process going on at the incision site. The symptoms you are having can occur after this surgery, but with a dressing in place it's hard to tell exactly what's going on.
I would contact the surgeon directly and inform him/her of the symptoms you are having. It is not uncommon to have some swelling around the surgical site and then for the dressing to cause some compression. The compression causes pain, with numbness/tingling. The surgeon may have you do strict elevation (keeping the hand above your head at all times), have you remove the dressing yourself, or have you come in to to see him/her or one of his staff.
Again, contact your surgeon. He/she is in the best position to advise you correctly. In the meantime, elevation and gentle ROM of the fingers not inhibited by the splint can help greatly.
Good luck.
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replied January 19th, 2013
Trapeziectomy
Hi wondered if you can help? I'm struggling with my left had dont have a twitter acc.
I had a trapeziectomy on Tues - 4 day ago - it was on my right thumb and I am right handed. Although I', keeping my hand elivated most ot the time it is very swolen and I stil don't have any feeling in thumb, index finger and part of middle finger. I saw the surgeon on Wed - day after op - because the half cast dressing was very tight. He said I'd had local anaesthetic put in when stiching up wound. I now have a splint with velcro. Please can you tell me if this normal post op? Many thanks. Rosie
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replied January 19th, 2013
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Rosiejor,

You should not have any numbness, four days after surgery. Local anesthetic will not last that long (Marcaine, a long acting local, will usually last no longer than about 24 hours at most).

However, if you still have a lot of swelling, that could be putting pressure on the median nerve (which supplies the radial digits - the thumb, index finger, middle finger).

It is very important to keep the hand elevated above your head (yes way up in the air). Only lower it when you absolutely have to. Also, you should move your fingers as much as the splint will allow several times a day. It is very important to keep the fingers moving, or they will become very swollen and stiff. It is a lot harder to resolve swelling/stiffness, than it is to prevent it.

If you are allowed, you can try loosening the splint a little, to allow for some of the swelling. But, keeping the hand elevated all the time and moving the fingers will help a lot with the swelling.


But, if the numbness is not resolving at all, you should contact your surgeon. He/she may want you to see you or may have you loosen the splint. Again, you should not have any numbness, four days after surgery (from any local anesthetic). But, swelling can put pressure on the nerves.


Keep the hand elevated (above your head) and move the fingers. If the numbness is not going away, contact your surgeon.

Good luck.
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replied January 21st, 2013
Trapeziectomy
Thank you for your info. I was pretty sure it wasn't still the affects of the local anesthetic.
The swelling has gone down, but the numbness is still there. It feels like very tight elastic bands on thumb, index and middle fingers, I can bend them, but have no feeling in them. I'm keeping hand elevated, mostly resting on my shoulder, it's very difficult to keep it above my head, and constantly moving fingers. Have taken support off, but it makes no difference. Waiting to hear back from surgeon.

Thanks for your advice
Rosie
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replied January 21st, 2013
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Rosie,

Keep trying to contact your surgeon.

The numbness is most likely from the swelling, and he/she will probably just tell you to keep the hand elevated and move the fingers, but he/she should know about the continued numbness.

If you still have a dressing on the hand, the surgeon may want to see you to remove the dressing.

Again, keep the hand elevated as much as you can and move the fingers several times a day. Also, keep trying to contact your surgeon.

Good luck.
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replied March 17th, 2011
trapeziectomy recovery
I had a trapeziectomy on 1st february and am now 6 weeks post op. I also had a constant ache in the palm of my hand and I had a cast with bulky dressinf which was removed and stitches taken out at 3 weeks post op.
I think that "gaelic" in previous message is correct in saying tat itit is not uncommon for compression to cause this. I kept feeling that I wanted to stretch my hand but couldn't because of the cast! You will have lots of exercises and massage of the scar to do but please persist with this as it is cricial for the recovery of your hand function. I had exercises to do for 5 times a day and also to do massage for an hour a day in total. the massage can be done several times a day eg 6 lots of 10 mins which equals a total of one hour. I do hope that this has been of some help to you but you do need to check your symptons with the surgeon as they can best advise you. good luck.
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replied March 21st, 2011
Many thanks for the advice. Pain has subsided. Thumb is still a little swollen and is itching like mad. Roll on Wednesday when the dressing is off.
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replied March 22nd, 2011
Pain after Trapeziectomy
Am pleased that the pain has now subsided. Let me know how you get on when the dressing has come off. I'm now back at work but my husband is driving me to work as I'm still not ready to do so. It's a long recovery time. I can't wait to just get in the car and go. I'm now just wearing the splint for work but I still have to wear the night time splint for another 5 weeks.
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replied March 24th, 2011
Had the dressing removed yesterday and was given the same kind of splint I was using before the operation which has a metal bar that runs the length of the thumb. Was told that I didnt need to wear it at night! Hence I do not have a night time splint. Have a small plaster over the scar. Didnt have stitches removed. It was held together with strips. The inner dressings had to be soaked off which caused the most grief. Surgeon was pleased with the result however. So who am I to question it. Was due to see Occupational Therapy nurse today but could not change the appt time of 11.30 as when I checked my bus timetable (I dont drive)and live in a village outside Scunthorpe I would miss my connection home at 12.15 (have to get a connection from the hospital to bus station)next bus to my village is at 2pm. Would not get home until 2.45pm.Husband took time off work yesterday which is unpaid as he is on contract work. Taxis out of the question due to cost.I am waiting for a phone call from nurse to arrange a more convenient time.It is quite clear that your post operative care is far superior to mine. So much conflicting info. By the way I did wear the splint last night, purely for my own reassurance. Many thanks for your reply.
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replied March 26th, 2011
Sidarigirl
Sorry to hear about the problem with transport and seeing the occupational therapy nurse.
The ot nurse supplied me with the splints. Tha daytime one was a thumb spica and the night time one was a spacer which she said was to help stop the thumb from contracting towards the palm of the hand.
Before my ot nurse appointment I googled the internet and found some exercises for the hand which were the same that the nurse gave me. If you like I could locate them for you and give you the web address to look at.
I will be going to see the nurse again in about 10 days time to check on my progression and she said she will be giving me some thumb strengthening exercises to do.

I hope you managed to get an appointment with the nurse. Good Luck.
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replied March 24th, 2011
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sidarigirl,

Have the occupational therapist (OT) make up a plan of exercises you can do at home. It usually doesn't take a lot of fancy contraptions to do excellent therapy. The OT can provide you with some "Theraputty", which is a substance that comes in various stiffnesses for you to squeeze. It is nontoxic, but do not get it on your carpets. Moist heat is often recommended and OT's often use a paraffin wax bath. These small units can be purchased for home use or the OT can tell you how to use medicinal paraffin on the stove top.

As for the brace, use it as needed, especially early on. Sometimes surgeons don't quite recognize the patient's anticipation. Just make sure you do the range of motion exercises, because overuse of the brace can decrease motion. It will take some time to regain strength, but it will come.

Again, there is a lot you can do at home, and since you do not drive, it will be to your advantage in the long run. Hope the swelling in your hand has gone down. Good luck.

P.S. As for your incision, some times hand surgeons will put in buried, dissolvable sutures and "steristrips" on the skin. That way you don't have to have the stitches removed!
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replied March 26th, 2011
Thank you for your replies and support. I was told not to wear a splint at night, and dont have another. I took the plaster off the scar and put the splint back on but it is irritating the scar itself. I have resorted to putting a piece of cotton wool between the scar and the brace. Only way I can get any relief. Am due to see OT on Wed next week. I live in the UK and its obvious to me that things are done differently elsewhere. I do have instructions and diagrams on exercises from another UK source but until I see my OT I had better just do as they say. I have found out now that they were dissolvable stitches as there were only two steristrips holding it together. Swelling is starting to go down at the front of my hand only because I am still elevating it. I wondered if a heat wrap would make any difference or whether it would make it worse.
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replied June 14th, 2012
Trapeziectomy
Hi, How long do we wear the plaster of paris cast. It is driving me crazy. I was told they will change it to a fibreglass cast. I had my procedure done 1 week ago.
Virginia (South spam unapproved)
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replied June 14th, 2012
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veemac,

Sorry, but that is up to the surgeon. Some surgeons go with plaster for the whole immobilization period. Others use fiberglass, while others use a splint of Orthoplast plastic, and some don't use any immobilization.

Every case is different.

However, if you are still in a post-op splint made of plaster, that should be changed shortly.

If you are having problems with the plaster rubbing or causing discomfort, contact your surgeon to have the immobilization evaluated.

Immobilization, while it can be frustrating, should not be uncomfortable. So, if it is causing problems, call your surgeon.

Good luck.
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replied September 25th, 2012
Trapeziectomy recovery
Hi, just to say that when I was wearing the spica and like yourself, I put a piece of cotton wool inside - my OT told me to use a non adherent dressing instead and that was much better. She was concerned about the hygiene aspect while the scar was still healing.
I'm now ten weeks post-op and still experiencing some strange "pains" around my wrist, but hope this will all subside with time.
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replied March 27th, 2011
Dear sidarigirl,
Glad you have an appointment with OT next week.
I live in Hampshire in the uk so am surprised that you were told not to wear splint at night. Don't be surprised if your wrist as well as your thumb is weak. I am having to also do exercises for my wrist as I do not have much strength at the moment. I can just about manage to carry a mug of coffee. Anything heavier than this I cannot carry. I have stopped using the thumb spica during the day as I can manage without it. I also have muscle wastage which can only get better if I try to use my hand as much as possible to regain muscle and also more hand strength. If I don't hear from you I wish you lots of luck at your OT appointment on wednesday.
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replied March 27th, 2011
Hello petlamb, what is a thumb spica? Never heard of it!
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replied March 27th, 2011
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sidarigirl,

I'm not petlamb, obviously, but, ... a thumb spica is a type of splint (brace). It is a forearm based splint that goes distally (towards the thumb) and holds the wrist and thumb still (static). It is placed on the radial (thumb) side of the distal forearm and wrist. You probably used one before your surgery, as it is a standard splint for thumb disorders. Some surgeons will have the patient use his/her splint from before surgery, for a little while after surgery, until the pain has subsided and the muscles are stronger. You don't want to use the splint for too long after surgery, because you may not regain ROM and not build the muscles back up.

(Some surgeons will use what is called an opponens splint, instead of the spica. It is smaller, hand based, and less restrictive.)

The term spica means going between two parts of different sizes. So, the forearm and thumb (thumb spica), or the waist and thigh (hip spica). This is opposed to a figure-of-8, which goes between parts of nearly the same size, around the ankle or wrist.

Sorry, that's probably more than you wanted.

Hope your therapy is going well. Hang in there, it can be tough at first, but you should be getting stronger little by little.

Good luck.
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replied April 7th, 2011
I wondered how soon after a trapeziectomy one could have the other thumb done? Does anyone have any experience of this? I have just had the op. 14th March and am struggling a little bit still but would like to have the other one done sometime.
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replied December 21st, 2011
trapeziectomy
I had left trapeziectomy with suspension arthroplasty on 20 th June with excellent results. I have on 1st December had the same procedure done on my right hand. I am 3 weeks post op and wearing a soft splint at all times apart from washing and exercising. On both occasions I have been massaging the scar with E45 and I think that has helped as the scar on my left hand is almost invisible. Hope this helps.
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replied April 7th, 2011
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sorethumb,

The earliest that it should be done, is when you can take care of yourself using only the hand that was operated on first. That hand should really be completely rehabilitated before considering the second operation. There are circumstances where both hands have been operated on at the same time, however, these are extreme cases. And, help had to be arranged ahead of time, because you find out who your real friends are when you can't wipe certain areas of the body.

Everyone is different. Discuss the timing with your hand surgeon. Then, depending upon both of your schedules, a surgery date can be arranged.

Hope you are doing well. Good luck.
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replied April 8th, 2011
Thank you very much for your reply which was very helpful. As I am still having quite a bit of stiffness and bruising in my fingers and thumb it is certainly making me think twice about having the second one done at all although it, too is painful. I find that at the end of the day my fingers and thumb on the operated hand are very tired and stiff although I am using them quite a lot in the day. When I am not using it I try to elevate it. I have had a bi-lateral mastectomy many years ago and wonder if the discomfort could also be due to lymphodema which I have had in a mild form since then. I have also had to have my cast changed three times after my initial dressing which was on for nearly two weeks (removed two weeks ago),as they were causing 'nerve' pains down my arm because they were too tight and also apparently the thumb wasn't set correctly until last week. I haven't seen the surgeon since the op on 14.3.11 and am not seeing him again for four weeks so am slightly worried in case the discomfort I am feeling isn't normal and I would very much appreciate your thoughts. At least the arthritis pain has gone but I just want it all to be right. Perhaps I am being too impatient?
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replied April 8th, 2011
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sorethumb,

Orthopedic surgery has been described as the worst of the surgical pains, since it involves the bones (which are not "dead"). They are a very living tissue and actually have a lot of nerve fibers. You do need to be patient, and not let what you are feeling during the surgery and healing process taint what you may feel once the "work" is done and your function is so much better than before. I have heard so many patients say exactly what you are, then, several months later come in, being so excited that they are doing activities (ie sewing, hobbies, writing, etc) that they had not been able to do for so long. Wait to see what your final outcome is; which is another reason to wait till it has completely healed before you consider doing the other. Also, as everyone says, everyone is different. Some patients can get to their final function within a few months (ie 4 to Cool, whereas others can take quite a long while (ie 12 to 18 months).

Of note, since you have problems with lymphodema, keeping a cylindrical cast on can become quite difficult. You will experience size changes so often, that changing the cast everyday or so, becomes unrealistic. You might speak with the surgeon or his/her assistant, about your history and the resulting lymphodema, and see if they can use a splint (which is not cylindrical and therefore adjustable), instead of a cast.

Good luck in your rehab. Keep up the fight. It will get better, day by day.
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replied April 9th, 2011
Thank you very much for your help and encouragement. I feel so much happier about it all now and I will talk to my surgeon about the possibility of a splint for the next one, if not this one. Thank you again..
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replied June 16th, 2011
After I last contacted you I have had my plaster removed and then unfortunately fell badly the next day which resulted in a sprained wrist and considerable discomfort in my hand. I was told that this would take five weeks to improve and that seems to have been the case. I have worked hard to exercise my hand, fingers and thumb and now am doing most activities. My thumb is now slowly getting more movement in it and becoming stronger although my fingers and thumb often feel swollen and stiff. Sometimes I feel that I have nearly solved one problem, pain in the thumb joint and yet have created other ones; pain in the wrist, fingers and numbness and loss of power down the side of the thumb. Now I am more reluctant to consider the operation in the other hand which is my right hand and yet the pain in that one is quite severe at times. I am due to see my consultant in three months time to assess the situation but as I am an artist I am very nervous of using the fine movement in my hand. I am sorry to sound so negative but you were so helpful previously so I was wanting to ask you whether you thought that it was normal for me to have these symptoms still and whether they will continue to improve.
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replied September 26th, 2012
Although I had my surgery several weeks ago now, I'm still experiencing odd feelings in the wrist and even my forefinger. I've particularly noticed a sharp pain when I first wake and mover the hand quite normally. I'm just hoping that "several months" will put this right as I have yet to have my other hand done, including fusion of the thumb joint and a replacement knuckle of my middle finger!
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replied September 26th, 2012
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Mabs19A,

Welcome to eHealth and this thread in particular.

Just a note, it is very difficult for other members to find a new post, when it is placed in the middle of a multiple page thread. The messages you are replying to are over a year old. The more recent postings will be at the end of the thread, on page three.

So, you will probably get more responses to your messages if you post at the end of the thread (where members who just had surgery are posting), or start a new thread of your own.

As to your stiffness in the morning, that is very common after surgery and injury. It is actually a hallmark of inflammation. Inflamed tissue will be its stiffest and sorest after a period of rest/immobility, such as after a night of sleep, and will usually feel better after a hot shower and some gentle range of motion.

Surgery for basal thumb arthritis is an extensive procedure. It is not uncommon for patients to take as much as 18 months to achieve full recovery. Most patient do not take nearly that long, but it does take time and effort to regain "normal or usual" function.


Again, you might want to look at some of the postings at the end of this thread. There are a few members who are at about the same stage you are in their recovery. Most likely, they would like to hear how you are doing also.

Good luck.
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Users who thank Gaelic for this post: Mabs19A  MSSurvivor22 

replied September 30th, 2013
Sorethumb:

I have just found this site and am wondering how you are getting on after your surgery two years or so ago?

I too am an artist and have been offered a trapeziectomy. I am also facing surgery on both my feet. I am very nervous about possibly losing the ability to control what I do. Not being able to draw is not an option for me. Are you now able to use your hands for artwork? Has it helped or hindered you?

Lorrinet
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replied June 17th, 2011
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sorethumb,

Glad you are doing somewhat better. Yes, it is difficult when you are doing well, to set yourself back with an accident. But, as they say, this too will pass.

Surgery for basal thumb pain, no matter what exact procedure is used, can sometimes take quite awhile to completely get over. In some patients, it can take as long as 18 months, before they feel that they have finally reached their endpoint. Of course, not everyone takes that long, but some do.

If you are concerned, and your operated hand is still rehabing, you can always delay the other side till you feel comfortable. Unfortunately, it is up to you to decide if you want to go through with the surgery. You are the only one who knows how bad the pain is and how it affects your daily activities. You know what is was like going through everything, so you basically have to determine if the pain is bad enough to go through it again.


Hope you continue to progress, so you can continue doing your artistic endeavors. Good luck.
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replied June 29th, 2011
Trapeziectomy & LRTI
Hi, I am due to have Trapeziectomy & LRTI in 4 weeks time. I am concerned about the recovery period. There would appear to be differing opinions even between surgeons. I have been told 4 weeks in a "backslab" cast, then - get on with it. No splinting, Physio etc. My profession involves alot of physical tasks, lifting, moving & handling patients & equipment. I have informed my boss that I will be off work for at least 6 weeks, but have since been told (by 2 other surgeons) - at least 8 weeks, and - you won't be able to come back for at least 12 weeks, this is very confusing and worrying, in this current climate of "attendance management" I am worried about taking any time off work, but by the same token I am worried about returning to work, only to have to go off sick again. Can anyone shed any light on a realistic recovery (ie, ability to use hand normally) period following the 4 weeks in a cast?

Pain wise, I cannot take NSAIDs due to gastric problems so will be relying on paracetamol, & elevation with the occasional 30/500 co-coda mol, will this be sufficient?
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replied June 30th, 2011
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Arthritic,

Unfortunately, it is quite variable. The main reason being is that there are several different procedures used to treat basal thumb arthritis (and surgeons perform the same procedure differently). Also, we tend to lump everyone together, rather than separating them by how severe the arthritis is. Someone with Eaton stage II most likely will do much differently than someone with Eaton Stage IV.

Immobilization time usually depends upon how good the patient's tissues are. If they are nice and strong and a good repair of the capsule can be achieved, then a transfixing pin is not necessary and a splint for 4 to 6 weeks is all that is needed. But, if the tissues are friable, then the repair has to be protected for much longer.

If a patient is going to do a lot of heavy activity after an LTRI, we usually protected him/her with a thumb spica splint (made of orthoplast) until he/she had regained full ROM and strength (usually about 3 months).

In general, most patients can get back of activities of daily living by 6 weeks and most other activities by 12 weeks. But, again, it is so variable. Some patients, usually the older ones, tend to take quite a while longer, even up to 12 to 18 months before they felt that they had reached the final result. They were not incapacitated until then, they just took that long to gradually get better (but, they usually also had been having symptoms for decades before having the surgery).


The best person to ask about this is your surgeon. He/she is the one that will be handling the tissues and thus, will know how much stress the repair can take.

Good luck.
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replied August 11th, 2011
Hi Gaelic, thanks for the info re: recovery. I had the surgery - trapeziumectomy & LRTI on 27 July, so now 2 weeks post op. I have a volar slab & bulky bandage. Surgeon said he found osteophyte & a loose fragment + cartilage completely worn away. The surgery was performed under a block. For the initial 5 days there was no pain as such just discomfort & swelling, mainly at night. Then the bandage loosened & I felt as if the slab was moving causing friction against the scars which resulted in burning sensations. I went to the dressing clinic where it was re bandaged but the wounds weren't checked, blooded gauze & slab kept in place. My fingers are free & I wiggle them to keep the tendon moving but anything more than that ie using them to stabilise clothing when dressing or attempting to moisturise my other arm after bathing is really sore. The pain in my thumb now feels deep & stabbing, I need to take 30mg codeine & paracetamol every 4-6 hrs & despite stomach problems have taken 100 mg diclofenac for the past 4 days (stopped now for fear of further stomach problems). I have 2 more weeks before the cast comes off ( stitches are absorbable) am worried whether all these pains/soreness are normal, don't want to appear to be a wimp & bother my doctor. Should I , a: be able to use my hand, and b: risk damaging anything , ie, tendon now it has been stripped in two?

I am also worried about when I can return to work, I guess I will have more idea when the cast comes off. I am worried about consequences if it is likely to be more than 6 weeks.

Also, I can set my clock by my hand swelling, by 8pm every evening it feels as if I have a blood pressure cuff attached & is really uncomfortable.

Sorry to moan, can you give any reassurance that what I am experiencing is normal?
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replied August 11th, 2011
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Arthritic,

If you are having soreness under the dressing, and the wound was not looked at the first time, it may be necessary to have the dressing completely taken off.

The burning pain you mentioned is often the first sign of a "hot spot", which is a pressure point, that can turn into a pressure sore (cast sore). Since the slab was not taken off from the time of surgery, it may not be fitting exactly correctly now that you have swelling and it has been rebandaged. You should not be having to take opioid pain medicine just because of the dressing.

If the clinic does not want to change the dressing, contact the surgeon. It is taught in residency training that all complaints of pain under a bandage or cast must be taken seriously, with removal of the bandage/cast all the way to the skin. That is the only way to actually make sure the skin/wound is okay. Sometimes, technicians do not want to disturb a "surgical dressing", because some surgeons get real picky about someone else changing their dressings. But, that is not an excuse to not do the right thing.


As to when you can return to work, depends upon what you do exactly. Strong grasping and manual labor will take longer than a sedentary desk job. And, of course, everyone is different. It takes about 6 weeks for the soft tissues to heal strongly. Though, range of motion and light activities can usually be started before that. Like you stated, you will know more when you see your surgeon and be sure to ask exactly what he/she wants you to be doing, and what to avoid.


Again, you should not be having that much pain under your cast, especially since you were doing so well right after the surgery (the first 4 or 5 days are usually the worst.) We usually changed the surgical dressing around 7 days post op because, by that time, the dressing has compressed and soaked up moisture from sweat, that they usually didn't fit too well anymore. And, since you have had to have it addressed already, it probably is not fitting you too well.

Do not feel like you are bothering anyone, you are not. It is their job to take care of issues like this. And don't let some underling dismiss you, you are having pain, and that needs to be addressed.

Good luck.
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replied August 14th, 2011
Gaelic, Thankyou so much for your advice. I was just worried about being a nuisance or appearing to be a wimp, but I took your advice & got an appointment to see my surgeon the next day. He removed & reapplied a fresh cast with more padding. I was relieved to see that the wounds looked to be healing well. The cast had moved & was compressing the area under my main scar, this had a blue line of bruise exactly where the cast had been digging in. Apart from that he appered to be pleased with the result so far, so I am reassured.

I have now stopped the codeine & am managing just on paracetamol.

The new dressing is smaller & I am surprised at the muscle wastage in my lower arm after only 2 1/2 weeks. So, I guess there will be some hard work ahead to rebuild the muscles.

Anyway, thanks again.

A
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replied November 8th, 2011
Trapeziectomy + LRTI +CRPS
Hi Gaelic,

I am now 15 weeks post op Trapeziectomy & LRTI. You may remember I was having problems with swelling & burning pain under my cast which I had adjusted once & changed once. The cast was removed at 4 weeks. The scars had healed well, but the swelling & burning pain continued until by 7 weeks post op I requested to see my surgeon. He examined my hand, commented on the swelling, burning/stinging pain, mottled/red colouring & excessive hair growth over the thumb area and diagnosed CRPS Type II. Although horrified, I was also relieved to have a diagnosis & be assured that I was not going mad or being soft.

I am now having weekly Physio, taking Gabapentin & trying to use my hand (it IS my dominant hand) as much as possible. I cannot tolerate heat, it brings on swelling, burning, stinging & itching. My thumb has contracted in towards my palm the skin in thickened & fibrosed near the palm. I have bony/tendon nodules on my finger joints, which are very stiff. I CANNOT tolerate sleeves or any brushing/stroking movement across my thumb, or both sides of wrist. My wrist appears fused, flexion is very limited in either direction.

My question is, what has caused this CRPS? I have been diagnosed as CRPS Type II, which my surgeon says can just occur following surgery, but is very rare, no-one knows why it occurs, he has only personally ever had one other case. From what I have read it is the result of "major nerve damage". Had this been caused by the surgery? I am aware that the radial nerve is retracted during surgery, has it been damaged as a result of retraction? My surgeon did not have a surgical assistant, only a scrub nurse, who acted as assistant

I am confused, that on the one hand I am told that it is a complication I must be predisposed to and it has an unknown cause. But then read that it is caused by major nerve damage - what caused the nerve damage?

If you can help to explain I would be very grateful.

Thanks,
Arthritic
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replied November 8th, 2011
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Arthritic,

Sorry that you have developed CRPS.

I am a little confused though. Usually, the type that just occurs, for no apparent reason (though usually seen after some type of trauma or surgery) used to be called reflex sympathetic dystrophy (RSD), but was renamed Chronic Regional Pain Syndrome, Type I, several years ago.

In this type, there is no know nerve injury. It is believed to be from the sympathetic nervous system getting turned on for the healing process to occur, but for some reason, does not get shut off. And, it basically goes into overdrive.


But, in CRPS, Type II, the is a known nerve injury. In these cases, a large peripheral nerve has either been stretched severely or has been cut/torn apart. You see cases of Type II in patients such as those who have had a hi-velocity gunshot wound to the limb (like in the military/police) and as a result one of their nerves was damaged. They too have the burning pain, increased pain with light touch, etc, but it is usually limited to the distribution of the parts of the limb innervated by the nerve branch(es).


So, I think someone may have the terms mixed up.


You are more likely to have CRPS I, like the old RSD. This type is rare, but not unheard of. It is sort of the bane of the hand surgeon. Because it is frustrating for both the patient and the surgeon, because, it just happens. It has not been liked to any particular personality type, body type, or anything. It would be so nice, if it could be. Because we could then at least warn patients that they may be a set up for it. But, right now, the only time we can tell a patient that he/she is a set up for RSD, is if he/she has had it before.

A long time ago, it was felt that patients who developed CRPS I has weak wills, had low pain tolerances, were depressed/anxious, etc, etc, etc, But, this has not been borne out. There has been absolutely so correlation with any of these.

If just happens.

The good thing is that it was caught early. Cases of CRPS I that are caught within 6 months of onset have very good outcomes. These patients usually respond very well to treatment and get back to pretty normal lives.

Patients that are not diagnosed till more than a year has gone by, do not do as well. Some of these patient may develop life-long problems.



It is possible that you have a Type II, if the surgeon has told you that he cut a branch of the radial sensory nerve (RSN) for example. And, it is not all the rare to get one of the branches of the RSN, because one of the major one goes right over the area on the radial side of the distal forearm/base of the thumb.

When any surgery around the base of the thumb is done, the surgeon really has to be on the look out for that pesky RSN and its branches. In some patients is can be irritated very easily. (Which is why a neuroma of the RSN is often called a "handcuff palsy". Some prisoners complain of pain/tingling in their thumbs after having their hands cuffed behind their back!!)

In fact, I can stroke across by radial/distal forearm, about 3-4 inches up from the wrist crease, and cause a tingling sensation across the back of my forearm/wrist/hand. My RSN comes out from under the brachioradialis at that point and can be irritated. I have trouble wearing tight sleeves at that area. But, anyways.




About the only difference in treatment between Type I and II, is that in some cases of Type II, the nerve ends can be freshened up and either repaired primarily or grafted. It a neuroma is present it can be resected. But, otherwise, they are treated basically the same.

Yes, it is a bad thing to have and it takes a lot of time, energy, effort, etc to get over, the only thing you can to is keep working and not give up. Again, this is also very frustrating to everyone, because there only so much the physician/therapsy/psychologist/family, can do. And the rest is up to you.

And with an attitude that says this: "Although horrified, I was also relieved to have a diagnosis & be assured that I was not going mad or being soft." you will probably do very well. 90% of getting over CRPS is having the right attitude about the situtation, and basically you telling yourself that you will get better.

Patients who go down this tract seem to do a whole heck of a lot better, than those that sit around and say why did this happen to me? and, who sit around waiting for someone to help them, rather than attacking the situation every way they can.

It is still hard for everyone. But, keep your spirits up. You now have something to attack.

Again, you might ask your surgeon is he really means Type II. And if he does, then ask which nerve was injured? It may be that he just misspoke and did really mean the Type that is the new name for RSD.


Good luck. Hang in there. You can get over this. And you will!!!
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replied November 24th, 2011
Hi,
I had a trapeziectomy and LRTI on 14 Oct. I was 2 weeks in a backslab followed by 2 weeks in full cast.When plaster was removed I was told just get on with it. No splinting or physio.The scar is very painful, particularily in one area. I have burning/stinging sensation in the whole area and cannot bear any touch eg sleeve or even a breeze.Initially I felt I was making progress with regaining movement etc but now I feel my thumb,fingers and wrist are getting stiffer. I am trying to do most activities as it is now almost 6 weeks post op.I am a nurse and need to get back to normal and work, sooner rather than later.Maybe I am being unrealistic.Any advice would be greatly appreciated.
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replied November 24th, 2011
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imfedupwaiting,

I think you are being a little fast on expecting to be back from this surgery.

When an LRTI used to be done, the CMCJ was pinned for a minimum of six weeks (of course the wrist was in a thump spica cast for that time). Then the patient was placed in an orthoplast (custom formed plastic) splint for a minimum of another 6 weeks. During that time they were allowed to start doing range of motion and strengthening out of the splint, but were to wear it at all other times. Then at 12 weeks we allowed the patient to begin weaning out of the splint. It usually took patients another 4 to 6 weeks to get totally out of the splint. And we told patients that it could take up to 18 months before a final outcome might be known.

But, then several years ago, some research came out that stated the pinning was not necessary and that just a short immobilization time was all that was needed. So, most hand surgeons are now taught this method.


But, an LRTI is not a simple little knee scope. There has been a lot of trauma to the area, which has to heal. In most patients that takes much longer than a couple of weeks.

At just 6 weeks out from surgery, that is barely at the limit for physiologic tissue healing (ie scar formation). Let alone any time for rehabilitation.

The burning pain may be due to an entrapped skin nerve, forming a neuroma. That can become disabling is some patients.


It is also very concerning that you were doing well, then started to go backwards. Having stiff fingers after hand surgery is not a good thing. If you are still working on your therapy, yet you are getting worse, you need to contact your surgeon for an evaluation. One thing you do not want to develop is complex regional pain syndrome I (formerly called RSD - reflex sympathetic dystrophy).

Call your surgeon for an evaluation. You may need to be in a splint for work at least. Hope you do better soon. Good luck.
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replied November 26th, 2011
Hi Gaelic,
Many thanks for your advice. I telephoned my surgeon yesterday. I could only speak on phone as to visit is a 2 hour drive and would need planning etc. Anyway, he more or less said what you did. I am being impatient. He advised me to take it slower and rest my hand more.He faxed a prescription for Lyrica (pregabalin) 50mgs B.D for the nerve pain which he thinks will dampen down the sensitivity. I'll give this a go and see how I get on. I'll post an update soon.Again many thanks for the advice.
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replied December 20th, 2011
Hi Gaelic, I am looking for your advice once again. I have indeed developed a very painful neuroma.Even after 2 dose increases to 150mgs B.D the medication had little to no effect except to make me feel like a zombie and I felt if it had been increased any more I would have been unconscious. My Surgeon told me yesterday I now need surgery to resect this neuroma. I was upset and shocked to hear this so didn't ask anything about the surgery which is planned for 20th Jan. All I remember hearing is 'it wont be as bad as the first surgery'. Can you shed any light on the procedure and what to possibly expect.Many thanks and Merry Christmas.
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replied December 21st, 2011
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imfedupwaiting,

If you look at the post just below this one, I think it covers most of what you are asking.

A neuroma excision is pretty simple, as surgeries go. About the only hard part is actually finding the nerve ending. But, that usually isn't really that difficult, since the nerve ending is usually pretty good size. It is actually a little ball of nerve tissue.

Again, once the nerve ending is found, the surgeon dissects it away from the surrounding subcutaneous tissue and buries it in the soft tissues.

Occasionally, if the surgeon is worried that the neuroma may come back or it is in a very superifical area, he/she may actually put the end of the nerve into a hole in the bone. This is a little bigger operation, and not always necessary. Usually, just cutting off the ball of nerve tissue on the end of the nerve, then burying the end is all that is necessary.


And, yes, this is a much easier operation than the first one. You should notice a relief in the electrical shock type of discomfort right off the bat. Except for the discomfort from the small incision, that is about all there is to this procedure. Most patients feel that it is well worth going through.

Hope you do well with the neuroma excision.

Good luck.
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replied December 21st, 2011
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imfedupwaiting,

Sometimes, when a patient has a neuroma and the surgeon is considering taking it out, the surgeon will sometimes inject the area around the neuroma with a tiny amount of local anesthetic. If the anesthetic takes all or the majority of the pain away, then the surgery should probably be a success. So, some surgeons will do this just to see if it will works. But, it is not necessary.


Excision of a neuroma is usually fairly easy, as surgeries go. The surgeon taps over the area, till the location of the neuroma is narrowed down. The area is numbed up with some local and the incision made eight over the neuroma. The neuroma is identified and dissected away from the surrounding tissues.

Then, there are a couple of ways to deal with it. In some cases, the neuroma is excised, and the nerve endings are buried deep in the muscle tissue. And in some cases, especially when it is a repeat procedure, a small hole is drilled into the bone and the nerve ending is fed into the hole, and is sutured in. In that way, the ending cannot be tapped on or hurt.

The small skin incision is closed and the area is dressed.


That's about all there is to it. The recovery time is pretty quick. And vast majority of patients think is was well worth it.

These usually work very well in taking way the sharp electrical type pain.


So, when you see your surgeon again, you will have some questions to ask him/her.

Good luck.
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replied January 6th, 2012
Gaelic,
Sorry for delay in thanking you for your reply but my computer crashed over Christmas.Your information has really put my mind at rest. Much appreciated.
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replied January 18th, 2012
Hand surgery
I'm waiting for this surgery and am now petrified...do most of these proceedures go by uneventful and I'm worried over nothing or is all the above common place??? If so, I'm backing out, please advise.
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replied January 18th, 2012
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Pinkwizard,

The vast majority of these procedures go very well and the patients are very happy with the results. If there was not a high success rate, the procedure would not be done.

You have to remember, that patients that do well, do not post to forums. So, there is a very skewed population on the forums. Basically, you only hear about those who have some problem (actual or perceived).


However, you should discuss the procedure with your surgeon. Tell him/her that you are apprehensive and would like to know the usual post-op course. Every surgeon has his/her own protocols, for how long the surgical dressing is left on, whether or not a cast is used, some surgeons use a surgical pin to stabilize the joint while others do not (which would usually be removed in the clinic), when occupational therapy is usually started, etc. Ask whatever comes to mind, whatever you want to know.

This is a fairly "big" operation in terms of hand surgery. It is not a simple mole removal. You will have some discomfort after the procedure, but this is usually easily taken care of with oral pain medications. You will have to do therapy (at home or formal) to get your motion and strength back.


So, again, this is a very successful procedure, that helps a lot of patients. But, there will be some discomfort after the procedure (just as there is with any operation) and you will have to put some effort into your recovery. It is your hand, and the more you work on therapy, the better the results.

Speak with your surgeon and anesthesiologist. Ask any questions you want answered.

Good luck.
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replied January 19th, 2012
Many thanks, hopefully all will be OK, will be back on-site to let you know....probably around late March
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replied February 6th, 2012
Hi Pinkwizard,
I just had the surgery done 3 weeks ago.
The first 2 weeks were the toughest. Once the swelling goes down, it gets a little more comfortable. Just remember to take it real easy and rest and elevate.
Sew or attach 2 pillows together and put your hand inside to help prop it up when laying down. You can find pics on how to do this on internet.This made it easier too. Very important to keep up with meds every
4-5 hours to control the pain. I took TRAMADOL on top of ALEVE which was recommended by hospital & it worked!When I had a partial Trap. done 2 years ago, the doc didn't advise this a it was horribly painful.
Still in recovery but I can type with onehand. GOOD LUCK!
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replied February 25th, 2012
I am waiting for Trapeziectomy with ligament reconstruction on my right thumb.Has anyone heard of any long term problems?I have been reading on the net-maybe not a good idea- and would really appreciate to hear from all of you who have already gone throught this.When can I expect to be able to work again? Any input would be very gratefully received .I'm really worried
Thanks
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replied February 25th, 2012
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paininthumb,

Yes, you do tend to get a skewed impression of the results of surgeries when looking at forums on the internet. Usually, patients who do well are out living life and are not posting on forums. It is usually only those that have a problem (perceived or actual) that post.


As to healing from an LRTI, it is actually quite personal. Some patients do very well, and are back to full activities in around three months or less. But others, take a long time, as much as a year or more till they are back to full activities.


The post-op protocols also varies from surgeon to surgeon, and how things go at the time of surgery. It is very important the the joint capsule of the CMCJ (carpometacarpal joint) heals solidly. If it stretches out or becomes loose, that will allow the base of the metacarpal to sublux (move out of joint). That would greatly affect your pinch and grasp ability.

So, some surgeons actually place a surgical pin across the joint for several weeks. Others just use a cast for 6 weeks or so. Others use a cast for a short time, then go to an OrthoPlast splint. Most will have the patient avoid pinching activities for several weeks, so as not to stress the CMCJ.


You should speak with your surgeon about his/her post-op protocol, so that you have an idea of how long you will be immobilized.

Once the immobilization is discontinued, then you will need to do therapy to regain your strength and flexibility. Some patients can do this on their own, others will need formal occupational therapy.


But again, some patients can do quite a bit while still in their cast, while others are pretty helpless. Some get back to full activities quickly, others take over a year. It is not really possible to tell your exactly how you will do.

You know your own pain tolerance and how well you put up with discomfort. There will be some pain right after the surgery. This is usually easily treated with oral pain medicine. And, you will have soreness when you start therapy. A lot of getting back to activity is being able to tolerate the discomfort and still work on the necessary therapy.


Good luck on your upcoming surgery. Again, be sure to ask your surgeon about any questions your may have.
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replied February 25th, 2012
Pain after Trapeziectomy
Hi Gaelic,
Thanks for this.Very helpful.It's actually very helpful knowing others have gone through it who I can "talk" to
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replied June 13th, 2012
Hi, I have just found this forum and find it very useful.
Eight months ago, I had a prosthesis inserted in my thumb, but unfortunately it was unsuccessful, so a few days ago I had the prosthesis removed and had a LRTI.
My question is:
Are there likely to be any complications due to the fact that I had an artificial joint removed first?
Thanks in anticipation.
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replied June 13th, 2012
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brigamard,

The chances of having complications are always a little higher in cases where there have been more than one surgery. However, it is not a given.

Your question is kind of broad and you do not state why the first surgery failed. Was it due to the joint subluxing (not staying in joint), infection, constant pain, loss of motion, etc, etc?

So, the reason for the failure may play an important role in how well your recent surgery does. For example, if the first joint failed due to subluxation, because the capsule was not competent, then that could still be a problem with the LRTI.

But, as stated, complications and/or failure are not necessarily given. The second surgery is always more difficult and the surgeon has to deal with scar tissue and possible loss of certain structures that would have been nice to have to work with.


So, you have been through the rehab once before, so you sort of know what to expect. Usually, after a redo, surgeons tend to be more conservative and may immobilize the joint for a longer period of time. So, don't be surprised.


You should speak with your hand surgeon, about the specifics of your procedure. He/she is the best source for information about your surgery.

Good luck. Hope that this procedure works well for you. The LRTI is a tried and true procedure (at least for the inital surgery that is).
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replied June 13th, 2012
Trapeziectomy LRTI
Hi Gaelic and thanks for the quick response.
I should have said that two months after the first op, my surgeon found a hairline fracture in the bone that the capsule was seated, although this did heal and disappeared eventually, the pain was still causing a problem.
My surgeon decided that because I was in so much pain, and had restricted movement seven months or so after the first op, that it would appear that it was unlikely to improve.
After the removal of the prosthesis, he did say that he was surprised at the amount of arthritis he found.
Could this be due to the fracture, and would it appear in just seven months?
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replied June 13th, 2012
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brigamard,

It is a little confusing about the arthritic changes, as the surgery is done to remove the arthritic joint at the base of the thumb. Was it arthritis is some of the other joints in the area that he was speaking about?

Depending upon the type of artifical joint prosthesis used, the general way the surgery is done, is to remove the joint (the end of the bones and the arthritic cartilage covering) and replace it with an artifical one. Again, there are several types of prosetheses, from one that looks like a miniture knee joint prosthesis to one that is just a sphere which is placed between the bones. But, in any case, the arthritic joint is gone, it is surgically removed.

But, in the placement of the prosthesis, usually the who trapezium is not removed, so the joint between the trapezium and the scaphoid/trapezoid (the STT joint) is still there. Where as in an LRTI or trapezectomy, the whole trapezium is removed and as such both the CMCJ (the carpometacarpal joint) and the STT joints are removed. (LRTI stands for Ligament Recontruction with Tendon Interpositional arthroplasty. Meaning that the beak ligament, yes like the beak of a bird, is reconstructed using a tendon from the forearm, and the remaining tendon is rolled up and placed in the space where the trapezium used to be, to act as a shock absorder and to help maintain length.)

So, it may be that the surgeon was speaking the the arthritic changes in the STT joint. This is not uncommon to have, in advanced basal thumb arthritis. The degenerative joint disease is usually not confined to just the CMCJ. Thus, the arthritis was probably there (at least in some capacity) when the first surgery was done. It could have progressed after the surgery, as more stress may have been placed on the joint. This could also be a reason for your continued pain.

A nondisplaced fracture (also called a hairline fracture) should not cause any significant problems, since the bones and joint surface remain in anatomical alignment. But, again, you may have already had some DJD in the STT joint, and when the pain in the CMCJ was taken away, it reared its ugly head.


This is one reason that many hand surgeons prefer the LRTI over the joint prosthesis, as it adresses both the CMCJ and the STT joints, all at the same time.


So, hopefully, the LRTI has taken care of the problem and you won't have the continuing discomfort. Again, your surgeon may have to immobilize you for a little longer, to allow the capsule (the envelope that surrounds the joint, providing support and holding in the joint fluid) time to heal properly. If the capsule is not competent, the joint can sublux (move out of correct the position). The capsule is very, very important to the stability of the base of the thumb. It contains some of the ligaments stabilizing the joint.

Some surgeons even place a surgical pin across the joint while it is healing after surgery, just to be sure. Others just use a cast, followed by a splint. Recently, there has been a trend to use the pin less and reduce the amount of immobilization time. But, this is in primary LRTI, not redo's.

Just don't be suprised if the post-op therapy goes a little slower. If not, then great.


So, again, hopefully, all of the DJD has been adressed, that the capsule heals nicely, and you get your function back soon.

LRTI's are basically done for pain controll, not function. But, in most cases, if patients' pain is controlled, their function will increase.

As to getting back to "normal" activities, we used to tell our patients that may take as long as 18 months. This is not to say that you would be laid up for that long, but that it may take that long before the final outcome is known. Most patients were back to usual activities around 5-6 months. But, some were a little slow, taking a lot longer than that.


Good luck. Hope the LRTI does the trick. Wishing you the best.
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replied June 14th, 2012
Hi Gaelic
The surgeon spoke to me about the arthritis found shortly after I came round from the anaesthetic, so I probably did not take in what he was telling properly.
I will be seeing again in ten days time, so I will ask him to clarify what he meant.
The prosthesis was pointed at one end, with a ball on the other end.
Thanks
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replied June 14th, 2012
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brigamard,

Okay, with that type of prosthesis you could have still had some arthritic changes in the CMCJ. With that prosthesis, usually, the end of the metacarpal bone (the long one) is taken off to place the spike up into the medullary canal of the metacarpal. The trapezium is basically left alone. The capsule is then close over the prosthesis. The soft tissues are closed and the hand dressed.

So, it is possible that you still had arthritis in the carpometacarpal joint (CMCJ), since the whole joint is not removed.

Hopefully, the LRTI will take care of that problem. With the LRTI, since the whole trapezium is removed, so are the joints. So, no joints, no bones to rub against each other.


Good luck, hope this surgery does the trick and you can get back to the activities you want to do.
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replied June 15th, 2012
Hi Gaelic
That certainly clears things up, as I didn't realise that the trapezium is left in place, I just assumed that it would be removed to make room for the prosthesis.

I know it's only a few days since I had the op, but apart from the fact that the wound feels a bit sore under the cast, everything feels great so far.

Thanks for the great advice and detailed explanation, as to what is involved in these types of operations.
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replied June 16th, 2012
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brigamard,

No problem. There are so many different types of prostheses for basalar thumb arthritis, and many different ways to do the operation.

That usually tells you, that the hand surgery community has not yet found the one prosthesis that works the best. They keep trying different things.

The LRTI has been around for a long time, with very few changes over the years. That, again, usually tells you that it works pretty well.

Hopefully, this will take care of your pain. Good luck with your upcoming rehab. Wishing you the best.
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replied March 19th, 2012
I had my operation 3 weeks ago.Thick padding on for 36 hours, then as i was in so much pain, it was reduced to a thermoplastic one.
In hospital i was on 10 mls oromorph 2 hourly, paracetamol and dihydracodine 4 hourly.
Then readmitted for i v antibiotics 5 days post op.
Went back 2 weeks later for pain, removed sutures early as reshaped splint was digging into suture line.
Added in amitryptlline at night, but only knocks me out, does nothingg for pain.
Back last week and given soft elastic thumb and arm splint, but squeezes arm which increases pain even more.
Still taking paracetamol and dihydrcodine but only lowers pain to a 6/10.
Tried tramodol, can't take NSAID's.
Is more comfortable out of splint resting on upturned lap tray.
Had tendon wrap round thingy as well.
Help, what else do you suggest for pain, Gp and pain management team and consultants team and OT bat me from one to the other.
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replied March 21st, 2012
Hi Juliedina,
It sounds like you may have gotten some type of infection which I think can happen.Did you have it done by an orthopaedic surgeon or hand surgeon? I think hand surgeons are better. But in any case I'm surprised they didn't fit you into a cast. I was in a hard cast as soon as they took the padding off. It got changed each time I went back to have it checked & after stitches were removed they put me in a cast for 4 weeks. This gives the thumb/tendon to heal up. Very important not to move that joint. In the meantime if you can take Tylenol, advil or aleve then take it on top of any painmeds they gave you like every 4-5 hours if you can tolerte. That was the only way I controlled the pain. I'm on 10th week after surgery. I didn't start occupational therapy until 7th week. Massage & doing hands exercises is best to control pain. There was definitely pins & needle & a feeling of swelling while I had cast on during the 4 weeks. This is normal, though they don't really tell you that. I had the arm/elbow bent most of the time when I was up, or sitting around. At night kept it elevated with a side pillow on a stool next to the bed and did that up the week 8. Go slow & let it heal!
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