Sandy’s Story: Thumb Pain

03/07/2015

For Omaha native Sandy Stetter, the pain was becoming unbearable. The 56 year-old had spent the previous five years dealing with a growing sense of discomfort in her right thumb. The former pharmaceutical sales rep and passionate gardener had come to a very painful and emotionally challenging crossroad. Either continue to live with pain in her right thumb or begin to eliminate those activities in her life that meant the most to her.

“It’s something that I love to do and it is something that I find therapeutic. I am one that loves to get my hands dirty,” says Stetter. Each spring she looks forward to planting hundreds of flowers at her family home and can be found maintaining and manicuring her acreage.

Last summer, as her thumb pain increased, Sandy found herself falling behind and not completing her work in the manner and quality she had so proudly been accustomed to. “It was taking me three to four days to complete the same work I would normally have gotten done in one. I simply had to stop more often because of the pain and then load up on more Advil.”

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The Opposable Thumb

It could be argued that in all of human anatomy there is no more important tool. Throughout existence, humans have been blessed with this amazing feature that allows us to function in ways nearly all other creatures cannot. Thumbs allow for a unique combination of precise hand function coupled with power.

From threading a fine needle to using a spade in the yard, we often forget just how important they are. It is well documented throughout evolution how tools were developed simply because of our thumbs. Even today, we continue to evolve around the thumb. Analyze those on cell phones around you now. Modern phones are strictly designed to be used by the dexterous thumb.

While highly mobile, thumbs conversely can cause a lot of pain. Because of the wide array of movement allowed, thumbs are highly susceptible to injury and, more commonly, degenerative change. Pain at the base of the thumb(s) is a very commonly treated condition at OrthoNebraska. From orthopaedic surgeons to rhuematologists and primary care physicians, thousands of patients seek medical care each year for the painful thumb.

What is it?

Thumb pain is most commonly the result of arthritis. The location of this pain is usually located at the base of the thumb where it meets the wrist. This area is anatomically known as the CMC Joint (Carpometacarpal Joint).

This painful condition itself can be referred to by many different names, including Basal Joint Arthritis, CMC Arthritis, and/or Trapezio-Metacarpal Arthritis. It is the most common form of arthritis in the hand. The joint is particularly susceptible to wear because of the tremendous physical stresses placed on it throughout life. Pinch pressures at the tip of the thumb are said to be magnified approximately tenfold at the CMC basal joint. Most commonly the pain and joint changes occur sometime in the fourth through sixth decades of life with women often more vulnerable due to ligamentous laxity. For Sandy, her pain began to intensify over a course of five years leading to a chronic and nagging pain at the base of the thumb and wrist.

Conservative Treatment

Like all conditions, treatment begins with conservative measures. Anti-inflammatories may alleviate symptoms adequately for some individuals. Splints that immobilize or support the CMC joint are commonly advised and can allow for a good night’s rest or assistance with certain exacerbating activities. Therapists at OrthoNebraska offer both custom-made splints, as well as several pre-fabricated options, in attempt to stabilize the painful thumb. In some scenarios, Corticosteroid injections are utilized as a tool for pain management. Surgery When conservative methods are no longer effective and the pain is disabling, surgical arthroplasty remains a time-honored successful procedure for this problem. Procedures known as CMC arthroplasty or LRTI (Ligament Reconstruction and Tendon Interposition) are most common.

While surgically different, the process is similar to the more well-known arthroplasty procedures for the arthritic knee and hip in that it involves the removal of the painful and arthritic joint. However, rather than using implants or hardware, these procedures exist to remove the painful portion of the thumb joint while also providing increased stability. The procedure removes the opposing arthritic surfaces (the trapezium bone or its surface) and then accessory tendons are used to stabilize, suspend and cushion the joint.

Post-operatively, a thumb splint is utilized, followed by range of motion exercises and therapy under the guidance of an experienced hand therapist. Typically, patients return to unrestricted activity at 10-12 weeks.

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Spring has now sprung in 2015. This year Sandy Stetter is as anxious as ever to return to her yard work and garden. After conservatively treating her thumb pain for years, Sandy was referred to me. In December 2014, Sandy underwent a right thumb CMC Arthroplasty procedure.

“I am so grateful that there was a surgery option such as this because I had tried everything”. Following her surgery she was referred to the outpatient hand therapy clinic. During her time in therapy, Sandy was advanced in care with an emphasis on restoring her thumb motion while progressively increasing her strength. “Every time I came to therapy I left more optimistic about my future. I was loyal to the exercises and to treatment and I am now seeing and feeling the results.”