Aches and pains are a part of life, but when the discomfort in her right thumb got to be too much, West Bend resident Jenny Schoofs had a series of steroid injections to relieve the pain. Over time, that treatment proved less and less effective and her primary care provider, Anthony Guthrie, DO, a family medicine physician who practices at the Froedtert & the Medical College of Wisconsin Jackson Health Center, referred her to Cameron Best, MD, orthopaedic surgeon and MCW faculty member. Dr. Best specializes in hand and upper extremity surgery.
After conducting a physical exam and ordering an X-ray, Dr. Best determined Jenny was suffering from arthritis of the carpometacarpal joint, the point where the base of the thumb meets the bones of the wrist. As with arthritis in general, the cartilage between these bones had worn away, resulting in the pain Jenny had first noticed two years earlier.
One of the most commonly diagnosed problems in the hand, thumb arthritis is seen primarily in women, usually in their 50s. Patients initially notice some difficulty turning a doorknob or opening a jar, and as the condition progresses, they experience increasing pain.
Dr. Best recommended a splint to offer Jenny some immediate relief as she went about her daily tasks, but he also discussed a surgical option.
“I really did not want to have surgery,” said Jenny, who is employed as a promotions manager. “But Dr. Best asked how old I was — 49 at the time — and how much longer I planned to work. I am planning to work until retirement age, and I am on the computer quite a bit. Considering those factors during our discussion, I determined that surgery was the best option for me.”
Dr. Best performed a ligament reconstruction tendon interposition. It is the most commonly performed surgery to ease thumb arthritis.
“Arthritis occurs where the thumb meets the small bones in the hand, one of which is the trapezium,” Dr. Best said. “The treatment is to make an incision on the side of the thumb and remove that bone in its entirety. I then used a tendon from Jenny’s forearm to reconstruct a ligament to hold her thumb in place.”
After the surgery, she spent five weeks in a cast before meeting twice weekly for a month with occupational therapist Anne Sharpe. As she recovered, Jenny worked to do common tasks like opening jars and bottles and washing and styling her hair. In addition to initiating an exercise program to increase the range of motion in Jenny’s right hand, Sharpe used massage to advance her recovery.
“The challenge with this diagnosis post-operatively is what we call the web space — the large muscle between the thumb and the first finger — becomes very tight, especially when it’s been shut down for four to five weeks in a cast,” Sharpe said. “We use soft tissue mobilization techniques to help that. Also, the scar tissue can become enlarged and hardened, so we teach patients how to use silicone gel sheets to make the scar more pliable.”
“Now, after surgery and completing occupational therapy, I am relieved that my right hand is perfect,” Jenny said.
Second Time Around
Jenny made a full recovery, but over time, she realized she was having similar trouble with her left hand. She returned to Dr. Best for surgical treatment on it, as well.
“Dr. Best is so personable and really put me at ease before surgery,” Jenny said. “And I could tell from his interactions with the West Bend Surgery Center staff that they respect him.”
“People don’t realize that this is a condition we can do something about,” Dr. Best said. “Patients will come in to see me about something else and when they bring up thumb pain, we discuss what we can do about it. Obviously, we use our hands every day and when your thumb hurts, it can be quite debilitating. This surgery works so well, and patients are so appreciative.”