Background: In the summer of 2019 Charlie had a large woodworking project that required extensive sanding - with orbital sanders and by hand. His right thumb got very sore. Finally on December 9, 2019 he sought the help of Austin Hand Group. A custom plastic splint on December 11, and some occupational therapy helped some.
By fall 2020 it was not getting better and the pain was increasing. A new splint, at the right, and more therapy, but the therapy was focused on how to cope not using the thumb - it would not be getting better. The fancy name is basal thumb arthritis, of the CMC (Carpometacarpal) joint. (I want to resume my role as a primate with two working thumbs.) Surgery would be required to fix it. So CMC Arthroplasty surgery was scheduled for December 29 with Dr. Ira Lown, assisted by Shelby Wasil, PA-C. |
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The surgery consisted of removing the small wrist bone, the trapezium, that the long thumb bone (metacarpal) connects to, since that joint was "worn out," and somehow reconnecting the thumb. Actually there will not be a new joint - the thumb is suspended and held in place by FCR tendon harvested from the wrist. The bone spur (osteophyte) that had developed on the end of the metacarpal must also be removed.
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Out of surgery (and on the way home in 2 hours) the right hand was huge - this is a thumb bandage. Some say I look dumber than usual, but an hour before this picture was taken, I was still unconscious - in surgery or the recovery room. |
48 hours after surgery the big bandage and splint went away, and was replaced by this modest bandage and splint that fit in long-sleeve shirt sleeves and coats. Normally the big bandage would have been removed after three days, but that was New Year's day, so I got out early! This smaller bandage and splint is scheduled to be removed Wednesday January 13 - mid-day; 15 days after surgery. |  |
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Day 15: The great unveiling! I still have a thumb! The area above the wrist (near the scab) is still substantially swollen, but it is uncovered for showers, bed, and light activity such as eating or updating this web page. |
There are two small cuts on the wrist/arm, where part of a tendon was removed. The tendon is described as much like string cheese, so only part is removed - the rest remains functional and will regrow to full strength in weeks. The tendon material is used to suspend the thumb and pad the new connection. My thumb is more wrinkly than normal for even someone as old as me! The feeling in that area is reduced due to the swelling pinching the nerves, but has returned to normal as expected. For an academic description of the operation (not bloody) see YouTube |
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For heavier things, a brace is required, but for light lifting, no brace is needed. Okay, I asked the therapist, what is heavy? She said anything over a couple pounds, like a laundry basket. Oops. I had done 5 loads of laundry yesterday. Every day since day 2 I have lifted about 25 pounds. A gallon of milk weighs 8 pounds, and I drink milk bought by the gallon. I don't know whether she was amazed or terrified. My right hand is weak, probably because of months of limited use. I can see the very fine sutures holding things together, and wouldn't expect them to carry much load. I have carefully returned to the shop, but starting with only small components of the project in process. I have already used the key power tools such as saw, planer, and sander. (Clamps are fighting me, since they have to be tightened with my left hand.) Six week update: In some directions the thumb is still weak, but I am doing "anything" in the shop - I have even moved a full sheet of plywood by myself (75 pounds). My stamina is still below par, but improving. The Occupational Therapist, Justine Wool, has given me a set of exercises to rebuild range of motion. Uncomfortable, and boring, twice each day, but that is what Therapists do for a living. Her second set of assignments is to rebuild strength. I can see progress, in spite of my bad attitude. Ten weeks after surgery I was discharged by Ms. Wool, with no restrictions, full flexibility, near full strength, and no pain. Pain after surgery was not an issue. Tylenol easily handled it, without even coming close to the maximum dose of 8 extra-strength pills per day. A narcotic (Hydrocodone) was prescribed for moderate to severe pain. I tried one pill which did not remove the pain but it gave a buzz so I wouldn't care about any pain. No thank you. If I want a buzz, I will use Scotch (but even that wasn't necessary). By day 3 I did not want or need ANY pain medicine. Yes, there was some discomfort, but far less than how my hand hurt before the surgery. Occasionally, not every day, I will take a Tylenol (to supplement the one I take every morning for the arthritis in my feet). |
This picture was taken in the doctor's office as the huge initial bandage (2-3 days) was replaced by a far smaller (2 weeks) bandage and splint. This is the picture that may not be for the squeamish.
There is a long cut around the base of the thumb, seen here with several pieces of surgical tape. You can see where the tendon was harvested on the forearm. |
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