Our Summary

This research paper looks at a surgical treatment for severe arthritis in the thumb joint, known as trapeziometacarpal (TMC) joint arthrodesis or joint fusion. While this treatment can relieve pain and restore strength to the thumb, it often limits the thumb’s movement.

The researchers conducted a study using eight human hand and arm specimens. They manipulated the thumb and nearby bones in a machine that simulated the thumb’s circular (circumduction) movement. They then measured how much the thumb could move and rotate using a special tracking system.

The thumb’s movement was tested in four different conditions: the normal thumb, after simulating the fusion of the TMC joint, after simulating the removal of a small piece of bone near the TMC joint (the TT joint space), and after simulating the removal of another small piece of bone (the T-2MC joint space).

The results showed that after the TMC joint fusion, the thumb’s movement decreased to only 25% of the normal thumb’s movement. However, removing small parts of the nearby bones improved this: removing a piece from the TT joint space resulted in 49% of the normal movement, and removing pieces from both the TT and T-2MC joint spaces resulted in 73% of the normal movement.

The study concludes that TMC joint fusion does limit the thumb’s movement, but removing small parts of the nearby bones can improve this. This means that patients with more flexible nearby joints might have better thumb movement after surgery. For patients who complain of thumb stiffness after TMC joint fusion, additional bone removals may be a way to improve their thumb’s mobility.

FAQs

  1. What is trapeziometacarpal (TMC) joint arthrodesis or joint fusion?
  2. How much does thumb movement decrease after TMC joint fusion according to the research?
  3. Can the movement of the thumb be improved after TMC joint fusion? If so, how?

Doctor’s Tip

A doctor might tell a patient undergoing joint fusion surgery that while the procedure can relieve pain and restore strength to the affected joint, it may limit the joint’s movement. They might also advise the patient that removing small parts of nearby bones during the surgery could potentially improve the joint’s mobility post-surgery. It’s important for patients to discuss their individual situation and concerns with their doctor to determine the best course of action for their specific needs.

Suitable For

Patients who are typically recommended joint fusion are those with severe arthritis in the thumb joint that has not responded to conservative treatments such as medication, splinting, and physical therapy. Patients who have persistent pain, weakness, and limited function in the thumb joint may benefit from joint fusion surgery. It is important to note that joint fusion is a last resort treatment option and is typically recommended when conservative treatments have failed to provide relief. Additionally, patients who have more flexible nearby joints may have better thumb movement after surgery, as shown in the study mentioned above.

Timeline

In summary, before joint fusion, a patient may experience severe arthritis in the affected joint, leading to pain and limited function. After joint fusion surgery, the patient will initially experience relief from pain and improved strength in the joint. However, they may also experience limited movement in the affected joint due to the fusion of the bones.

In the long term, patients may need to undergo additional procedures, such as removing small parts of nearby bones, to improve the joint’s mobility. This timeline highlights the initial benefits and potential challenges associated with joint fusion surgery for severe arthritis.

What to Ask Your Doctor

Some questions a patient should ask their doctor about joint fusion include:

  1. What is the success rate of joint fusion surgery for severe arthritis in the thumb joint?
  2. What are the potential risks and complications associated with joint fusion surgery?
  3. How long is the recovery period after joint fusion surgery, and what is the expected outcome in terms of pain relief and thumb function?
  4. Will I need physical therapy or rehabilitation after joint fusion surgery?
  5. Are there any alternative treatments to joint fusion surgery for severe arthritis in the thumb joint?
  6. How will joint fusion surgery affect my ability to perform daily activities and tasks that require the use of my thumb?
  7. Will I need additional surgeries or procedures in the future after undergoing joint fusion surgery?
  8. Are there any restrictions or limitations I should be aware of after joint fusion surgery?
  9. What are the long-term effects of joint fusion surgery on the thumb joint and surrounding bones?
  10. Can removing small parts of nearby bones improve thumb movement after joint fusion surgery, and is this a suitable option for me?

Reference

Authors: Omokawa S, Hojo J, Iida A, Nakanishi Y, Kawamura K, Shimizu T, Mahakkanukrauh P, Tanaka Y. Journal: J Hand Surg Am. 2021 Dec;46(12):1126.e1-1126.e7. doi: 10.1016/j.jhsa.2021.03.016. Epub 2021 May 2. PMID: 33952413