CMC DENERVATION for Thumb Arthritis

I have not had this procedure, but have had denervation for my wrist which was very successful. Recently my thumb arthritis has increased greatly and is not responding to usual treatment. Next month I will have a consult at Mayo regarding my thumb. I would definitely consider a denervation procedure.

@kathynv thank you so much for the feedback. I'm relieved to hear positive results. The denervation for my thumb is actually done in the wrist, so I'm wondering if it's the same thing you had or if a different nerve is involved. Please send an update after you talk with Mayo and best of luck!!!

@granddilulsion
It is my understanding different nerves are involved. Where I live no Dr offers this option. It was shorter recovery than other options and has a high success rate. I’ll update after my consult in a month and would appreciate hearing from you as well after your procedure. Take Care!

@kathynv Thanks. Where are you located? I'm having this done in Flagstaff Arizona. You mentioned Mayo so I thought you may be near our Mayo Clinic in Phoenix. I will definitely post with my results.

I'm also interested in results for people who have had this denervation surgery for the cmc joint. I am considering the surgery but don't feel like I have enough real life information to make a decision.

@deborah1031
Well.... I am the author or this post and I'm now 4 month post devernation surgery on my right hand and should have had my other hand done last month. I had such high hopes, but sadly it didn't work for me and in hindsight I wouldn't have had it done because I have more pain than before surgery. I was told I wouldn't need physical therapy with this surgery, but at my 6 week follow-up, the top of my thumb was still numb and I couldn't tell if the arthritis pain was gone because I still had additional pain and stiffness from the surgery. The surgeon said he still expected the numbness to subside with time (and it has) but suggested physical therapy. He said that because of my results with this hand, they would not recommend denervation on the other hand, which is actually has worth arthritis. I just wanted my dominant hand done first. That may also have been a mistake in retrospect. I've now been through 6 sessions of PT and have seen no improvement. I still have the same arthritic pain I had prior to surgery, but now I also have stiffness in my wrists and additional pain on the top of my thumb that I didn't have pre surgery. I'm really discouraged. My physical therapist said that they don't see many cases where denervation works, but they have good results with the bone removal surgery although it's more invasive, painful and the healing takes longer. The other thing that has become a concern is the cost of physical therapy. Three years ago when I broke my ankle, I had no copay for PT... which is what I was expecting with this round of PT. My insurance apparently changed at some point and it is now a $52 co pay each session. This adds up! I've paid more out of pocket for unsuccessful PT than I did for the actual surgery. If I opt for the bone removal, I'm looking at 3 months of PT (minimum and could go up to 6 months for slow healers) at 2-3 times per week, plus a 2 hour round trip drive to get to a hand specialist for the treatments. I'm considering toughing it out for another 1.5 years until I can get on medicare so physical therapy would be covered... IF they don't change that by then. I don't know if that helps or confuses the issue for you, but I know when I was looking, I couldn't find many people who'd had it done. I wish you the best.

I recently had the CMC joint removed with a tendon sling put in place. Dr never suggested de enervation surgery. Recovery has taken longer because he had to do another procedure at the same time to prevent hypertension of the thumb. I had my right thumb similarly corrected with out the hypertension procedure 15 yrs ago and it’s been great. Consult with a certified Hand Therapist who might comment on de enervation recovery and whether it works or not.

@deborah1031 Instead of denervation, I elected CMC surgery on both hands, using the "trapeze" or suspension technique. Why? Because denervation, if it works, does nothing to preserve function - the joint continues to deteriorate, and at some point actually collapses. When that happens, fusion seems to be the only repair option.

I will not sugarcoat - recovery took quite a long time, with the first 5-6 weeks basically no use of thumb. PT and daily exercises took several months for full recovery (less than the old "anchovy" or rolled up tendon though.) It was annoying, but I managed to be back at my computer job after a few weeks.

What is it like today? The "old one" is over 15 years old, the new one nearly 7, and they function perfectly and without pain. I am retired and can sew, garden, paint and generally do anything I want. Would I do it again? Yes, and I would do as before, finding the BEST surgeon I could. I asked my hand therapist for recommendations.

@sueinmn

Thank you so much for your reply, Sue! I have been doing a little bit more research into the denervation procedure. I have not been able to find much that reports outcomes in more than a few patients. One person messaged me from this forum and said she had quite a bad experience with the denervation: a longer recovery than she was expecting that involved quite a bit of physical therapy and still left her with numbness in her thumb after quite a long time. So I'm still thinking about it all. The long recovery for the regular CMC joint surgery that you're talking about is a bit off-putting given that I am a gardener and I'm about to turn 75. My husband also needs the surgery, probably on both hands, and so we have to figure out how to manage that so that one of us has usable hands for the time of the recovery. Its complicated! But I really really do appreciate your response. I'm dictating this because, you know, bad hands! Take care.

@deborah1031 I understand about the recovery but it was worth it forme to get rid of pain and get function back. My hands are a trial, now I am 6 weeks out from wrist replacement, still in a splint with serious limits but already glad I did it because that pain is gone. I did have to hire garden helpers for this summer - it's fun working alongside young people and getting to know them. The 16yo is gaining both knowledge and confidence- she hopes to work for the city next year with my reference, much better rhan cashiering! Even 7 & 10 year olds can pull tree seedlings, trim bushes, spread mulch and clean the pond and filters! They love having permission to use hoses and tools.

But it sure takes a long time to do things one-handed and is so frustrating to have to wait for help! However at 75, this prolongs my productive years.