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CMC Osteoarthritis | 2nd opinion
Greetings ~ I have been dealing with bilateral CMC and wrist pain for more than 20 years. I was diagnosed with osteoarthritis in every major joint around the age of 30 but it has decided to focus its ire on my hands.
A little history: I have had a total of 13 surgeries (8L & 5R) and my right CMC is in dire need of some help. I had a traditional CMC arthroplasty on the left in Oct. 2018 and within 2 weeks of starting OT, the surrounding bones shifted and I was in unbearable pain. I then had the mini-tightrope in Jan. 2019 to stabilize those bones and keep them from moving further. Unfortunately, this did not resolve the pain or the issues of the osteoarthritis continuing to attack and I had to have a scaphotrapezoidal fusion the following September. I went through the traditional route of OT but never made it close to 60% function or strength. The following July, finally convincing my surgeon that I was in pain, I had an osteophyte removed from my thumb metacarpal and then, it was decided that, I needed a revision basal joint arthroplasty in Sept. 2020. More than a year later I am still dealing with lack of function, weakness and constant pain at the CMC, up through the thumb and 1st metacarpals and across the back of my wrist.
Now, here I am needing the same surgery on my right hand that started the cascade of surgeries on my left only this time, my surgeon wants to start with the mini-tightrope rather than the traditional arthroplasty. But, we can't proceed until my left hand is at least a little better.
I have tried for years to find a surgeon to review my records and provide a second opinion but once they hear that I have had 9, 10, 11, 12 and now, 13 surgeries they decline to even review my case, let alone meet with me. (I willing to travel and I've tried cold calling and emailing surgeons in my home state of MA, NY, CA, TX, FL, CO, MN, KY, DC and WA) Has anyone else run into this problem? I trust my hand surgeon and value his opinion but he doesn't have any answers as to why I am still having so much pain in my left hand and, therefore, hasn't been able to offer any solutions. I had a cortisone (my 23rd overall) in my left CMC 10 days ago because I am literally willing to throw any and everything at the problem at this point. I hate to use the word desperate but, since we can't proceed with the surgery on my right cmc until my left is more under control, that's the only word I can think of.
If anyone has any suggestions of surgeons who might be wiling to review my all-too-thick file or has heard of complications with any of the surgeries mentioned above that I could research or alternative treatments for OA, scar tissue or nerve damage, I would greatly appreciate a reply.
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Hi @kwyckoff and welcome to Mayo Clinic Connect. Thank you for sharing your story. That is a lot of surgeries to endure for any one person.
I am including some links to other conversations on Connect that you may be interested in reading. There are some members that have had similar issues as you.
Thumb Pain: https://connect.mayoclinic.org/discussion/thumb-pain/
2018 - CMC Arthroplasty with STABLYX Implant: https://connect.mayoclinic.org/discussion/cmc-arthroplasty-with-stablyx-implant/
2018 - Bone on bone thumbs: https://connect.mayoclinic.org/discussion/bone-on-bone-thumbs/
Do you have a primary doctor that would be willing to give you a referral for a second opinion to Mayo's Orthopedic department? I know that having your own physician backing you up can help to get you a second opinion.
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2 ReactionsHas your surgeon suggested the removal of the buttons/ fiber wire from the original mini tight rope to alleviate your index finger and dorsal hand discomfort?
Hi. I am having the SBS implant removed tomorrow following a revised CMC surgery I had in December on my right hand.
In 2020 I had LRTI on my left thumb. I’m a 53 yr old male, and osteoarthritis is hereditary (my mom had both thumbs done in her 50’s). With my left thumb surgery, I had a considerably long recovery. Today it’s about 80-85% of function, though the pain level is significantly lower than pre-op.
In Sept 2022 I had CMC arthroplasty on my right thumb, but opted this time for Suture Button Suspensionplasty since it seemed like a faster recovery and required no tendon interposition. Soon after the surgery (~1 wk) I noticed a “clicking” on the dorsal side of my wrist near my surgery. The pain began soon after, and the recovery seemed to stall.
While putting up Christmas decorations the week before Thanksgiving, a heavy object fell exactly on the right thumb repair location. An X-ray revealed that the suture button on my 1st metacarpal had “broken” off. So, I had the surgery redone in early December. This time the 1st and 2nd metacarpals were pinned and I was placed in a cast. At the end of 6 weeks, the pins were removed. All seemed fine for about a week.
In mid/late January, the pain and “clicking” returned. My hand surgeon, who I respect very much took the case to his colleagues. After several discussions (including my input) it was decided that the implant should be removed because of biomechanical issues yet to be fully explained. The implant is simply being removed and not being replaced with LRTI or any other type of suspensionplasty. I WILL LET YOU KNOW HOW IT GOES!! I’ve read a lot of literature and consulted with my surgeon several times. We believe that chance of painful metacarpal subsidence is very low. In fact, suspensionplasty is NOT performed throughout most of Europe. Instead, simple trapeziectomy alone, coupled with pinning/casting for 6 weeks, is the norm.
Back to the Christmas decoration incident… we now believe that the tension placed on the thumb metacarpal was so great that the chance of the SBS implant dislodging was significant.