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Old February 7th, 2010, 01:32 PM   #1 (permalink)
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thumb base arthritis surgery?

I'm reposting this with a more specific title - sorry for the redundancy. BTW, I am using very heavy picks, when I use a pick, but I also play fingerstyle as well as dobro. Anyway, here's the original post:

I have arthritis at the base of my right thumb that's bad enough I went to a specialist the other day - now I'm contemplating surgery.

There are two options: a procedure called suspensionplasty where the little bone (trapezium) at the the base of the thumb is removed and a tendon re-routed to support the thumb. The other option is placement of a special spacer (Artelon) between the trapezium and thumb, which is less invasive but may not work as well due to the severity of my condition.

Anyone have either of these done? Effect on guitar playing? I asked, of course, but didn't get a definite answer.

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Old February 7th, 2010, 01:50 PM   #2 (permalink)
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Dill,

I'm not familiar with the Artelon implant. I am familiar with the suspensionplasty (we call it an "Anchovy"). People have had very good results with the anchovy. I'm not sure how it would work for a guitarist. I would think pretty well. Often we will do a couple of these surgeries a week.

Fusing the carpal/metacarpal joint (basal joint) is probably not a good option for you. For less severe arthritic changes there is a prosthesis. It's made by Ascension, it's made of a material called pyrocarbon. If you have a lot of bone loss of the trapezium you're not a candidate for it.

I'll ask the docs I work with about the other implant, will Google it and see what that tells me.

Our thumbs do a LOT of the work of our hand, the basal joint is probably undersized for the demands we put on it.

Michael
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Old February 7th, 2010, 02:24 PM   #3 (permalink)
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I can't answer your specific question but I has trigger finger surgery in November.

I urge you to find a surgeon that is a specialist regarding musicians injuries.

I was lucky to have my surgeon recommended to my by the musicians union.
He performed a slightly different surgery on my hand to what is normally done because of the range of motion needed by a guitarist.

Had I gone to a surgeon who was not a specialist I may have had a much longer recovery time and perhaps not had full use of my hand.
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Old February 7th, 2010, 02:43 PM   #4 (permalink)
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Something to consider. Now I have no idea how bad yours is or how long its bothering
you. But I had alot of pain at the base of my thumb on my freting hand and had it xrayed and they said it was arthritis and even showed me the xrays. I chose to do nothing about it. A month or so later the pain went away. Ya, it may come back.
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Old February 7th, 2010, 03:22 PM   #5 (permalink)
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dill,

i looked up the Artelon spacer. I'll ask one of the hand surgeons I work with about it. It's less invasive than the "anchovy", the casting period is longer than with the anchovy. The casting is longer, I think to prevent dislocation at the joint. The implant does some "double duty" in providing both a spacer in the joint and augmenting the soft tissues over the joint.

Good questions to ask about this product/surgery. How many have you done? Failure/complication rate? range of motion versus other procedures? If this fails, what revision options are available?

I'll let you know what I find out this week. Did you check out their website for this spacer?

Where I live I haven't found anyone (surgeon/occupational/hand therapist) with a special interest in musicians.

DISCLAIMER: this is a guitar forum and in no way substitutes for a real medical professional :)
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Old February 8th, 2010, 01:46 AM   #6 (permalink)
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Teleagain - the Doc was a little hesitant to recommend the Artelon for me as I have some subluxation which can make keeping the implant in place as it heals in a little more problematic. He said that out of the 85 he has done, 3 have required revision, and all of those were in joints with notable subluxation, hence his caution. He said he wasn't ruling it out, but that he had reservations. After I expressed some concern about the extent of the anchovy procedure (interesting nickname - where's that come from?) he said he was willing to try the Artelon first, with the understanding that I may require the more extensive procedure in the end.

Now, I would certainly prefer to have only one procedure, especially when they both come with pretty lengthly recovery periods. My only concern with going straight for the anchovy is: will I have the mobility and fine motor control necessary for my music after such major mucking around in there.

There is a woman I know who has had the anchovy done, and she seems to have pretty good use of her thumb, 11 months out. Its only one person, but encouraging. Also, the Doc's PA, who was very helpful and spent probably 15 minutes with me, said that in his experience patients with the anchovy actually have shorter recovery, which is counterintuitive, and do amazingly well considering the invasive nature of the procedure. Also, the Artelon has only been in use for 12 years, vs. 50+ for the anchovy.

I have found some websites with patient discussion of the Artelon implant - mostly by folks contemplating it, or who have had it fairly recently, and none of them musicians, so not much help. Mostly positive, however, and a couple very negative. I'm a little concerned by its newness, and also skeptical of the claims about its action - its supposed to stimulate the formation of "fibrous tissue" to protect the joint and then be absorbed itself and disappear. How long is this fibrous tissue supposed to last after that?

Anyway, I didn't intend to write a speech - I'll be very interested to hear what your Drs say, and thanks very much for the help.
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Old February 8th, 2010, 02:21 AM   #7 (permalink)
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Your arthritic joint is slipping out (subluxing) because it is a saddle joint, you've worn away the edge of the saddle that keeps the keeps the bone in place. what holds the bone back in place after the Artelon is the soft tissue over the joint. when we do an anchovy, we loop the tendon that we are using as the spacer back under the tendon as it goes by the thumb and connects to the second metacarpal and essentially tie it in place. Before we did this, we used to put a pin from the thumb to the index metacarpal to hold things in place so they can heal. the tendons/ligaments in the hand are amazingly strong. this provides the stability. The surgery is more invasive in that we harvest half a tendon, remove bone, drill a hole, etc.

Our patients are very happy with the anchovy. One lady had the pyrocarbon implant done for her second thumb surgery. we did the anchovy on one, then the implant came out, she didn't like the implant, we went in and removed the implant, made it into an anchovy.

I would think you'd do fine playing music with your thumb after an anchovy. I can't recall us taking care of any guitar players.

I hadn't heard of the Artelon before so I can't really say much about it.

You're wise to be skeptical of ANY surgery.

I'll let you know what my docs think.
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Old February 9th, 2010, 09:54 PM   #8 (permalink)
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One doc had heard of the implant but isn't familiar with it...other hand doc is on vacation this week
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Old February 10th, 2010, 12:19 PM   #9 (permalink)
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I think I'm going to go with the anchovy - the more critical joint for guitar is actually the next one distally anyhow, the more I think about it. Thanks for helping me think through this -I really appreciate it.
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Old February 15th, 2010, 11:42 PM   #10 (permalink)
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Dill,

the doc I work with was back today. Someone he knew had the implant and was not at all happy with it. My doc has arthritis there too and thought about the implant for his thumb but decided against it.

good luck with the surgery whenever you get around to it.

your welcome for the help

Michael
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Old February 16th, 2010, 02:02 PM   #11 (permalink)
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Scary ... both my basal thumb joints are painful and inflamed ... i generally take four Advils before a gig. But i think i'd rather live with it than gamble on surgery.
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Old March 13th, 2010, 12:14 AM   #12 (permalink)
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54 yr old So Cal surgeon search

Interesting.
I can't believe this arthritic thumb base. It has progressed. I was wondering:

-- Does anyone know a great surgeon in So Cal?

-- Anyone contemplate Regennex (colorado) stem cell therapy?

-- I wonder how they image for subluxation to warrant the anchovy surgery?
thanks, Mike
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Old September 14th, 2010, 06:25 AM   #13 (permalink)
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Arthritis is a problem that causes inflammation and cartilage loss within the joint. There are several types of arthritis, the most common type, osteoarthritis, or wear-and-tear arthritis, occurs commonly in the thumb.

Arthritis of the thumb usually occurs at the joint found at the base of the thumb, where the thumb meets the wrist. This joint, called the carpometacarpal (CMC) joint, is important when trying to grip or pinch. Thumb arthritis is more common in women than men, and increases in frequency over the age of 40 years.
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Old September 14th, 2010, 11:55 AM   #14 (permalink)
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Quote:
Scary ... both my basal thumb joints are painful and inflamed
Me too and they are getting quite a bit worse. Getting tougher to grip stuff & carry heavy things + play guitar. I've got big toe arthritis and had my right big toe fused to relieve pain, and the left one is getting near needing it. Thumb basal arthritis is sometimes associated with big toe arthritis, looks like I'm one of those who is gonna get both. Rats...

Well, there are certainly worse things to have in this world. This thread is interesting as I didn't know of these surgeries.
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Old November 13th, 2011, 03:50 AM   #15 (permalink)
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Wanna revive anold thread?

Quote:
Originally Posted by Muku View Post
Interesting.
I can't believe this arthritic thumb base. It has progressed. I was wondering:

-- Does anyone know a great surgeon in So Cal?
Yes. Mark Halikis at OSI in Orange.

Quote:
-- I wonder how they image for subluxation to warrant the anchovy surgery?
2 or 3 angles with an X-Ray takes care of it. Plain old eyeballs work well too.

Before & after. Look carefully. There's something missing. What the after image (the one on the right) can't show is the repair, which uses the FCR tendon.



Google search for CMC Arthroplasty.

I'm two months post-op. It is not an easy or simple surgery and total recovery time is L O N G compared to, say, a tendon repair or a 'scope meniscus cleanup. I haven't played bass in months and don't expect to for a few months yet. But if everything goes well, as it has so far, and I behave myself, I should be able to play again.

Ken...
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Old November 13th, 2011, 08:30 AM   #16 (permalink)
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I've had pain on and off in the basal joints of both thumbs. Playing guitar for 37 years, plus spending about 8 hours/day on a computer keyboard and mouse, plus practicing Aikido for 16 years, I'm probably lucky it's not worse.

Normally I have no problems. But when it kicks in, something as simple as picking up a cup of water can be painful. If I give the affected hand a rest for a while it goes away, so I'm thinking it's more to do with inflamation at this point. I also have arthritis in both big toe base joints and maybe there's a connection there. So far it's not so bad that I've been tempted to do anything more than rest, Advil and MSM.
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