Try this experiment. On your dominant arm, take a piece of masking tape and strap your thumb to the side of your hand. Then leave it in place for a few hours as you try to go about your normal activities. You will soon find out just how integral this appendage is to getting through the day. Answering your cell phone, grabbing the coffee creamer from the refrigerator, turning the key to unlock the front door, are all activities that depend on proper functioning of your thumb.

Recreational activities such as golf or tennis – forget it. Now, if you have arthritis in the thumb joints, then this experiment does not end after only a few hours. It keeps going until treated medically by a qualified hand surgeon.

Degenerative arthritis of the thumb is one of the most common types of hand arthritis. It usually strikes at the base of the thumb where it meets the wrist. This joint, known as the carpometacarpal (CMC) joint, is a highly mobile joint that allows motion in all directions. It is also the joint that allows for a strong pinching motion.

However, because of its wide range of mobility, the bones that comprise the CMC joint must give up some stability, similar to the shoulder joint. Because of this, the ligaments around the joint are forced to bear most of the burden of stabilizing the thumb during hand use, and if they are unable to do it effectively then the aberrant motion in the joint over time can contribute to arthritis.

Diagnosis

The bones of the body at the joint surfaces are covered with cartilage, a slippery coating that allows smooth motion at the joints. Arthritis is an inflammation and eventual wearing away of the cartilage, creating rougher surfaces and painful motion. In my practice, arthritis of the thumb is a common occurrence with a straightforward diagnosis. Palpation of the joint as the patient moves the thumb will often reveal the typical grinding sensation as if the joint surfaces were lined with sandpaper. There also may be an audible grinding sound known as crepitus. I may also order an X-ray to confirm the extent of the arthritis and determine the most effective treatment options. Other tests such as the CT scan or MRI are most often unnecessary.

Treatment

In the earlier stages of the disease process, this type of arthritis is usually treated with anti-inflammatory medication. This is often successful for months to years, allowing the individual to fully use the hand at home and work. Thumb splinting may also be advantageous as it allows the thumb to rest in a neutral position where mechanical stress is at its least, which in turn may settle the inflammation.

However, arthritis is a generally a progressive condition and because the thumb is used so frequently and strenuously, the disease often progresses despite these measures. As more conservative treatments fail to provide adequate relief, I will attempt to reduce the joint inflammation with one or more cortisone injections to the affected joint.

In the later stages of arthritis, as more and more hand function is lost, surgical reconstruction is often the best course of action. Part of the diseased joint is removed and reconstructed using a tendon graft from another part of your body. Following surgery, you will have to wear a splint for several weeks to allow the surgical repair to strengthen. If your occupation depends upon heavy use of your hands, then you may need to be out of work during this time if you are not able to find restricted duty work.

It is important to factor this into your overall planning prior to surgery. After removal of the splint, occupational or physical therapy with a therapist who specializes in rehabilitation of the hand will be prescribed. This will help you regain strength and motion and allow you to fully utilize the thumb and hand.

If you believe you are suffering from degenerative arthritis of the thumb and need specialized orthopedic care, Orthopedic Specialists of Seattle has excellent treatment options available for you.

Have you ever noticed how a tomato plucked from a garden tastes so much better than store bought? It’s near impossible to purchase that amount of flavor. Anybody that has ever planted a vegetable garden is sure to agree. Enjoying a salad or sandwich made with fresh vegetables from your own backyard is one of summer’s many benefits.

Flower gardening is also enjoyable for many people, and often those who like to be outside in the warm weather will spend considerable time planting, weeding, and harvesting the fruits of their labor. For those with chronic hand pain due to arthritis, this once pleasurable activity could now become a chore due to the aggressive hand movements that are involved, and the anticipated discomfort that it may cause. Luckily, there are some ergonomically designed tools on the market that will help those with hand pain continue with their hobby, and also some self-treatment strategies to minimize pain. So take heart, you can still get out there and enjoy one of your favorite activities with a little planning and strategy.

Pace yourself

You may be used to planting an entire garden or pruning an entire yard full of bushes in a day, but working with arthritis means that you should often work slower to minimize the cumulative stress on your hands. Whether you have osteoarthritis or rheumatoid arthritis, this is a good idea. Plan your activity so that you spread the work out over a few days. This will help keep the arthritis from flaring and causing increased pain.

Use arthritis friendly gardening tools

Gripping is one of the major movements in gardening work. Repetitive clamping of pruning tools can put excessive pressure on the joints of the fingers and thumb. Some tool manufacturers such as Fiskars® have designed garden tools specifically for those with limited hand and arm strength. Many of these tools have been commended by the Arthritis Foundation due to their ease of use.  These tools include spring opened scissors and pruners which maximize leverage with the use of gears and longer handles.

Keep tools sharpened

Having a dull blade on your tools means that you will have to exert more pressure in order to cut branches and stems. Have your pruning tools sharpened annually to maximize their effectiveness. Many local hardware stores offer a sharpening service, and pricing is usually very reasonable compared with the cost of new tools.

Wrap tool handles in foam

Wrapping the handle of a trowel or hand rake in foam tubing increases the handle’s diameter and reduces the muscle pressure needed to keep the tool steady within your hand. Some tools made specifically for the arthritis sufferer already have a wider handle, but otherwise this is a great technique to alleviate hand stress. You can use water pipe insulation found at the same hardware store where you get your tools sharpened.

Wear gloves

Gardening gloves do more than just keep dirt from getting under your fingernails. They also absorb perspiration. This is important because as your hands get sweaty, they also get slippery. That means you must grip your tools harder to keep them from sliding in your hand. Wearing gloves mitigates this and results in less force needed to handle your tools.

Use a lightweight coiled hose

Managing a standard garden hose can be aggravating for anyone. The kinks that develop and cut off the water supply often lead the gardener to vigorously shaking the hose to untangle it. Of course, this adds to the cumulative strain on the arthritic hand and wrist. Today’s pre-coiled garden hoses are made of a lighter weight material than standard hoses, and they resist tangling. When you are finished, the hose automatically recoils, making clean up easier.

Stay ahead of the pain

Taking ibuprofen or naproxen based medications 30 minutes prior to gardening can reduce the inflammation associated with heavy use of the hands. If you know that working in the yard will produce some soreness, then you may wish to employ this strategy prior to starting.
So get out there and enjoy the nice weather. You don’t have to give up your gardening hobby because of arthritis. Try these tips, but if pain persists you should feel free to contact my office so we can discuss effective treatment options if further detail.

What is arthroscopic surgery?

Arthroscopic surgery is a technique that orthopedic surgeons use to diagnose and repair structural damage within a joint.  The surgeon makes 3 or 4 small incisions around the joint, about ½ inch each. Here, a fiberoptic camera is used to see within the joint and miniature surgical tools are used to perform the repair.

Arthroscopic surgery of the shoulder is an outpatient surgery, which means that you will not have to be admitted to the hospital. You will return home shortly after the surgery is over.

Arthroscopy of the shoulder joint has been a major advancement in surgical technique. This procedure allows less cutting of intact tissue to perform repairs, allowing for faster recovery times than with open surgery.

What types of shoulder surgeries can be performed using arthroscopic technique?

Dr. Shapiro performs many types of shoulder arthroscopy. Among those are:

• Rotator cuff repair
• Subacromial decompression (removal of bone spurs)
• Glenoid labrum repairs (SLAP tears)
• Repair of shoulder instability (dislocation)
• Biceps tendon repair
• Bursitis
• Debridement due to arthritis
• Frozen shoulder release

How long will my surgery take?

Most surgeries will take 45 minutes to 1 hour. You will then be required to stay in the recovery room for about another hour. You will then be discharged home. Please be sure to make arrangements for a ride home, as you will not be able to drive the day of surgery.

How long is the rehabilitation process after shoulder arthroscopy?
This depends on the type of procedure you had performed. It is important to understand that physical therapy is an important piece of recovery. You must be committed to the post-operative rehab if you wish to achieve the best outcome.

General rehab guidelines for specific surgical procedures are as follows:

Rotator Cuff Repair, SLAP Repair, & Shoulder Dislocation Repair: Physical therapy is grouped into several phases, beginning with gentle mobility and progressing to strengthening through the full range of motion. The process generally takes 4-6 weeks. Dr. Shapiro will provide both you and your physical therapist with specific instructions following your surgery.

Bone Spur Removal: Because the shoulder is left structurally intact, the rehab process flows quicker, about 6-8 weeks.

How much pain will I have following my shoulder surgery?
This varies greatly from patient to patient. You will be prescribed pain medication following surgery, along with instructions for icing the shoulder, which will help control excessive swelling. During physical therapy sessions, you will be asked to move the shoulder joint in order to restore full arm motion.

This may cause an increase in your pain level, and for this reason it is recommended that you take your pain medication 45 minutes prior to the start of therapy sessions. In time, you will need to take less pain medication.

Will I have to wear a sling following surgery?
This depends on the type of surgery that you had performed. For rotator cuff repairs, SLAP repairs, and dislocation repairs, you will be required to wear the sling for 2 weeks after surgery. For subacromial decompression surgery, a sling may be worn for comfort measures following surgery, and discontinued as pain decreases.

Can I take a shower following surgery?
Showering is permitted 72 hours following surgery.

When do I follow up with Dr. Shapiro following my arthroscopic surgery?
Dr. Shapiro or his physician assistant will follow up with you 1 week following your surgery. The goal of this visit is to make sure that your pain is under control, and the incision is free of infection and healing well.

Physical therapy is also prescribed at this time. This visit is designed to give the patient an opportunity to ask any new questions that may have arisen following your surgery.

When can I return to work?
Of course, this is highly dependent upon your occupation. You will be unable to actively use your arm following rotator cuff repair, SLAP repair, or dislocation repair. This is important in order to allow for proper healing and to not disrupt the surgical area.

If you have a sedentary job or are able to secure restricted duty where use of the arm is not required, then you should anticipate being out of work for 5-7 days. If you are required to use your involved arm, then time away from work is greater. You should discuss your situation with Dr. Shapiro prior to surgery so that you can make appropriate arrangements with your employer.