What is it?

The thumb is an important component of the hand, it is vital in powerful/grasping hand functions as it acts as a 'post' against which the hand can hold objects, it is also vital in fine movements / functions of the hand, such as when picking up a small coin or writing etc. The joint at the base of the thumb is called the "carpo-metacarpal joint", and is responsible for taking much of the load and providing the vast mobility of the thumb, that is it does alot of work through life!

As the joint wears it develops arthritis, this is termed CMC (carpometacarpal) joint arthritis of the thumb. As with most other joints it occurs from use of the joint over the years but may also be associated with injuries or over use. It results in pain, stiffness, and deformity of the affected joint. There may also be weakness associated.

For individuals who rely on their hands for work or sporting activities etc, the loss of function can be quite disabling. It is important to know also that there are a number of other possible causes for pain in that part of the hand, and that they can co-exist or mimic each other, which Dr Ihsheish can talk you through.

How is BASE oF THUMB (CMC) JOINT ARTHRITIS managed?

A thorough clinical assessment is required to make the diagnosis, this may well also require the use of imaging studies such radiographs (x-rays). Dr Ihsheish can discuss with you the suspected diagnosis and any other problems, and the merits of the various management options available.

As with most arthritic joints, the first line treatment consists of

• pain relief and anti-inflammatories
• activity modification, and
• appropriate splinting of the joint.

If these are not successful then surgery may be required.

Surgery aims at removing the painful articulation. In recent decades many surgical options have been developed and used, and many have good results pubished in the scientific literature. Dr Ihsheish can discuss the appropriate ones with you for your case if needed. In general, following surgery, you will be seen at two weeks for a wound check, no sutures will usually be visible (absorbable sutures are used), you will be in a splint for 4-6 weeks, and arrangements for physiotherapy will be made.

What is carpal tunnel syndrome?

The ‘carpal tunnel’ is an area in the palm of the hand that is bound by bone and strong ligaments to form a 'tunnel', through which the median nerve travels to reach the hand and fingers. This is one of the important nerves supplying sensation to the hand skin and nerve supply to hand muscles. The tunnel also contains many tendons that attach to the fingers. If the nerve is under pressure from any cause as it travels through the carpal tunnel then this results in pain or altered sensation, and sometimes weakness in the hand.

Patients often feel paraesthesia (a feeling of ‘pins and needles’ or ‘burning sensation’), sometimes during the night.

Carpal tunnel syndrome is most often not associated with any specific illness, but Dr Ihsheish will identify any specific illnesses or medications that may be causing or contributing to the symptoms. It may be associated with injuries around the wrist, the type of work that you do with your hands, inflammatory diseases, or certain medications etc.

How is carpal tunnel syndrome managed?

It is important that you see your surgeon to have the condition accurately clinically diagnosed, this may require tests such as xrays or nerve conduction tests etc.

Dr Ihsheish will be able to gauge the severity of the condition and recommend suitable treatment. In the early less severe stages you may only require activity modification or an injection, some patients also find relief  from using a light splint,  and later on surgery may be indicated.

How is surgery for carpal tunnel syndrome performed?

The surgery is called ‘carpal tunnel release’. It may be done under local anaesthetic or general anaesthetic. A small incision is made in the palm and through this the strong ligament is released and the nerve inspected. The surgery is quick and you are allowed to leave the hospital the same day. Your surgeon will ask you to leave the bandage on your hand and keep the area dry for two weeks. At two weeks you will see Dr Ihsheish and have the wound inspected, there will often be no sutures to remove as they are absorbable.

Gentle exercise and wound area massage will be prescribed to help you regain hand function.

Can carpal tunnel syndrome re-occur?

Scar tissue is the normal response in the body around sites of surgery or injury. If the scar tissue is enough to cause nerve compression, or the underlying causes or risk factors continue, this may end up causing carpal tunnel syndrome again. This is uncommon. It is best to talk to Dr Ihsheish as soon as possible if you think your symptoms are re-emerging.

Please be aware that the symptoms of carpal tunnel are the result of nerve compression and damage, and that the rate and degree of recovery after surgery mirrors the degree of compression and nerve damage that exist.