Thumb fusion

[Jooolz]

I have recently been told I have hypermobility syndrome ( GP and orthopedic surgeon) - I am due for an op on my right thumb next week.
I had two MRI scans ( one on each thumb)and apparently they showed slight effusion with no fluid.... ( Consultant is away so cant explain it yet!!) the joint has become very unstable and when it was in plaster for 4 weeks to try and stabilise it - the left thumb started getting much worse!!
Now its out of plaster and both the top and bottom joints pop out with minor movements- just gesticulating in conversation can make it pop out - holding glasses - picking up carton of milk - let alone heavier stuff like kettles and bags!! I have been told a soft tissue op is not an option!
it aches most of the time and is very painful when it over extends or pops out - I have to pull it to get it to go back in again.
I will also have an operation on my wrist at the same time to release a tendon as I have deQuervain's tendonitis!
Has anyone else had a thumb ( MP) fusion? How limiting is it ? how much has it helped? do you still get pain in that joint?
I am hoping someone els on this forum has had an op like this or somethimg similar?

[Joski]

Hi Joolz,

I had my left thumb fused in 2003 - the middle (MCP) joint. I was having horrible instability and dislocations just doing very simple things and movements and due to the complex nature of my condition, fusion was the only way forward.

I had the surgery done under general and as a day case. They created an S shaped incision, exposing the joint, then they removed the surfaces of the ends of the two bones that create the MCP joint, to encourage new bone to form and make one long solid bone. To stabilise it during the healing and fusion process, in my case they used two wires (called K wires) inserted through the joint to pull it together and keep it still as it healed. In some cases they will use bone grafts or metal plates though, depending on the surgeon and situation.

They used dissolvable stitches on the wound, then I was then placed into a very large and heavy POP cast, that weighed a tonne and hurt my shoulder. It was quite painful afterwards, but on the whole was bearable with medication, rest and elevation .The original cast stayed on for 2 weeks until I returned to clinic for x-rays and wound checks. The K wires protrude through the skin, so if they are used don't be too alarmed when you see your thumb out of cast! After checking wire positions etc I was then placed into a large fibre glass cast, which was much lighter and manageable. I was in that for another 10 weeks, then returned to have the wires removed.

This was done in clinic, with the OS just pulling them out. because I don't react to local anaesthetics, it was done without, but in most cases they will offer you some numbing agent first if you require it. To be honest it wasn't that painful, just unpleasant more than anything. It was very sore afterwards and bled quite a bit from the wire entry wounds, but again it was manageable. I was then placed into a removable, rigid plastic splint for another few months, before gradually weaning off as the bone fully fused.

The surgery certainly solved the problem with the joint dislocating as it's perfectly solid and stable now, so in that sense it was a success. However, as with any fusion surgery, the knock on effects for the surrounding joints is always an issue, and I've found that the remaining joints are looser now, although not as bad as the original problem thankfully. As for loss of mobility, I have found my hypermobility has helped me adapt very easily and I haven't really lost that much ability to do things. I can still grip and hold things just fine, it just takes time to develop and adjust to. I have actually since also had my entire wrist joint fused on that arm too, and still manage to cope quite well with most tasks.

Basically, my thumb fusion was a success and if given the option all over again knowing what I do now, yes I would do it again. Having said that though, there are draw backs that must be considered and addressed fully before going ahead and to be perfectly honest, I would recommend that any fusion surgery in HMS or related hypermobility conditions is a very last resort. I am in a difficult position of knowing due to my situation and complex issues, that fusions are largely my only option and face several more in years to come sadly. But please, if anyone is considering a fusion surgery make sure you have exhausted every other option first, as they are brutal, invasive operations, with long, painful rehabs and a very definite, final outcome that can't be undone. If it really is your last resort, I would recommend that you spend a few months wearing a very rigid splint that totally immobilises your joint to give you an indication of how and if you will cope.

I hope that helps and your surgery goes well. If you have any more questions please feel free to ask or PM me.

Best wishes........Jo x

[flyingfairy]

it is a nightmare mine are also very unstable

[nonyanomemory]

Hannah_Bananna has had thumb surgery who posts on this site - so searching under her user name for posts will find her story in this. Small help I know - a difficult decision.

take care nonya

[Joski]

Have you tried looking at Silver Ring Splints? They design special splints for fingers and thumbs which look like jewellry. I'm not sure how you go about getting them in the UK, but it may be worth mentioning to a PT or OT about them and checking out their website:

http://www.silverringsplint.com/

In most cases decent bracing can make a huge difference and aviod the need for surgery. Good luck.

Jo x

[nonyanomemory]

Here is a link to a jeweller who has a collaboration with medical profession in UK - Just for info.

rheumatoid.org - clickable link
nonya

[Hannah_Banana]

Hi Jooolz

Nonya Mentioned my surgery in a previos post.My op wasnt a fusion but a tendon transplant that was put around my thumb joint But my surgeon has said about having my thumb fused as that operation wasnt a success as my thumb still keeps dislocating.Im glad theres a thread about fusions as i have no idea what happens in the operation.

The thread i started is in this part of the board titled "The procedure on my thumb".Its kind of like a diary in a way as it says about all the worries/problems.

Has your surgeon/dr suggested an operation like that?

Thumb surgery worried me because i thought it would be so painful afterwards but they gave me a nerve block which helped me recover better.Nerve blocks are a life saver as they completely cut out the pain but make your arm all floppy


(I dont really have a big hand its the way the pictures been resized)
That is what my hand was like 2 weeks after surgery.I had my op in the 21st on december 2005.With a fusion hopefully the scar/incision wouldnt be like that.

I hope this helps a little bit.Sorry its a bit of a late posting,i havent been on the board much lately.

Take Care

Hannah xox

[Retro]

Hey,

Hannah, Glad to see you back, we've missed you

Lindsey

[Jooolz]

Hiya all
Thanks for all your posts- very interesting and useful information.
My op which was due to day has been cancelled - consultant wants to talk to me again after seeing the mri scans of my thumbs... so i will wait and see what he says tomorrow morning! I will probably ask for a referral to one of the HMS clinics mentioned on this site.

PS: Originally I was told that a soft tissue op would not work effectively so I was due for the fusion

[Joski]

Hi Joolz,

I'm sorry your surgery was cancelled, but in a way it's good too, as it will give you a chance to fully understand your problems and what is the best way forward. I hope your appt with the consultant goes well tomorrow, please don't be afraid to ask him questions and discuss all of your options before committing to a fusion. As I said before it's a huge step and should only be a last resort.

I hope all goes well and you can work out the best way to help your situation. Please let us know and feel free to PM if you wnat any info about fusions.

Jo x

[bendytwistything]

Sorry if this is the wrong place but i've done a search and can't find what i need (and i didn't want to start a new thread unnecessarily). I am going to have an op on the cmc joint of my left thumb soon which will either be a fusion, a procedure where they make an articificial ligament and loop it through both bones like an elastic band (in the words of the surgeon ) or something similar but a soft tissue procedure won't work for me apparently so they're not sure what to do.
I was wondering if anyone else has had this done or if they've had the fusion done as, initially i was told it would be really simple, but was then told it wouldn't be. Also if it is fused, is the prominence of the joint in your palm an inconvienience?
I'd really appreciate any input

Thanks

[Sue New]

Hello Bendy,

Sorry to see you didn't get any replies to your post about your upcoming surgery.

It's happening very soon isn't it?

I really hope it goes well and you will soon be finding you are on the road to recovery.

Please let us know how you get on

Sue.

[Shadowlady]

Best of luck with your op honey, I'll be thinking of you.

[Kayzee]

Good luck with your op chick

Kay x

[sarahh]

Hi BendyTwistyThing

Good luck with your op hun, I'll be thinking of you.

Sarah x