Learn more about Thumb Carpometacarpal Joint Arthroplasty
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Procedure Highlight: Thumb Carpometacarpal Joint Arthroplasty
Arthritis of the first carpometacarpal (CMC) joint of the hand is a common and often debilitating disease. Diagnosis can be readily made with history, physical exam, and radiographic evaluation. Patients with advanced disease who have failed conservative treatment modalities have multiple surgical options including ligament reconstruction, resection arthroplasty, silicone implantation, tendon interposition, or total joint arthroplasty.
The typical presentation is a female between 50-70 years of age, complaining of an insidious radial thumb pain that originally worsened with use, has
decreased her ability to perform activities of daily living, decreased strength, and decreased dexterity. Opposition requiring activities, such as writing, opening jars, or carrying heavy objects between the thumb and fingers, are instigators of the pain. There has been an increasing weakness of pinch, progressing to stiffness and cramping with increasing stage. As time progresses, the pain may exist at rest. However, there is also a younger group of patients, 20s-30s complaining of pain in the thenar eminence, or cramping in the first web space, resulting from joint laxity and synovitis of the trapeziometacarpal joint. This pain may radiate up the radial aspect of the forearm with activities such as writing. Regardless of the patient’s age, the pain is often mitigated by rest and analgesics.
Non-Surgical Treatment Options
All patients, regardless of their initial staging, require a trial of conservative therapy before any operative considerations. This management consists of activity modification, joint protection, thenar muscular strengthening, and non-steroidal anti-inflammatory drug (NSAID) use, and splinting with a long opponens, or thumb spica, for 3 to 4 weeks. If the patient must continue work, a short thumb-stabilizing splint can be utilized during work hours and switched for the thumb spica during off hours. If symptoms improve, the patient can be gradually weaned off the splint. If they do not, surgical options enter the conversation.
Although procedures vary on a case by case basis, Dr. Salem Samra prefers the mini tightrope CMC technique. The Mini TightRope provides a unique method for stabilization of the thumb metacarpal following trapezial resection or removal for the treatment of CMC arthritis. The Mini TightRope can also be used as an adjunct and stabilizer in CMC instability and in the case of revision with proximal migration after tendon reconstruction.
mini tight rope
The Mini TightRope supports and maintains the thumb and index metacarpals in proper relationship while allowing for healing and scar tissue formation in the trapezial space. The construct consists of two strands of #2 FiberWire, which are fixed with two oblong stainless steel buttons for cortical fixation.
For more specific information on the Mini TightRope CMC Fixation technique, please call Dr. Samra: 732-739-2100.
We are pleased to report Dr. Salem Samra performed the FIRST ever CMC arthroplasty at Bayshore Hospital with the mini-tightrope in August 2013.
You’re Diligent About Hydrating at the Gym…
New wrinkle worry identified: Water Bottle Mouth
Facial wrinkles occur because people lose skin elasticity as they age, but there are also habits that can contribute to premature signs of aging. For example, forgoing sunscreen can cause sun damage, which leads to lines on the face. Repetitive motions, such as constantly squinting at the sun or sucking on a cigarette, can also make you more likely to develop wrinkles. In a recent article, The Inquisitr.com identified another potential cause of facial lines: water bottles.
Think before you drink
If you live in an area that has less-than-stellar tap water, drinking bottled water may seem like a no-brainer. There’s nothing wrong, nutritionally, with drinking H2O from a bottle, but the cosmetic dermatologist told the news source that it’s the repetitive motion that could cause lines to form around the mouth when they otherwise might not.
“We tell our patients, keep on drinking, it’s great for your body, it’s great for your health, it’s great for your skin,” a physician said in the interview. “Unfortunately, over time it either causes these lines or it aggravates them.”
Of course, there are ways to avoid this issue. Water purifiers may do the trick if you’d rather drink from the tap, and this will also save you money in the long run. You can pour your bottled water into a cup or drink through a straw, thus eliminating the lip-pursing motion.’
A cosmetic solution
Unfortunately, for those of us who have been drinking out of water bottles for years, this news may come a bit late in the game. If wrinkles have already formed, you can discuss other options with a board-certified plastic surgeon. Facelifts and deep chemical peels offer long-term results that can make you appear younger, while dermal fillerscan help fill deep wrinkles and reshape the facial contours.
Call us today for a complimentary consultation.