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Made by AJ Julka MD
“What a wonderful experience I’ve had with Dr Julka. My CMC ARTHROPLASTY on my right hand was done on May 20th. I can’t believe I waited so long to get this done! The pain I had prior to the surgery is gone! If anyone experiencing joint pain in the thumb get an appointment with Dr Julka soon! He’ll take excellent care of you! I will return to him when I have my left hand done..”
~ Jodie from Google Reviews
Thumb basal joint arthritis or thumc CMC joint arthritis is a condition in which cartilage is gradually lost between the thumb metacarpal and a small saddle shaped bone called the trapezium. These bones are located where your thumb meets the wrist and ver important for full pain free mobility and use of the thumb. The condition effects more women than men and tends to get worse in your 50s and up.
The key symptoms of classic thumb basal joint arthritis are pain in the base of your thumb. If you look at your palm you will notice an area of muscle where your thumb meets the wrist. This is called the thenar muscle and is often the location of achy, throbbing pain of CMC arthritis. Pain can occasionally be sharp with a catching sensation as well. Pain is made worse with pinching activities; pulling up your socks or pants, squeezing a tube of tooth paste, knitting, opening a bottle top or even simple writing with the affected hand. As the arthritis worsens patients may notice a deformity set in to their thumb where they can no longer flatten their hand fully on a table. This is a sign of more advanced disease and deformity.
Thumb CMC arthritis is diagnosed with an Xray conducted at your appointment with Dr. Julka and a detailed examination.
You do not require an MRI to demonstrate thumb arthritis. In a majority of patients the pathology is very evident on Xray and examination alone. There are a few patients every year that may have other conditions such as undiagnosed rheumatoid arthritis with normal appearing Xrays on whom we will obtain MRIs but this is rare.
Thumb CMC arthritis is treated both non operatively and operatively. Non operative measures include appropriate education as to the activities that worsen the disease, splinting, use of anti-inflammatory medication as well as cotisone/steroid injections every 3-6 months. If you are a good candidate for injections this will be done for you at your appointment.
One of the things we take pride in is doing things differently than many other practices. Dr. Julka performs his thumb CMC joint injections in a manner to make them largely pain free for a majority of patients. We use the smallest needle possible (30 Gauge), a numbing spray, use a small amount of steroid, and every single injection is performed by Dr. Julka. You will not have an injection performed by a trainee, medical assistant or any one other than Dr. Julka in our clinic. We feel if you have to undergo an injection you want it done by the most experienced hands possible.
Surgery for thumb CMC arthritis consists of removing the small trapezium bone to eliminate the inflammation, grinding and pain from the arthritis and suspending your thumb metacarpal in an appropriate position. This is done in a number of ways across the country. Dr. Julka’s technique is with one small 3 cm incision and a suture suspension which allows for a suspension without requiring multiple incisions or taking a tendon from your forearm. If we do use a tendon we use a small tendon that is readily available and does not require additional incisions. Incisions are closed with dissolvable stitches and glue for most patients.
Our protocol differs significantly from many others. We do not place patients in cast after CMC arthroplasty. We have found the ability to shower, get ice to your hand, and simply live life without a cast for 6 weeks is very important to the recovery of our patients.
The vast majority of our thumb cmc arthroplasty surgeries are performed with numbing of the entire arm as well as some mild sedation as you might receive during a colonoscopy. General anesthesia is done in some instances and this is based on patient and anesthesia physician preference.
All of our thumb CMC arthroplasty surgeries are performed in a surgery center on an outpatient basis.
You will be placed in a small splint to immobilize your thumb. This will be removed by Dr. Julka 3-7 days after surgery and you will be given a removable splint. You will start some gentle home exercises and be allowed to shower over the incision at this stage. The removable splint is typically worn for around 4-6 weeks. While we allow you to move your thumb gently we do not allow thumb use with any pinching or gripping for 8 weeks.
We allow you to start exercising while maintaining restrictions on your thumb at 2 weeks after surgery. We restrict vigorous cardiovascular exercise for the first 4 weeks as this can lead to increased swelling. We restrict you from any pinching activities
We see many patients on a daily basis that tell us they wished they would have sought out treatment sooner. Whether you are early in the disease or have end stage arthritis we have treatment options for you that could enhance your life. You do not have to live with thumb pain. Dr. Julka and the hand surgery team is here to help. If you are having progressive signs and symptoms of thumb basal joint arthritis please contact us for an evaluation.