Initially, the symptoms may respond to limited activities and rest. If this fails, use of an anti-inflammatory medication and a protective splint may be of benefit. Additional relief of symptoms can sometimes be achieved by a cortisone injection of the joint. When conservative methods of treatment no longer provide benefit, surgery may be warranted.
The goal of surgery is to decrease pain and preserve motion in the thumb. This is accomplished by removing the destroyed joint and creating a substitute joint called an arthroplasty. (Fig. 3)
Presently, two types of procedures are used to reconstruct the joint. Both involve removing all, or part, of the trapezium and replacing it with either an artificial substance or a strip of tendon to create a sling suspension. These procedures can be performed on an outpatient basis and require either an regional block or general anesthetic. A small stainless steel pin may be used to temporarily stabilize the reconstructed joint.
Following surgery, the hand is immobilized in a bulky compressive dressing with a rigid splint to protect the thumb. The fingers are usually left free to permit early motion. Elevation of the entire upper extremity and movement of the fingers is extremely important to prevent undesired swelling. Although the fingers and tip of the thumb are free, the hand is generally not able to do normal daily activities in the bulky dressing. The postoperative dressing is changed and sutures are removed 10 to 14 days after surgery. A splint or cast will next be applied for an additional two to four weeks of immobilization. Approximately four to six weeks following surgery, a therapy program is initiated for restoring motion to the thumb. The fixation pin, if used, is removed at this time. A small splint is made to protect the thumb between exercises and to maintain the web space between the thumb and index finger.
A therapist will provide a specific exercise program and advice on what activities are allowed. Discomfort with the early therapy is not uncommon and improves with time. Unrestricted use of the thumb is usually permissible at 12 weeks after surgery. Up to one year may be required before the maximum benefits of surgery are achieved.