Indiana Hand to Shoulder Center in the News

Thumbs up on this surgery

(Republished from indystar.com, original post on Aug. 21, 2011)

When a woman develops arthritis in her hand, most often it affects the thumb. For many, the arthritis will develop to the point where surgery is the best way to alleviate the discomfort.

Dr. Robert Baltera, a Hand and upper-extremity surgeon with the Indiana Hand to Shoulder Center, performs about 270 of these surgeries a year.

Question: Why is this more common in women than men?

Answer: Women have looser ligaments.

Q: Are there any activities that predispose a person to this?

A: Not typically, though there are activities that aggravate it — opening jars, turning keys, pinching, grasping activities.

Q: What should people try before surgery?

A: Splints; anti-inflammatories can help quiet down some of the inflammation, but that doesn't take care of the primary problem, where the cartilage lining is worn off the bone. Typically for arthritis, non-operative treatments are palliative, but they don't cure the problem. Arthritis tends to progress.

Q: Please describe the surgery you offer.

A: We take out the part of the wrist joint, which the thumb bone sits on top of, called the trapezium. That leaves a space between the base of the thumb and the rest of wrist, typically we will take a tendon from the forearm and place it in that space to act as a cushion. In most patients, it's a permanent fix.

Q: Why would someone not do surgery right away?

A: Some people are not symptomatic enough to warrant surgery. Some people can live with some discomfort when it's mild and knowing that there's an option down the road;
there's no harm in waiting.

Q: Do patients typically get back to normal?

A: About 90 percent of people are pain-free or have mild discomfort when they do certain things. Your strength improves, but we're not creating a normal joint. It improves significantly, but it never gets back completely to normal.

Q: How long does it take to heal?

This is an outpatient procedure. Most patients are still awake if they choose. Typically, after surgery, they're placed in a bulky dressing that gets changed after 10 days.

Two months after the surgery, it's better, but still it takes several months to get full strength back. If they're comfortable, they can go back to work in a few days.

Most people have a significant improvement in function after surgery. They're able to do a lot more things than they were preoperatively with much less pain and greater strength.