Some relief for overworked thumbs

The Middle Ages

September 16, 2007|By SUSAN REIMER

I am over 50 and sometimes I feel like I am breaking down, one joint at a time.

My hip hurts. My knee hurts.

But it's my thumb that really hurts.

The pain at the base of my left thumb is so great that sometimes I can't button a shirt, open a jar or grip the steering wheel in my car.

I am pretty sure it is the result of using my thumb to hook my purse up and over my shoulder 10 times a day for 30 years. But the doctors can't say for sure.

And, typical for my lowest-common-denominator life, I am suffering from a type of arthritis that is just about epidemic among women my age.

Dr. Thomas J. Graham, chief surgeon at the Curtis National Hand Center at Union Memorial Hospital and the physician who examined my hand, said that surgery on the basilar joint of the thumb may soon eclipse knee and hip replacements and is perhaps the most common procedure hand surgeons perform.

"It's way up there and it makes sense that it is," Graham said. "The hand is our primary instrument of discovery, of commerce, of communication."

We ask a lot of the thumb. The bones are held in place by ligaments that allow a lot of sliding and rotating. The thumb moves much like the pestle in a mortar - with all the grinding that suggests.

"We can put it in a lot of places in space, but once it gets there, we want stability," said Graham. "And we are relying on relatively flimsy ligaments for that.

"You have a few birthdays, with your thumb shimmying and shaking back and forth with more and more cartilage wear. And there you have it."

It is most often the sub-dominant hand, as it is in my case (I am right-handed), and Graham suspects it is because the dominant hand passed off the heavy work to its lesser partner while it takes care of the smaller, fine motor tasks.

He's right. I carry the grocery bags in my left hand so I can reach for the keys to the front door with my right.

Though plenty of men have arthritis in this joint, it is most often women who suffer. Graham said science could not say why, but agreed with my explanation: We do all the work.

"I have a wife and two daughters. That is the safe answer."

My thumb will never get better.

"Regrettably, cartilage wear only goes in one direction. You will have good days and bad days, good months and bad months.

Cortisone shots in the joint worked for a while. However, the period of relief became shorter and shorter between shots.

The pain nearly disappeared once I started wearing a brace that stabilizes the thumb, rests it and allows the inflammation to die down.

But I am a full-contact gardener, and I like slinging heavy pots around in the kitchen. I take yoga classes and spin classes, and I kayaked while on vacation. I need my thumb.

There are surgeries to replace the trapezium - the area where the thumb bone connects to the wrist bone - with an artificial bone, but they are often not as successful as the surgery Graham may ultimately recommend for me: removal of the trapezium and its replacement with a small disk of tendons taken from my arm.

"It is a good surgery that is tried and true. We fill the void to stabilize the thumb and buffer the joint.

"You will like it after two to three months, you will love it after four to six."

Graham, who focuses his work on the complex injuries of professional athletes, performs a somewhat modest 50 of these surgeries a year.

But for every patient who has the surgery, Graham and his team - and probably other hand specialists as well - are working with 10 patients like me who are trying to manage the pain until it seriously interferes with life.

There may be good news in the interim. Graham and his team have participated in research that may soon result in a nonsurgical remedy - an injectible physical buffer that can diminish pain without removing bone.

But there is no getting around it. We are living longer and we are more active and we are wearing ourselves out, joint by joint.

If there is a lesson for the next generation of women, it may be this: Carry a clutch, not a shoulder bag.

susan.reimer@baltsun.com

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