DENERVATION OF THE BASE OF THE THUMB IN THE TREATMENT OF TRAPEZIO-METACARPAL JOINT ARTHRITIS OF THE THUMB

Abstract

Aim of the study: The evaluation of denervation efficiency in the treatment of the arthritis of the base of the thumb.

Material and method. Between 2001– 2004, 15 patients were surgically treated for arthritis of the basis of the thumb. There were all females of an average age of 53 years. In all patients the procedure was done ambulatory under local anesthesia. After completing a protocol form, regarding pain motion and power of the thumb, an incision was made at the level of the wrist crease extended from the level of FCR to the level of the 2nd extensor compartment. Through this incision the articular branches which conform the studies of Wilhem and Fusche supply the 1st CMC joint were divided.

A supplementary incision for the first intermetacarpal space was made. The patients were free to return to their activities the third postoperative day and they were reviewed after 3, 6, 12, 24 months by an independent doctor. Their data were also recorded conform the protocol

Results: Twelve patients out of 15 had excellent improvement of their strength. Pinch and grip power was doubled. Mobility of the thumb according to Kapanji scale was improved in all cases. Pain was reduced in 65% average. The patients were satisfied from the operation. There was one patient with poor improvement and two patients who never shown up at the follow-up. As the last were at the beginning of our learning curve we think that could have a less satisfactory result.

Discussion: The method is simple with minimal impact to the patient activity or life. It gives good results in 65% –75% and leaves further operative procedures possible. Although there not enough data yet for this procedure and our number of cases is small with short follow-up we believe that it is a nice procedure, it satisfies both the patient and the surgeon regarding the overall improvement of mobility and pain.