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Posts Tagged ‘thumb joint replacement’

I’m still living with RA after being diagnosed in 2008. But like many patients, symptoms tend to rear their head prior to being formally diagnosed. For me, that was bilateral iritis (inflammation) in 2004. The ophthalmologist questioned me about joint problems and with nothing to note, we ignored possible autoimmune causes. In 2007 I had my first joint surgery – the left ankle. In 2008 I had surgery on the right ankle. Then other symptoms prompted my perceptive primary care doctor to send me to a rheumatologist. Since 2007, I’ve had multiple surgeries associated with RA – three ankle, both shoulders, joint replacement in both thumbs, cervical discectomy and vertebrae fusion, right elbow, and sinus surgery to treat persistent infections caused by RA meds. The 11th surgery was one week ago on the left elbow. The procedure was designed to clean up damaged tissue caused by ongoing RA related inflammation in the joint. The surgeon said that my elbow “was on fire” from RA and the MRI showed that the entire joint had inflammatory fluid around it. The sutures come out tomorrow (see pic below) and I start occupational therapy in a couple of weeks. Adding insult to injury, I just had thumb joint replacement on the left side six months ago and it’s making use of the left hand much trickier. At the same time, I’m in the midst of getting radio frequency ablation (“burning”) of nerve roots on the facet joints in both the lumbar and cervical regions of my spine. A future post will describe this process in more detail.

The scars of surgery are outward reminders of the permanent impacts of RA.

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It’s been 12 days since having a second Ligament Reconstruction Tendon Interposition (LRTI) surgery designed to replace the damaged carpometacarpal (CMC) joint at the base of the thumb. This procedure was on the left thumb – the right side was done in April. Today the cast and sutures were removed (see pic below). During the procedure, the trapezium bone is removed from the wrist and a tendon is harvested from the forearm and rolled up and secured in place of the trapezium. Artificial materials such as metal and plastics tend to be rejected as artificial joints in this area.

Instead of being placed in another cast for 3 weeks, the surgeon placed me in a splint with the notion that periodic, gentle movement of the metacarpophalangeal (MC) joint just above the CMC joint may prevent stiffness and freezing of the joint which would ultimately compromise and damage the replaced CMC joint. This is what has happened with my right thumb which my surgeon and rheumatologist suspects is from RA-induced inflammation since RA isn’t really under control at the moment. My occupational therapist spent considerable time attempting to “unfreeze” the joint to no avail. A procedure to either remove the synovial capsule and surrounding soft tissue or to permanently set the MC joint with screws at a 25 degree angle is being considered once the left thumb heals enough for everyday functioning.

This is my 10th surgery in 10 years since being diagnosed with RA and it’s pretty much a toss up as to the difficulty of recovery between this procedure and cervical (neck) discectomy and fusion surgery. My surgeon says the hands contain many nerve endings and it’s difficult to function without the grip of a hand for such a duration. Occupational therapy will begin around 8-10 weeks.

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