Can an accident be at fault for the emergence of carpometacarpal osteoarthritis?
Yes. There are (dislocated) fractures of the base of the first metacarpal bone which after years of friction between the thumb and the trapezium bone lead to an increased wear of the cartilage (carpometacarpal osteoarthritis).
These fractures in medicine are referred to as Bennett fracture or Rolando fracture.
The image on the left shows a Bennett fracture with considerable dislocation of the fragments.
When a fracture heals in such misaligned position, it causes a gap on the articular surface between the thumb and the trapezium bone. This will cause an increased wear of the joint cartilage.
The long-term prognosis for a fracture of this severity is the emergence of carpometacarpal osteoarthritis (rhizathrosis).
How long is one usually on sick-leave after having undergone surgery on carpometacarpal osteoarthritis?
There really is no rule of thumb that addresses this question. It very much depends on what activity the patient performs. Activities which put a lot of strain on the hands typically require a recovery time of about three to four months.
If the patient is at liberty to choose the degree of strain that is placed on the recovering hand, certainly the sick-leave will be much shorter.
What can you do if the procedure did not bring the expected result?
First of all it is important to understand that the result of the procedure cannot be determined after a few weeks or months. I personally experienced hundreds of patients who three months after surgery on carpometacarpal osteoarthritis were unsatisfied with the result. However, nine to twelve months later they were able to put their thumb at use without experiencing any more pain. Therefore it is safe to say: surgery on carpometacarpal osteoarthritis is not a quick affair!
There are however isolated cases where even after a year or longer pain and malfunctioning are being experienced. This is where an experienced hand surgeon comes in. An analysis of the circumstances that lead to the failure of the procedure has to be performed in order to determine whether a correction may be achieved.
Does it make sense to wear an orthosis during immobilization of the thumb?
Wearing an orthosis may make sense if a patient experiences discomfort or during unavoidable straining activities as the orthosis may help alleviate the pain. The orthosis for the first extremity however does not constitute a replacement for the required reduction of strain on the healing thumb. Think about it: virtually all activities of the hand also require the involvement of the thumb.
In concluding this informational paper I would like to encourage you to address all questions you may have in connection with the thumb saddle joint and rhizarthrosis with your attending physician as this document does not constitute a replacement to a personal examination or consultancy through your doctor.