Potential risks during surgery on carpometacarpal osteoarthritis (rhizarthrosis)

What are the potential risks that may arise during surgery on carpometacarpal osteoarthritis?

Hereafter are a few examples (in excerpts) of some important complications and problems that may occur in connection with surgery on carpometacarpal osteoarthritis:

Dystrophy risk (Complex Regional Pain Syndrome (CRPS):

severe hand dystrophy

In isolated cases severe mobility dysfunctions accompanied by soft tissue swellings along with significant decalcifications manifesting in the bones of the hand may arise after surgery on carpometacarpal osteoarthritis (CRPS, Complex Regional Pain Syndrome Sudeck´s atrophy, algodystrophy).

A typical symptom of this condition in an advanced stage is the patchy decalcification of the bones in the hand.

The image shows a Complex Regional Pain Syndrome (CRPS) with severe swelling on the dorsum of the hand.

Those patients who experience persisting pain during post-surgery treatment are particularly at risk to develop Complex Regional Pain Syndrome

Complex Regional Pain Syndrome may generally occur after any type of surgery or injury to the hand!

Since the cause for this disorder is unknown, no physician can really be certain to avoid this potential surgery-related risk.

Infection, impaired wound healing:

Infections or wound healing impairments on the surface of soft tissue typically can be addressed through simple measures such as the early removal of stitches, administration of antibiotics, etc. Fast response times after detecting first symptoms such as redness, in most cases will prevent the infection to advance into deeper layers of the thumb saddle joint which underwent surgery.

Deep infections are not too common however they are extremely problematic. Second interventions and permanently remaining dysfunctions may be the result thereof.

How can a patient find out whether he/she suffers from wound healing impairment?

The pain after surgery on carpometacarpal osteoarthritis typically should recede a few days after the procedure. The mobility of the fingers and the thumb increases and the patient will experience less post-operative pain during his/her night rest.

If, however, after first signs for a positive recovery new pain flare-ups occur several days after surgery and if these are also accompanied by a decrease of mobility in the thumb, the other fingers or the entire hand, the patient should immediately consult an experienced hand surgeon, orthopedist or trauma surgeon to seek help. (The wound can best be assessed by the surgeon who performed the procedure!)

It is of particular importance to quickly seek help if the wound turns red, swells up or the experienced pain is of throbbing nature as the possibility of an infection must be ruled out.

Should the suspicion substantiate that indeed the patient developed a deep-lying infection, the wound requires immediate opening. A second intervention in such a case should not be procrastinated.

Mobility impairment of the wrist:

Surgery on carpometacarpal osteoarthritis requires the immobilization of the wrist and the first extremity (except for the thumb interphalangeal joint).

The early pro-active exercising of the fingers and the thumb interphalangeal joint (without straining!) lowers the risk to incur wrist or finger mobility limitations later on.

The wound should be dressed in a way that allows the patient enough mobility to pro-actively exercise his/her fingers and the thumb interphalangeal joint.

Nonetheless each surgical procedure to a hand due to pain and swelling may lead to a permanent limited mobility.

Injury of cutaneous nerves within the operating surface of the thumb:

On an exceptional basis, a larger cutaneous nerve which runs in the thumb may be injured during surgery. The nerve may either get cut or “just” pinched. If the nerve is just compressed the numb sensation will let up – typically on the extensor side of the thumb – allowing the local nerve pain to recede over a period of months.

If, however, the nerve was cut an almost spot-like “electrifying” bruise will form within the scare. A neuroma develops leading to the loss of cutaneous sensitivity within the area supplied by the damaged nerve.

The injury of nerves may be at cause for the development of a very particular pain pattern (CRPS II).

Will the scar in connection with surgery on rhizarthrosis hurt for a long time?

Yes! About six month!

Carpometacarpal osteoarthritis:  1  2  3  4  5  6  7  8  9

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