Losing opposable thumb (fusion)

Triathlon Forum
1

My dominant hand was damaged in the Navy. I was flown to the best Naval hand surgeon at the time, who performed a successful CMC arthroplasty using my wrist tendon. His best-case surgical expiration date passed many years ago, and my thumb is becoming increasingly decorative. My current options are fusion and waiting (for a better option to be developed).

Has anyone had their thumb fused to their wrist (CMC joint)? If so, what functions have you lost/gained?
Can you readily change a bike tire? Use the standard mtb shifters? Grab a gel and a bottle on the (bike/run) fly?

Thanks.

2

Caf0 - as you’d likely anticipated, not a plethora of responses. You already know that you deserve an A+ for having what some refer to as a salvage procedure and having it last beyond the warranty period. If there were a joint replacement option here as successful as, say hip replacement, you wouldn’t need this thread.

If somebody were asking me this question, I would ask them about their non-triathlon function, work, using a lawn mower, picking up a child or grand child, writing a check, these sorts of things. And, when *they *got too painful, I’d consider the procedure. After the surgery, if it’s not all you’d hoped it would be, there are no take backs. So, in the end, it’s what’s right for you that matters in this decision making process. If it’s of any consequence, I’m sure there are lots of us who’d be more than happy to run quickly to hand you that water bottle or gel, share our cafe latex if you get a flat and generally help out. Best of luck!

John

3

cafo, Have you been to a hand therapist? The CMC joint can often be restored to pain-free and functional with good therapy.
If you go with the fusion then you will have an opposable thumb it just won’t have mobility for a variety of positions. One risk with the CMC fusion is that the next joint toward the tip, the MCP joint gets hyperextended and injured due to trying to attain positions that the CMC joint would usually be responsible for. If you have any hyperextension then you may need to wear a small ring splint to avoid further injury there.

4

Caf0 - as you’d likely anticipated, not a plethora of responses. You already know that you deserve an A+ for having what some refer to as a salvage procedure and having it last beyond the warranty period. If there were a joint replacement option here as successful as, say hip replacement, you wouldn’t need this thread.
If somebody were asking me this question, I would ask them about their non-triathlon function, work, using a lawn mower, picking up a child or grand child, writing a check, these sorts of things. And, when *they *got too painful, I’d consider the procedure. After the surgery, if it’s not all you’d hoped it would be, there are no take backs. So, in the end, it’s what’s right for you that matters in this decision making process. If it’s of any consequence, I’m sure there are lots of us who’d be more than happy to run quickly to hand you that water bottle or gel, share our cafe latex if you get a flat and generally help out. Best of luck!

John
John Post, MD
Medical Director, Rock Star Triathlete Academy
Medical Director, Training Bible Coaching
http://johnpostmdsblog.blogspot.com
Dr. Post’s Blog is a medical/injury resource for triathletes.

Well, I was hoping at least one person either had the surgery or knew someone that did.

Really my surgeon gets the A+. And my ortho for getting me on this Top Doc’s schedule. The surgeon did comment that my admiral outranked his…

The salvage procedure never allowed me to put much pressure on my palm (I passed the Navy fitness test doing fist pushups), so mowing the lawn hasn’t been in my cards for ages. But it did allow me to easily get dressed, to hold a beverage, to grasp paper for short periods of time. Huge, really. But my rather limited strength and control are failing. Some tasks require two hands, so it’s not possible for my left hand to simply take over. I’m willing to tolerate much pain for function. Pain without function, not so much. It isn’t clear to me what functions I’ll lose, and what I’ll gain, with fusion. Which is why I thought I’d ask if anyone had experience. That so few have had the procedure is perhaps itself telling.

Yes, people are and have been extremely helpful. For that I am truly grateful. You are one of those who always help. Thank you, Dr. Post.

5

cafo, Have you been to a hand therapist? The CMC joint can often be restored to pain-free and functional with good therapy.
If you go with the fusion then you will have an opposable thumb it just won’t have mobility for a variety of positions. One risk with the CMC fusion is that the next joint toward the tip, the MCP joint gets hyperextended and injured due to trying to attain positions that the CMC joint would usually be responsible for. If you have any hyperextension then you may need to wear a small ring splint to avoid further injury there.

I’ve seen a couple of docs since the surgery. They didn’t suggest therapy, nor offer that hope of function. Perhaps because mine is the result of trauma, the outlook is different. I will certainly inquire, though. Thank you.

6

I’m coming to this thread years late, but I just had thumb fusion due to cutting into the CMC joint during an accident.

The surgeons told me going in that my function would return based 10% on the operation and 90% on the therapy, and by how much I bought into it. I’ve hit it hard— too hard, they say, but I work with my hands and I need the money, and need the functionality even more.

To that equation I’d add an as yet unknown amount of biomechanics. The Trapezium does not pivot like the metacarpal does, or from the same place, and that’s just a fact.

So even though it’s late, go for Occupational Therapy from the best hand people you can find. It will make a world of difference. As far as therapists, training and experience counts for a lot.

BEs of luck.