26841 Arthrodesis, carpometacarpal joint, thumb, with or without internal fixation

Name of the Procedure:

Arthrodesis, carpometacarpal joint, thumb (also known as thumb joint fusion).

Summary

Arthrodesis of the thumb carpometacarpal (CMC) joint is a surgical procedure that aims to relieve pain and restore stability by solidly fusing together the bones of the joint. This may be done with or without the use of internal fixation devices like plates, screws, or pins.

Purpose

This procedure addresses severe arthritis or instability in the thumb CMC joint. The goal is to eliminate pain and provide a stable and functional thumb for daily activities.

Indications

• Severe arthritis where other treatments have failed
• Chronic instability or dislocations of the thumb CMC joint
• Persistent pain that interferes with quality of life
• Significant loss of thumb function

Preparation

• Pre-operative fasting as advised by the healthcare provider
• Adjustments to current medications, especially blood thinners
• Pre-surgery imaging tests like X-rays to assess the joint

Procedure Description

1. Administration of general or regional anesthesia.
2. An incision is made over the thumb CMC joint.
3. The joint is exposed and the articular cartilage is removed.
4. The bones of the joint are positioned together and may be held with internal fixation devices like screws or plates.
5. The incision is closed with sutures.
6. A splint or cast is applied to immobilize the joint during healing.

Duration

The procedure typically lasts about 1 to 2 hours.

Setting

The procedure is usually performed in a hospital or an outpatient surgical center.

Personnel

• Orthopedic surgeon
• Anesthesiologist
• Surgical nurses
• Possibly a surgical technologist

Risks and Complications

• Infection
• Non-union or improper fusion of the bones
• Nerve damage
• Reduced range of motion
• Pain at the fusion site
• Complications related to anesthesia

Benefits

• Significant reduction or elimination of pain
• Improved stability and function of the thumb
• Long-term relief from symptoms of arthritis

Recovery

• Immobilization in a cast or splint for several weeks
• Gradual increase in activity as directed by the surgeon
• Physical or occupational therapy may be needed
• Full recovery can take several months

Alternatives

• Conservative treatments like medication, splinting, and injections
• Joint replacement surgery (arthroplasty)
• Pros: Less invasive options may suffice for less severe cases
• Cons: May not provide as effective or lasting relief

Patient Experience

• During the procedure, the patient will be under anesthesia and won’t feel pain.
• Post-procedure, patients may experience pain and swelling which can be managed with prescribed pain medication.
• It is important to follow all post-operative instructions to ensure proper healing and avoid complications.