Thumb distraction

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What is thumb distraction?

Thumb joint distraction is used to treat painful thumb osteoarthritis (OA). It can prevent or slow down the progression of OA by relieving stress on the cartilage. This prevents further wear and tear and allows the cartilage to recover.

What is thumb joint distraction?

Joint distraction is a minimally invasive surgical procedure that preserves the thumb joint. It combines advanced surgical techniques with the body’s natural healing processes to repair damaged cartilage in the thumb.

What conditions can be treated?

Thumb joint distraction is used to treat painful thumb osteoarthritis (OA). It can prevent or slow down the progression of OA by relieving stress on the cartilage. This prevents further wear and tear and allows the cartilage to recover.

Who can it help?

It can help many people affected by arthritis. Thumb joint, or first carpometacarpal joint OA, affects more than one-third of people aged over 55. It’s most common in women aged 50-70.

What can I do to prepare for my thumb distraction surgery?

Research carried out by the World Health Organization (WHO) revealed that patients who have the knowledge, skills and confidence to manage their own condition enjoy better outcomes.

It’s important to feel well informed about your treatment and to carry out any exercises you’ve been given to do before and after your surgery. A member of our physiotherapy team will be able to advise you about the kind of exercises that could help.

What happens at my pre-surgery appointment?

You’ll have some pre-operative tests including blood tests that check your levels of
Vitamin D (which is important for bone and joint health) as well as swabs to rule out infection or other problems. As well as being weighed, there’ll be an opportunity to discuss your medical history and any risks of surgery that might affect you.

We’ll discuss the risks and complications of treatment with you so that you understand exactly what’s involved.

If you decide to go ahead, it’s important to follow the preparation advice from your healthcare team. This includes:

  • If you smoke, you should stop at least 8 weeks before the operation and not restart for at least 3 months afterwards. This is because the toxins in smoke can affect your body’s ability to heal. It can also raise the risk of complications including blood clots in the lungs (pulmonary embolism) or calf (deep vein thrombosis). Smoking also increases your risk of having an infection
  • Taking advice about any medication you’ve been prescribed and whether it should be taken during the week before your surgery, the day of surgery and the first few days afterwards. This is particularly important if you are taking blood-thinning drugs such as warfarin which can increase bleeding during surgery
  • Following any instructions you’ve been given about fasting (including drinking) before your operation. This is to avoid problems associated with the general anaesthetic, such as nausea
  • We’ll be able to advise you about the level of activity you can safely do while you are waiting for surgery

What type of anaesthetic will I need?

Most people have a general anaesthetic, but this is something we’ll discuss with you during your pre-operative appointment.

How long will I be in the hospital?

The procedure itself usually takes around 45 minutes and, in most cases, you’ll be able to go home the same day.

What does thumb distraction surgery involve?

During this minimally invasive procedure, a small external frame is fixed across the joint where the thumb meets the palm of the hand. This enables it to be distracted (pulled apart) by about 3mm. Creating space in the joint helps the cartilage to heal itself. The device will stay on your hand for around 8 weeks before it is removed.

What will happen immediately afterwards?

Your hand will feel numb and will be raised to minimise swelling. You’ll be encouraged to get up and move about as much as possible. This helps improve blood flow and reduces the risk of deep vein thrombosis (DVT).

After your surgery, you’ll be shown how to clean the wounds to avoid infection. Your hand therapist will give you some exercises to help speed up your recovery.

The more closely you stick to your rehabilitation programme, the more benefit you’ll get from your surgery.

You’ll be given a schedule of follow-up appointments to check the frame and how well you’re recovering. We’ll be able to advise you about which activities you’ll be able to do.

What about pain relief?

During your operation, you’ll be given an injection of pain relief in your hand. Afterwards, you’ll be given painkillers as required. Any pain is usually from the pin wounds rather than from the distraction in the joint. In most cases, this settles down within a few days after the operation and only requires mild painkillers.

Are there likely to be any complications after surgery?

The risk of complications is low but can include infection in the pin wounds. You might also have stiffness around the joint, but this can be helped by doing your exercises regularly.

Other complications can include:

  • Nerve damage – this can cause numbness which is usually only temporary (but can be permanent)
  • Bleeding or bruising around the pin sites, but this usually heals quickly

Before you go home, you’ll be shown how to keep the wounds clean. You should contact us, or your own GP straight away if:

  • You have pain that becomes worse
  • You have a temperature and/or feel unwell – this could mean you have an infection
  • Your thumb joint is very inflamed, swollen or the wound is bleeding/oozing
  • You have extreme discomfort in your lower leg (this can be a sign of DVT)

How long is the recovery?

  • In most cases, the frame remains in place for around eight weeks while new tissue grows in the joint
  • The frame is removed during an outpatient clinic visit. You won’t need to have an anaesthetic or sedation

How long will I need off work?

That depends on the kind of work you do. If your job involves manual work, you may need up to four months off.

When can I drive again?

This can vary from person to person, but your surgeon will be able to advise you.  In most cases, we recommend that you don’t drive while the frame is on your hand (for around 8 weeks after your surgery) and, in some cases, for a while afterwards. Your surgeon will be able to advise you about this.

Please note: it’s your own responsibility to drive safely, and you should check with your insurer to confirm you are covered.

How can I help improve/speed up my recovery?

The best way to improve your rehabilitation is to follow any advice from your hand therapist about gradually building up your exercises so you can get back to normal as soon as possible.

What is the long-term outlook?

It can take up to a year to feel the full benefits of surgery. You can help your recovery by carrying out the rehabilitation exercises your hand therapist advises.

  1. Kings Fund. Supporting People to manage their health. Available at: Accessed 22 November 2016.