Did you know your thumb accounts for 60% of your hand's total function? What happens when arthritis makes it too hard to use your thumbs?
The Ohio State University Wexner Medical Center now offers a new implant for people suffering from painful thumb arthritis.
Dr. Ryan Schmucker, who was recently trained on the procedure, joined Morning Edition Host Stu Osborne to discuss the surgery.
Stu Osborne: You traveled to France to learn how to perform this surgery. Tell us about that training and the surgery itself.
Dr. Ryan Schmucker: It was an incredible opportunity. This implant has been used in Europe for the last 10 years or more, over 40,000 implants have been put in over there. And so we go to meetings or academic meetings all the time. And we've been hearing about this for years and very eager for this to be brought to the United States. When I went over there, I trained with surgeons who have put (in) thousands of these implants. I spent time with a surgeon in Nîmes, France, for a couple days, and then I went actually up to the place where they manufacture these implants and spent a couple of days up there doing some cadaver labs, learning the procedure with around 10 surgeons from the U.K., from Spain, from France and from Germany, who have all done many of these, and so it was really an invaluable opportunity to gain experience that normally would have taken a long time to gain. I gained that over a very short period, over three days, which was excellent.
Stu Osborne: A lot of people associate arthritis with gnarled knuckles or misshapen hands, but that's not always the case, right?
Dr. Ryan Schmucker: Correct, absolutely. You do not have to see it for it to be there. And in fact, when it starts, you often don't see anything at all. You just have pain. And oftentimes people feel pain and they think actually they have weakness. If you go to grip a key to turn on your car or you try to open a jar and you're not able to, people often think, hey, my muscles are getting weak. Maybe I need to do some exercises. But in reality, a lot of times, whenever we pinch and grip, all that force goes right down to the base of our thumb. And if you have arthritis there, your body actually turns off your muscle and says you can't squeeze anymore because it hurts. And that pain actually isn't muscle weakness at all. It's usually the beginning signs of arthritis.
Stu Osborne: When I think of thumbs, I can't help but think of fellow Gen Xers who probably played a lot of video games as a kid, you know, Nintendo doing the A, B and stuff, and now a lot of us use our thumbs when we're typing or scrolling on our phones. Are you seeing a lot cases kind of tied to those type of things?
Dr. Ryan Schmucker: Yeah, you know, it's interesting. We see a lot of what we call "texter thumb" or people that are on computers all day. We use our hands a lot differently now than we did even 10 years ago. But, the interesting thing is that there can be two people that played the same amount of games or did the same amount typing, and one of them gets horrible arthritis and one of them doesn't, and there are a lot of factors associated with it. Some of it's genetics. You know, if your parents had awful arthritis, you may have a chance of that as well. So, it's not a one-to-one that everyone that does those things gets arthritis, but there are predispositions to it. And certainly texting or the way that we're holding our phones over time can aggravate this. And what happens in this joint specifically is this is a saddle-shaped joint. It makes our thumb able to do all the cool motions that it can do and allows us to function the way that we can. But it's an inherently kind of unstable joint. It's like someone sitting on a saddle. It's easy to slide off either side. And so those ligaments that surround that thumb joint kind of wear out over time. And as they do, the thumb kind of slides in that saddle and then it's rubbing kind of abnormally and wears away the cartilage over time so that, and arthritis really is just the absence of cartilage. Once we start rubbing bone on bone, that causes pain. That's not supposed to happen. And so that's how that arthritis progresses.
Stu Osborne: One important thing to note, the surgery is not seen as a first option for those suffering from this arthritis, correct?
Dr. Ryan Schmucker: Very correct, yeah. I rarely offer surgery the first time I see people. This is something that we can manage over the long term. Most of my thumb arthritis patients, I've known for years before I operate on them and that's because we go through all the other options. We usually start with something called a comfort cool splint. I don't want them to stop moving. Anyone with arthritis, we always say motion is lotion. So I want them to keep moving. And using their thumb, and we're going to give them a support brace. We're going to teach them how to use heat and cold and topical anti-inflammatories to kind of control their symptoms. And if they get to a point where those don't work, then we start to employ things like steroid injections and other modalities like therapy to kind of keep their baseline a little bit lower. They may not have an absence of pain, but as long as you can do everything you want to be able to do. Then we don't do surgery. It's when you reach the threshold of now. I can't do the activities I love. I can't knit anymore, I can't play pickleball. I (can't) play golf. Those things, once you're not able to do the things you want to do. That's when we talk about surgery.
