Wanted for arthritic pain sufferers: pain relief. Added stability and strength would be a bonus. In this article hand surgeons report on the use of APL suspensionplasty to treat arthritic pain at the base of the thumb (carpometacarpal joint). Pain relief without weakness was the favorable outcome for most of the patients.
Pain at the carpometacarpal (CMC) joint can be very disabling. Weak pinch and grip limits daily activities. Many operations have been tried for this problem. Ligament repair and tendon transfer are the most common.
Suspensionplasty is the use of the abductor pollicis longus (APL) tendon as a sling. First, the arthritic bone at the base of the thumb (trapezium) is removed. Then the APL is taken from its attachment to the CMC and threaded through two tunnels. One tunnel goes through the bone of the index finger. The other goes through the thumb. The APL is stitched to another tendon to hold it in place. The overall effect is to stop the deforming force of the APL on the CMC joint.
Everyone was followed for at least one year. Grip and key-pinch strength was measured before and after surgery. Range of motion and pain levels were also recorded. X-rays were taken before and after as well. Two-thirds of the patients were pain free after surgery. Pinching and gripping activities were much easier. Two patients still had some weakness when opening jars and using keys.
The authors show how suspensionplasty is an effective surgical treatment for painful arthritis of the thumb. Short-term results in this small study showed improved thumb stability and function. Pain relief at last!