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I went to see three different surgeons (one was a hand specialist) and got three different suggestions for my thumb. They each explained that I have a zigzag deformity from arthritis but they didn't agree on what to do for it. Now I don't know what to do. What do you tell your patients?

Management of the type of thumb deformity you describe (caused by arthritis) can be a complex challenge. Decision making between surgeon and patient becomes a collaborative process. The goal of surgery is to stabilize the joint and possibly bring the thumb into a more functional position. Both function and appearance can be improved. But which surgery to choose remains an unknown. Without evidence to show what works best, the choice of surgery is left up to the surgeon. A review of the literature shows many different surgical approaches. But no one single procedure has risen above the others as being superior. There are ligament and tendon transfers, fusions, pinning procedures, bone removal, and capsulodesis. This last technique involves shifting the metacarpal attachment of the volar plate. The volar plate is a very thick ligament that prevents hyperextension from occurring. Results seem to vary depending on severity of deformity, presence of joint instability, and surgical approach taken. Some patients regain full use of the thumb. Others have an improved cosmetic result but no change in their ability to use the thumb. Some studies show that unless the deformity is at least 30 degrees or more, no change can be expected with surgery to correct the problem. For patients with degenerative joint disease and an unstable joint that won't realign, joint fusion may be the only reasonable choice. Experts agree there is a need for future studies to compare results of different treatment options. Research is needed to show if there is even a need for surgery at all. The question needs to be answered whether surgery improves function enough to make it worth it. And of course, which procedure is the most effective must be determined. This is one problem you may not find complete agreement on. Each of the three surgeons you have consulted has given you the best advice he or she has based on clinical and surgical experience. You may have to work through this problem slowly until you find the choice that seems best for you.

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