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 Right thumb CMC arthritis
Author: DougR 
Date:   2020-07-05 17:12

Hello all--

Checked the threads, found nothing specifically on this. Just wondering if anyone else has had a medical diagnosis on this; it's basically a degeneration of cartilage between the basal thumb joint and the wrist bone adjacent, causing bone-on-bone contact with resulting inflammation of the joint and pain associated with it.

It's not a case of "my thumb hurt so I changed the thumb rest" etc., it's a specific diagnosis with a hierarchy of non-surgical treatments leading up to surgical intervention (which is where I am right now).

Playing bass clarinet, with all those right-hand thumb levers, is out of the question, and THAT needs to get fixed.

Just wondering if anyone else has HAD the surgery, and what your results were?

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 Re: Right thumb CMC arthritis
Author: MichaelW 2017
Date:   2020-07-05 18:13

I found this:

https://www.mayoclinic.org/diseases-conditions/thumb-arthritis/symptoms-causes/syc-20378339

and here, a short time ago, I answered to a similar question:
http://test.woodwind.org/clarinet/BBoard/read.html?f=1&i=483942&t=483928

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 Re: Right thumb CMC arthritis
Author: DougR 
Date:   2020-07-05 18:45

Thanks, Michael. Yeah, sounds like you have the same thing, though in my case it's not the weight of the instrument (since it rests on the floor) but the pressure needed when pressing the thumb down on all the weighted levers--diclofenac sodium 2x day doesn't help, cortisone injection helped briefly but only temporarily. Surgery is the only option left AFAIK, and was wondering if anyone had HAD the surgery & how the recuperation went.

Thanks for weighing in.

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 Re: Right thumb CMC arthritis
Author: m1964 
Date:   2020-07-05 19:46

Hi DougR,
If the arthritis is in a very advanced stage (bone-on-bone), I wonder what kind of surgery were you considering.
In case of knee or hip arthritis, the whole joint can be replaced, but I am not aware of CMC joint replacement surgery.
I would get a second opinion from another hand surgeon. Unfortunately steroid injections do not help in a long run and may cause ligaments and tendons weakening due to uncreased laxity of the those structures due to side effect of steroids.
Have you tried hand therapy? Not physical/occupational therapy, but specifically hand therapy with a certified hand therapist - if not I would give it a try before the surgery.



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 Re: Right thumb CMC arthritis
Author: DougR 
Date:   2020-07-05 22:17

Hi m1964--You remind me I haven't yet considered hand therapy seriously enough. You sound at least familiar with the ins and outs, which I appreciate. I'm at either stage 3 or 4 in terms of pain, difficulty etc.; in terms of most customary types of surgery, I'm considering excision arthroplasty with or without tendon interposition (a very common operation, as I understand it). BUT--I have no more than a Web-MD knowledge of any of it, and I like your suggestion of hand therapy as a next step. Will be looking into that, thanks.

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 Re: Right thumb CMC arthritis
Author: graceej13 
Date:   2020-07-10 21:59

I have had both of my thumb joints replaced due to basal thumb arthritis. I do not have any issues playing B flat clarinet, tenor or alto sax. I had the peocedure where they remove the bone at thr base of your thumb and harvest a tendon from your arm to squish into the place where the bone was. I would suggest finding a good surgeon who has lots of experience with this procedure and have it done. No more pain. No more grinding and no more feeling of electric shock when you turn a doorknob or a key. Best of luck

PGrace

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 Re: Right thumb CMC arthritis
Author: DougR 
Date:   2020-07-12 08:47

thanks, Grace. That is great to hear, because that particular operation was spooking me a bit, due to the drastic-sounding nature of it. that's what I might end up with; playing tenor sax and especially low-C bass puts a huge amount of strain on the right thumb. Glad to know your operation worked out.

If you don't mind, are you using a neck strap with the Bb? How long ago was your operation and for how long could you absolutely doctors-orders NOT play after you had it done? any loss of strength in either hand?

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 Re: Right thumb CMC arthritis
Author: graceej13 
Date:   2020-07-13 02:00

I had my right thumb done in 2011 and did not play from April until mid July. I did use a neck strap that first year as things were recovering. I no longer need it. Also, at that time I was not playing sax at all. I just did not own one and it didnt really have anything to do with the surgery. I did go through a fair amount of physical therapy on my hand.
The second hand was a few years later, and I ran into some issues that at first appeared to be surgery related, but were actually due to a pinched nerve I had in my neck, that I eventually had surgery on. This was really an unfortunate coincidence, and as soon as the neck surgery healed I was good to play. I suspect I could have been playing less than 3 months after the left hand surgery without this complication.
I know it is frightening to consider, and the decision is yours to make but I know having this surgery was the right choice for me.
Good luck

PGrace

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 Re: Right thumb CMC arthritis
Author: DougR 
Date:   2020-07-13 04:12

Thanks again, PGrace. Meeting the doc tomorrow, and while removing the trapezius bone and stuffing a ligament into the cavity could be horrifying to contemplate, on the other hand I have a nearly-new low C bass I can't play at all, and a beautiful tenor sax I can barely play, without pain, which is ALSO horrifying, certainly contemplating putting those instruments aside for good is even more horrifying.

I thank you for all the details you've provided. They will definitely inform my decision. Cheers!
doug R.

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 Re: Right thumb CMC arthritis
Author: richardstone 
Date:   2020-07-17 01:23

I have had right thumb arthritis pain for about 6 years and 3 years ago was forced to quit playing violin because the pain was so bad. I played in two regional symphonies. I decided I would learn to play the clarinet but did not take long for the pain to develop in the left thumb. Tried all of the thumb rest solutions. The Kooiman rest helped a lot but the pain continued to get worse. Finally went to the ortho. doctor yesterday. He took ex-rays and said bone on bone for both thumbs. He offered the surgery but suggested I try cortisone in both thumbs along with thumb splints. The cortisone has started to work after one day and the thumb splints allow me to play the clarinet just fine. They do not impede finger placement or hand movement and I could still use the Kooiman rest. The splints are called MetaGrip Thumb CMC Orthosis and come in several sizes for each hand. They were covered by insurance because they are a prescription. Don't know if they can be purchased on the Internet. I am sold after one playing session and see this as a way to continue playing along with pushing off an eventual surgery along with its several month recovery.
Hope this helps
Richard

richarddstone@mac.com

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 Re: Right thumb CMC arthritis
Author: DougR 
Date:   2020-07-18 22:34

Thanks, Richard! Glad you're getting some relief. After my initial visit with the orthopedist, I walked out of the office with a semi-rigid splint for overnight, and a softer splint for regular use, plus diclofenac sodium gel applied topically 2x a day. A month later, on my 2nd visit, I got a cortisone shot, since the other stuff didn't work well enough to make an appreciable difference. I got some immediate relief, but again not enough to return to normal playing--one short practice session on the low-C bass was enough to cause pain that shot up to a 6 on the pain scale, gradually subsiding down to a 4--again, it's not adequate relief for my purposes.

I hope the splints and thumb rests do the job for you, and thanks for replying. I'm pretty much resigned to the surgery, even with the several (as much as 6?)-month recovery. Good luck and happy playing!



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 Re: Right thumb CMC arthritis
Author: RKing 
Date:   2020-07-25 20:00

I have been MIA for the past 18 months because I was recovering from my own right wrist surgery.

I realize that every situation is different - in my case my right thumb had been jammed against the adjacent wrist bones in an auto accident about 30 years ago. I play sax, clarinet, bass clarinet, and flute. Each instrument puts its own stress on the right thumb and the pain had increased over the years to the point that I finally had to do something about it.

I talked to my doctor (a hand specialist) as they say on TV and the x-rays showed that I had no cartilage in that area and the doctor said that my bones were basically trying to fuse themselves together. So I asked her to finish the job.

She fused my Trapezium and Trapezoid bones to the Scaphoid and used staples to hold things together. She joked that she bought the staple gun from Lowes and we had a good laugh. :-)

After a couple of months in a cast and a few weeks of therapy, I was able to play the concert flute okay - I picked up a student C-foot to try because it's lighter. In the past six months I have also been able to pick up my saxophones and the soprano clarinet. But the fused wrist does NOT let me play the bass clarinet. I don't have the flexibility to cock my wrist enough - yet - to play it and that is the same issue I had with a straight-head alto flute.

I wish I could play all of my woodwinds, but I can play my favorites totally free of pain. As more time goes by (and I heal even more) I might regain enough flexibility to play the bass clarinet. Even with this caveat, I consider the surgery to have been a wonderful success and it has allowed me to continue playing music.

I wish you the best,

Ron



Post Edited (2020-07-25 20:02)

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 Re: Right thumb CMC arthritis
Author: DougR 
Date:   2020-07-26 08:12

Thank you, Ron! Really glad to hear you're able to play without pain. I've been thru several physically limiting injuries over the years, and my recuperative concerns have always focused on whether I'd be able to play the [fill in the blank] again--which gave me an impetus in PT that maybe 'civilians' don't have otherwise.

Again, thanks for your response and best possible wishes in recovering as much flexibility as possible!

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