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  • Trapezium-Sparing Options for Thumb Carpometacarpal Joint Arthritis

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    Old 05-02-2014, 05:58 AM   #1
    scotia99
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    Trapezium-Sparing Options for Thumb Carpometacarpal Joint Arthritis

    Went to surgeon 5 years ago for pain in my thumb base. Told me CMC surgery, removing trapezium etc. I didn't do it. I am ready to maybe consider surgery again. Now he says, they spare the trapezium, clean off the osteophytes and then spilt the tendon, and cushion the trapezium. Has anyone done this type of surgery? Please share! I can't seem to find much info on this. Thanks in advance.

     
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    Old 05-19-2014, 11:21 AM   #2
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    Re: Trapezium-Sparing Options for Thumb Carpometacarpal Joint Arthritis

    Quote:
    Originally Posted by scotia99 View Post
    Went to surgeon 5 years ago for pain in my thumb base. Told me CMC surgery, removing trapezium etc. I didn't do it. I am ready to maybe consider surgery again. Now he says, they spare the trapezium, clean off the osteophytes and then spilt the tendon, and cushion the trapezium. Has anyone done this type of surgery? Please share! I can't seem to find much info on this. Thanks in advance.
    That's not something I've heard of. I did a fair amount of research before my recent trapeziectomy and found a number of variations on trapeziectomy but not what you described. It would be interesting to learn from your surgeon how many times he has performed that surgery and what the long-term (at least 5 years) results are. Trapeziectomy has been performed since the 1940s.

    Are you considering getting a second opinion?

    Good luck with whatever you decide!

     
    Old 06-24-2014, 08:27 PM   #3
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    Re: Trapezium-Sparing Options for Thumb Carpometacarpal Joint Arthritis

    I am now 4 days post op. Apparently I misunderstood what procedure I was having. Surgeon did remove the trapezium and did the tendon transfer. And after the surgery was over he stated to me that he has always said the trapezium comes out. Not a nice Doc for sure. But what is done us done. He does not like when I ask questions and treats me like a fool for asking. I also had issues with the anesthesia... I was a restless patient and would not settle. The surgeon told me right after the surgery... That I am not a good candidate for surgery and I shouldn't have surgery. I was so upset... The anesthesiologist told me privately that I am not the only one that has had reactions to fentanyl...and he said I was challenging but no problem. After being told these things from the surgeon... He stormed off and I guess I will find out in 10 days what condition my bone etc was in and how the surgery went.
    So, with no information given to me after the surgery about what to expect, I am home and desperately need the advice the advice of others.

    I have been icing and elevating constantly. I didn't have much pain for 2 days except for the swelling and tingling and burning sensation. And possibly from the drugs got sick to my stomach for the first few days.

    Day 3 and 4 have been much more difficult... I am experiencing a sharp pain on the top of my hand and I guess on the thumb itself. Is that normal? Surgeon I think also put a pin inside that doesn't come out.

    Every where I read on the boards, people are placed in several casts for what seems to be almost 6 weeks. This surgeon says he is removing the cast and taking the stitches out on day 10. At that time he will put me in a removable splint, ( one like you get at walgreens) that I will wear everyday, all day for 6 weeks. At the 6 week mark he will take an X-ray and if all is good I am done. No PT. He states that pt does more harm and that I am to be moving and exercising my hand at my own pace.

    I could really use advice on what type of pain is normal in the first 10 days and if anyone else has been given a walgreens splint to wear. Also, the X-ray... Is that normal to wait until the 6 week mark?

    I am nervous to see him on the tenth day to get stitches and cast off. I am powerless but still have a voice. I need to ask questions and this guy hates that.

    Advice?

     
    Old 06-25-2014, 09:05 AM   #4
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    Re: Trapezium-Sparing Options for Thumb Carpometacarpal Joint Arthritis

    Quote:
    Originally Posted by scotia99 View Post
    I am now 4 days post op. Apparently I misunderstood what procedure I was having. Surgeon did remove the trapezium and did the tendon transfer. And after the surgery was over he stated to me that he has always said the trapezium comes out. Not a nice Doc for sure. But what is done us done. He does not like when I ask questions and treats me like a fool for asking. I also had issues with the anesthesia... I was a restless patient and would not settle. The surgeon told me right after the surgery... That I am not a good candidate for surgery and I shouldn't have surgery. I was so upset... The anesthesiologist told me privately that I am not the only one that has had reactions to fentanyl...and he said I was challenging but no problem. After being told these things from the surgeon... He stormed off and I guess I will find out in 10 days what condition my bone etc was in and how the surgery went.
    So, with no information given to me after the surgery about what to expect, I am home and desperately need the advice the advice of others.

    I have been icing and elevating constantly. I didn't have much pain for 2 days except for the swelling and tingling and burning sensation. And possibly from the drugs got sick to my stomach for the first few days.

    Day 3 and 4 have been much more difficult... I am experiencing a sharp pain on the top of my hand and I guess on the thumb itself. Is that normal? Surgeon I think also put a pin inside that doesn't come out.

    Every where I read on the boards, people are placed in several casts for what seems to be almost 6 weeks. This surgeon says he is removing the cast and taking the stitches out on day 10. At that time he will put me in a removable splint, ( one like you get at walgreens) that I will wear everyday, all day for 6 weeks. At the 6 week mark he will take an X-ray and if all is good I am done. No PT. He states that pt does more harm and that I am to be moving and exercising my hand at my own pace.

    I could really use advice on what type of pain is normal in the first 10 days and if anyone else has been given a walgreens splint to wear. Also, the X-ray... Is that normal to wait until the 6 week mark?

    I am nervous to see him on the tenth day to get stitches and cast off. I am powerless but still have a voice. I need to ask questions and this guy hates that.

    Advice?
    I am sorry to hear you've had a bad experience with your surgeon. He's someone you want to be able to trust and talk to but he isn't doing his part to alleviate your concerns.

    I had my CMC arthroplasty exactly 8 weeks ago. The pain I had was some aching, occasional sharp stabbing pains, and burning. It was never awful, though if the stabbing pains had been constant, that would not have been fun.

    The most critical element in my opinion is keeping your hand elevated above your heart all the time - yes, really, 24 hours a day, every day, for 6 weeks. You can apply an ice pack to the inner portion of your elbow; that will cool the blood as it goes toward your hand and reduce swelling.

    I had my stitches removed on day 9 and a therapist formed a plastic splint. Although it was removable, I was instructed not to take it off until the 6 week point. I was allowed to remove it to change the liner but otherwise it stayed on.

    At 6 weeks, I began therapy with a certified hand therapist (CHT), a specialized occupational therapist (OTR). I was extremely stiff from having been immobile for so long. Her first concern is to get my range of motion back to normal in both my wrist and my thumb. That is coming along nicely. I am doing exercises several times a day. The benefit of seeing a therapist is she can assess my current status and knows when to move to the next level of exercises. She also does massage to help loosen up the stiff muscles and connective tissues.

    At 4 days, you're still in the early stages. The first week, I felt very run down and needed a lot of sleep. After that, I had more energy and was able to do more, though not with my hand.

    There are some good threads here that will let you see how others have recovered. See "Basal Joint surgery" started by Haydena. Also see "going through the basal joint surgery process - my story" by Janet20. Haydena is still on the boards and is very helpful and welcoming. Don't hesitate to reach out directly to her by PM and she'll be very supportive.

    Stay strong! This is a tough surgery to get through but you are on your way. Please keep in touch and let us know how you're getting on.

    Linda

     
    Old 06-25-2014, 10:58 AM   #5
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    Re: Trapezium-Sparing Options for Thumb Carpometacarpal Joint Arthritis

    Thank you for your input. I do feel pretty exhausted.. But suspect that will change soon. I think I had a lot of fear and some confusion going into the surgery. I am a very active and independent person...so that unconscious side of me must have resisted during the surgery. I will do and follow whatever is recommended to the letter! Good advice about icing at the elbow area and continuing to elevate for those 6 weeks. Today I woke up with no pain unless I rotate my hand outward to a palm up position. Thanks again for your input.

     
    Old 06-25-2014, 12:32 PM   #6
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    Re: Trapezium-Sparing Options for Thumb Carpometacarpal Joint Arthritis

    Quote:
    Originally Posted by scotia99 View Post
    Thank you for your input. I do feel pretty exhausted.. But suspect that will change soon. I think I had a lot of fear and some confusion going into the surgery. I am a very active and independent person...so that unconscious side of me must have resisted during the surgery. I will do and follow whatever is recommended to the letter! Good advice about icing at the elbow area and continuing to elevate for those 6 weeks. Today I woke up with no pain unless I rotate my hand outward to a palm up position. Thanks again for your input.
    scotia, hi, I have just read all your posts here on this thread & I am in shock!
    your surgeon has no bedside manner at all & I am sorry he behaved so unprofessionally towards you. I honestly think that you need to take a friend or a family member along with you on your next visit to his clinic/rooms. 4 ears are better than 2 & you will need moral support.

    Please dont feel bad about having a bad reaction to the anesthetic you were given.( I came out of my anesthetic like a crazy woman, shaking my head non-stop. The nurses around me were ok with that) It is natural & normal to feel very tired after a general anesthetic. Drink lots of water to flush all toxins out of your body. By the way, it takes up to 1 year for the anesthetic to leave your body! Eat nourishing meals. Rest as much as you can. Be patient with your recovery.

    An xray is taken of your operated hand on the 2nd day, to see if the bones have received the tendon. Some doctors do xray the hand after 10 days - 2 weeks.

    I have never heard of a patient not having physical therapy after 5-6 week healing period.

    I also have never heard of a patient going into a simple splint once the cast is removed. Your hand & wrist will need a firmer kind of support.

    If you have a pin in your hand, you will see it on the xray, so be sure to ask to see that xray.

    The first week is the hardest, pain wise. Stamm correctly explained to you to elevate your hand above your heart. Sleep with you arm raised on pillows, which is very important as it allows the blood to flow back to your heart, reduces swelling & is also good for the pain. Try not to tense up your upper arm muscles nor your shoulder.

    You can also place the ice pack onto the cast. Ice is going to be your best friend! remember not to place the ice pack directly onto your skin; use a thin towel between your skin & the ice pack.

    Do not rotate your hand outward to a palm up position. Best not to move your hand at all for now. You can however move the tip of your thumb.
    Your hand needs complete rest.

    I hope you continue to be pain free. If you have any further questions, dont hesitate to ask.

    I wish you well.
    Haydena.

     
    Old 06-25-2014, 12:53 PM   #7
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    Re: Trapezium-Sparing Options for Thumb Carpometacarpal Joint Arthritis

    Thank you Haydena. He definitely plans on putting me in the walgreens small splint for 6 weeks and he definitely won't take X-ray until the 6 week mark. He did make that very clear to me. He believes that pt makes it worse and is worked to hard. Doc said no pinching or grasping for 6 weeks. Not really sure how not to use hand unless pain stops me while in the tiny splint. The other hand surgeons in this office all do the casting and pt. My confidence is low and now I feel embarrassed since I made a scene and was difficult to operate on.
    I am going to the surgery center Friday and requested the operation notes and any other notes surgeon has made. I am bringing a family member with me, who also witnessed his agitation and aggression towards me. Prior to the surgery he didn't review or talk to me or my spouse about the procedure.
    All this is in the past and I need to focus on the healing. I saw in a previous post that you recommended traumeel? Where would I get that? I am already using arnica and have my vitamin e ready for the stitch removal. How many stitches are there normally? And have you heard about using and leaving in a plastic pin for the tendon to adhere to?

    Thank you for your quick response.

     
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    Old 06-25-2014, 01:29 PM   #8
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    Re: Trapezium-Sparing Options for Thumb Carpometacarpal Joint Arthritis

    [QUOTE=scotia99;5300167]Thank you Haydena. He definitely plans on putting me in the walgreens small splint for 6 weeks and he definitely won't take X-ray until the 6 week mark. He did make that very clear to me. He believes that pt makes it worse and is worked to hard. Doc said no pinching or grasping for 6 weeks. Not really sure how not to use hand unless pain stops me while in the tiny splint. The other hand surgeons in this office all do the casting and pt. My confidence is low and now I feel embarrassed since I made a scene and was difficult to operate on.
    I am going to the surgery center Friday and requested the operation notes and any other notes surgeon has made. I am bringing a family member with me, who also witnessed his agitation and aggression towards me. Prior to the surgery he didn't review or talk to me or my spouse about the procedure.
    All this is in the past and I need to focus on the healing. I saw in a previous post that you recommended traumeel? Where would I get that? I am already using arnica and have my vitamin e ready for the stitch removal. How many stitches are there normally? And have you heard about using and leaving in a plastic pin for the tendon to adhere to?

    Thank you for your quick response.[/QUOTE

    Scotia, did your surgeon inform you of the risks of this surgery? I have no intentions of frightening you, but the law states that your doctor has to inform you of the risks)

    As far as I know the operation you had has a high success rate.

    If you had a general anesthetic, you were knocked out,you were fast asleep, how is it possible that you were ''difficult to operate on''
    Sounds like your surgeon has major personal issues & you should go into his clinic, calm, cool & collected,with your head held high up, because he has no right to make you feel embarrassed. You did nothing wrong. Please do not allow this man to intimidate you. You & you alone are in charge of your own body.

    I have heard of leaving a plastic pin in hip replacement procedures, not hand surgery.

    Was the tendon taken from your wrist or your upper arm?

    Traumeel has the highest amount of arnica in it. You can order Traumeel online, or try to find it at a drug store that sells herbal/homeopathic products.

    There are 12-14 stitches, depending on the length of your incision.

    There are also many posts on this forum, from patients who write about their PT. There are sites on the internet that go into detail about PT for this surgery.

    If you feel that the simple splint does not support your hand, how about finding an orthopedic firm who could fit you with a proper splint/hand-wrist guard?

    He probably believes that PT is worse to save him paying for a physical therapist to deal with your hand! Shame on him.

    Yes, you now need to focus on your healing & shove all the negative feelings out the window.

    Is it possible that you could find yourself a physical therapist to help you by showing you some worthwhile exercises that you could do on your own? If not, we are here to guide you.

    I wish you good luck for Friday. Please keep us informed.

    Haydena.

     
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    Old 06-26-2014, 12:06 PM   #9
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    Re: Trapezium-Sparing Options for Thumb Carpometacarpal Joint Arthritis

    Scotia, what a shame your recovery got off to a rough start because of the abrasive attitude of the surgeon. You are going to be ok, because your hand will heal, but it will take some time before you see the good results. I would like to offer you some advice...follow Haydena' s detailed instructions, she is an expert. Rest the WHOLE hand for at least another week, don't be tempted to use the fingers sticking out, except for gentle wiggling.
    Later, when you are seeing the doctor, ask him very nicely if he would refer you for an occupational therapy EVALUATION, just to see if a few sessions would be helpful. If he agrees, the ot will of course recommend therapy and he should go along. If you have an eval, it would then be unethical for him to refuse. Like Haydena I have never heard of this surgery being done without it afterwards, because you need guidance on how to regain strength, grip, pinch and dexterity after your hand has had such extensive changes.
    Good news is that the oa pain will be gone, because the trapezium is gone.
    One more thing...don't forget to move elbow and shoulder do as not to lose Rom and strength.
    Keep us posted.
    L

     
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    Old 06-29-2014, 09:25 PM   #10
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    Re: Trapezium-Sparing Options for Thumb Carpometacarpal Joint Arthritis

    In the morning, Monday... I will be going back to the surgeon to get cast off. Stitches out and get the small brace. This surgeon believes in not casting so there really is no point asking about it. I agreed to his method prior to surgery...or at least I signed a paper stated I did!
    I have to believe despite his bad manners, that he is a solid surgeon. He has a good rating and reputation. I did see other similiar complaints online about him though...
    I am thinking that I upset him by asking too many questions and wanted more answers. Who knows...I have to move on!

    With that said...here are some of the questions I have prepared.

    1)Please tell me about the condition of my arthritic trapezium and how the surgery went. How many screws and is there wire in my hand?
    2)How long does it take to get all the numbness to go away.
    3)Why does my wrist hurt?

    The plan:6 weeks wearing removable brace.
    1) when can take brace off
    2) what kinds go stretches or exercises should I be doing? Brace on or off when exercising hand.
    3)What am I allowed to do the first week and so on. For example, no pinching or grasping? Essentially not use it?
    4)What am I allowed to do and not.
    5)Examples of everyday things I should not be doing.
    6)What kind of pain is typically felt in this early healing stage? Ice and elevate still?
    7)When will the X-ray be taken?
    8)Do you have a list of hand exercises that I could have since there will be no pt.
    9)In 4 weeks I will be back at work teaching...what can I typically expect of my hand by then?
    10) If I have any problems or concerns about how my hand is progressing can I contact you to clarify? Do I call your assistant and have her ask you?

    Any other questions anyone can think of would be helpful. I am nervous to talk with this guy...but it is my hand and I will have to be brave!
    I am taking someone with me and hope they will track the conversation and remind me the things I want to ask!

    Thank you so much. It is amazing to have this type of support!

     
    Old 07-02-2014, 12:00 PM   #11
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    Re: Trapezium-Sparing Options for Thumb Carpometacarpal Joint Arthritis

    Quote:
    Originally Posted by scotia99 View Post
    In the morning, Monday... I will be going back to the surgeon to get cast off. Stitches out and get the small brace. This surgeon believes in not casting so there really is no point asking about it. I agreed to his method prior to surgery...or at least I signed a paper stated I did!
    I have to believe despite his bad manners, that he is a solid surgeon. He has a good rating and reputation. I did see other similiar complaints online about him though...
    I am thinking that I upset him by asking too many questions and wanted more answers. Who knows...I have to move on!

    With that said...here are some of the questions I have prepared.

    1)Please tell me about the condition of my arthritic trapezium and how the surgery went. How many screws and is there wire in my hand?
    2)How long does it take to get all the numbness to go away.
    3)Why does my wrist hurt?

    The plan:6 weeks wearing removable brace.
    1) when can take brace off
    2) what kinds go stretches or exercises should I be doing? Brace on or off when exercising hand.
    3)What am I allowed to do the first week and so on. For example, no pinching or grasping? Essentially not use it?
    4)What am I allowed to do and not.
    5)Examples of everyday things I should not be doing.
    6)What kind of pain is typically felt in this early healing stage? Ice and elevate still?
    7)When will the X-ray be taken?
    8)Do you have a list of hand exercises that I could have since there will be no pt.
    9)In 4 weeks I will be back at work teaching...what can I typically expect of my hand by then?
    10) If I have any problems or concerns about how my hand is progressing can I contact you to clarify? Do I call your assistant and have her ask you?

    Any other questions anyone can think of would be helpful. I am nervous to talk with this guy...but it is my hand and I will have to be brave!
    I am taking someone with me and hope they will track the conversation and remind me the things I want to ask!

    Thank you so much. It is amazing to have this type of support!
    You got the answers you were looking for Scotia?
    I hope so.
    How does your hand feel today?
    Haydena.

     
    Old 07-02-2014, 04:03 PM   #12
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    Re: Trapezium-Sparing Options for Thumb Carpometacarpal Joint Arthritis

    Scotia,

    Good job in coming up with a detailed set of questions. It is so easy to think you'll remember and then find yourself totally perplexed when you get into the office. That's what happens with me.

    There is a local surgeon here who uses a procedure in which the patient is out of the cast at 10 days and then wears a removable splint for another several weeks. Perhaps that is the type of surgery you had? A big benefit of not being immobile for 6 weeks is you won't have to overcome so much wrist and finger stiffness that comes with casting.

    Many doctors have a brusque and almost rude manner to them yet are experts in their fields. If at all possible, try to approach this with a sense of curiosity and don't go in expecting to be treated badly. If he does reacts poorly, as he did in the past, remember it is all his problem and nothing you have done wrong. It is your right to ask pertinent questions and receive thorough answers. Best of luck and let us know how it goes and how you are doing.

    Linda

     
    Old 07-03-2014, 09:41 AM   #13
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    Re: Trapezium-Sparing Options for Thumb Carpometacarpal Joint Arthritis

    I went in with a positive attitude and was greeted by the surgery in a respectful way. He was a different person! I was able to ask my questions and felt like it was a good visit. My hand is doing very well... I am able to move all fingers to a fist and when I do take the brace off I can bend my thumb slightly. I can touch all fingers except for the pinky!
    I can't say all the pain from the surgery is gone but that horrible arthritis pain is gone! Yahoooo! My biggest enemy at this point is myself. Patiences....and not using my hand too too much. I am fully aware of the consequences of the tendon detaching...so won't be going there.
    A question that I forgot to ask is...my scar. He put on steri strips to ensure the stitches hold. When can I take that off and when can I start gentle scar massage? And does vitamin e help with the scarring?
    Thanks everyone for the support given on these boards!

     
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    Old 07-03-2014, 11:39 AM   #14
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    Re: Trapezium-Sparing Options for Thumb Carpometacarpal Joint Arthritis

    Quote:
    Originally Posted by scotia99 View Post
    I went in with a positive attitude and was greeted by the surgery in a respectful way. He was a different person! I was able to ask my questions and felt like it was a good visit. My hand is doing very well... I am able to move all fingers to a fist and when I do take the brace off I can bend my thumb slightly. I can touch all fingers except for the pinky!
    I can't say all the pain from the surgery is gone but that horrible arthritis pain is gone! Yahoooo! My biggest enemy at this point is myself. Patiences....and not using my hand too too much. I am fully aware of the consequences of the tendon detaching...so won't be going there.
    A question that I forgot to ask is...my scar. He put on steri strips to ensure the stitches hold. When can I take that off and when can I start gentle scar massage? And does vitamin e help with the scarring?
    Thanks everyone for the support given on these boards!
    No way can you massage your scar whilst the stitches are still there. The strips will be removed when your stitches are removed. Your doc put the steri strips on your scar to hold your stitches. Patience is required here!
    The less you use your hand the faster you will allow it to heal. Of course you need to do your easy exercises.
    The best cream for your scar is Calendula ointment. It is more greasy than the Calendula cream.( Calendula is a healing preparation.) Traumeel is also advisable to use. Both can be applied at the same time. I found that Vit E didnt help as much as the 2 mentioned above.
    I am pleased your doc's visit went well....great relief for you, I am sure.
    I wish you well.
    Haydena.

     
    Old 07-03-2014, 01:08 PM   #15
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    Re: Trapezium-Sparing Options for Thumb Carpometacarpal Joint Arthritis

    Hi again,
    My stitches have been removed and the nurse put steri strips on to make the stitches dont bust open. It looks and feels together. I am being really careful... Feeling positive about this surgery, especially since it was a huge decision. I am 51 and an avid rock climber. I need my hand and tendon to grow and heal correctly! I will look into the cream you mentioned for the scar! Thanks for your input.

     
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