Yesterday (May 16, 2025), I had an appointment with a new-to-me hand and wrist doctor for pain I’m having in my right thumb.  As a pianist/organist/bell ringer/balalaika-ist this isn’t a good place to have pain.

I even have a handle on my coffee cup that’s giving me pain so I’ll have to drink left-handed for a while.

Of course, the first thing they did was take x-rays.  The tech put my hand in all kinds of positions I didn’t know were available and asked me to hold them.  I’m sure that  these didn’t help my pain at all.

The x-rays showed:

Ok, then.

The doctor came in and asked questions, touched, pushed, pulled places on my thumb – “Does this hurt?”  DUH

There were the usual 3 options.  Brace/Voltaren, injection, surgery (Trapeziectomy).

Google AI Says:

This surgical procedure, commonly known as trapeziectomy with ligament reconstruction and tendon interposition (LRTI) or suspensionplasty, is used to treat thumb carpometacarpal (CMC) joint arthritis. It involves removing the trapezium bone, a small bone at the base of the thumb, and then either suspending the thumb’s metacarpal bone (the bone in the thumb) to the second metacarpal bone with a suture or tendon or using a tendon to support the thumb metacarpal base. 

Here’s a more detailed explanation: 

1. The Problem:

• Thumb CMC joint arthritis causes pain, stiffness, and limited movement in the thumb. 
• The trapezium bone is a key part of this joint and can become damaged or worn out due to arthritis. 

2. The Procedure:

• Trapeziectomy:
  The surgeon makes an incision near the thumb’s CMC joint and carefully removes the trapezium bone. 
  
  
• Suspension:
  To prevent the thumb metacarpal bone from collapsing into the space where the trapezium was, the surgeon often uses one of two methods:
  • Suture Suspension: A suture is used to connect the first metacarpal bone to the second metacarpal bone, providing support. 
  • Tendon Interposition: A tendon is used to support the thumb metacarpal base and act as a replacement for the trapezium. 
    
    
• Other Procedures:
  In some cases, other procedures may be performed to further improve stability or function. 

3. Benefits:

Reduced pain and improved thumb function, Increased thumb mobility and flexibility, and Better grip and pinch strength. 

4. Potential Risks:

• Continued pain, swelling, stiffness, or weakness.

• Nerve damage and numbness.

• Scarring.

• Infection.

• Bleeding.

• Allergic reactions. 

trapeziectomy-factsheet

So, yesterday, I opted for everything except surgery…for now.

First up was the dreaded injection.  I’d read on some message boards and found out from some friends that this “could” be painful.  Major DUH.

As usual, the doctor froze the skin with lidocaine (XYLOCAINE), then injected Betamethasone (CELESTONE) into the carpometacarpal (CMC) joint of right thumb.  This was a new steroid for me so…

Celestone Soluspan is a steroid that prevents the release of substances in the body that cause inflammation.

Celestone Soluspan is used to treat many different inflammatory conditions such as allergic reactions, ulcerative colitis, arthritis, lupus, multiple sclerosis, inflammation of the joints or tendons, and problems caused by low adrenal gland hormone levels.

Celestone Soluspan may also be used for other purposes not listed in this medication guide.

From drugs.com

I showed the doctor the brace I had been using.  Years ago with my knee issues, I discovered BioSkin braces for people –

like me who are allergic to neoprene among other things.

Of course, the one I showed him was a reject, being more for carpal tunnel so he “gave” me a thumb spica.  I said “gave” in quotes because they billed me $105.  Presumably, insurance will pay.  I looked it up on the brace company website and found that it would have cost me $45 to buy from them.  Nice markup!

The new spica worked well – I’m to wear that during the day – but I can tell I was starting to itch, so I ordered the BioSkin version from amazon.  That won’t come for a couple weeks, though, so I’ll be itching some.

The doctor also recommended icing for 20 minutes at a time several times a day.  I told him I’d bought a thumb freezer gel pack and he’d never heard of that.  Maybe I’ll take one in next time.

Looking at past posts in this blog, I found that thumb issues have been going on since 2018 but I guess that what the ER did then worked until now!

Hopefully, I get another 8 years out of this visit!