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Forum Name: Joint surgery

Question: Thumbs became dislocated gradually on their own


 hpatel450 - Wed Jan 28, 2009 6:36 pm

My mom thumbs became dislocated gradually on their own last year. We thought they were just callus at first on her joints, but after they didn’t go away for a month, we visited a hand surgeon who took x-rays and determined that they were dislocated completely from the joints. My mom has had lupus since 1995 and has been treated for it for about 10 years. Since 2005 she felt fine and healthy, displayed none of her prior symptoms. This was the first thing in nearly 4 years to indicate that her lupus is still present. After learning about my mom’s history of having lupus, he sent us to a rheumatologist to check it out before he performs any surgery. The rheumatologist concluded that the lupus most likely caused the dislocation and obviously no medication can put them back into place. He could treat my mom from a medical standpoint but not surgically, he said it was ok for my mom to get the surgery but there’s no telling if the same thing might happen again.

My mom works at home and needs the use of her thumbs, the state they are in now interferes with her daily tasks and there is pain associated at the dislocated joints. She would like to get the surgery done, but before we do anything, we wanted some input on this condition. We would like to know what’s involved in having this type hand surgery done, the risks and complications. What will be the typical procedure? Will this surgery be a minor surgery with a quick recovery, or something major? Is it better to have it performed in a hand surgeon’s clinic, or at the hospital? The hand surgeon we initially visited does not accept my mom’s medical insurance, and before we move on to other hand surgeons, we would like to know what options will lay ahead of us, and how to plan this out. Or is it just better to leave the thumbs how they are, and learn to live with them like that? Thank you for any help and advice at all, it will be greatly appreciated.

Links displaying x-rays

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 Tom Plamondon PA-C - Sat Jan 31, 2009 12:15 pm

User avatar Hello,
Thanks for writing in.

You have described your mom's history of dislocated thumbs (DIP joint) secondary to lupus. And want information on surgical options.

Lupus can cause inflammed tendons and joint hypermobility in the thumb which lead to deformity. In your mom's case, lupus caused a dislocation.

Since the lupus causes a hypermobile joint, even if the thumb joint is reduced, it will be prone to dislocate again. So one of the pros for sugery will be to lower risk of dislocation. Splinting may be needed post op to protect the joint. Goal of surgery will be to reduce the dislocation and prevent further dislocation. For specific procedures, I will defer to the hand surgeon to explain treatment options.

In general, risks of surgery will include infection, pain, recurrent thumb dislocation, and poor tolerance to anesthesia. Whether the surgeon replaces the joint, fuses it, or snugs up the joint capsule, he may be able to perform the procedure with local or regional anesthesia and light sedation.

Rehabilitating the thumb through occupational therapy post op will be important and she may need to wear a brace on a daily basis.

So, I think it would be a good idea to seek a hand surgeon's opinion because without surgery, the thumb will probably dislocate again.

Take care and keep us posted.

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