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Sculpting with Surgery: Basal Joint Arthritis, Carpal Tunnel Syndrome, and Microsurgery

Visit the library in New Canaan, Connecticut and you will find a display of the work of Peggy Ogden. Her sculptures, which she calls Whimsical Art with a Heart, are well-known around town and in the art world. At age 62, however, Ms. Ogden’s passion began to take a toll in the form of basal joint arthritis and carpal tunnel syndrome—both in her left hand. Friends recommended that she see Andrew J. Weiland, MD, a member of the Hospital’s Hand Service.

Carpal tunnel syndrome develops from increased pressure on the median nerve at the wrist in the carpal tunnel. This nerve supplies sensation to the thumb, index, middle, and part of the ring fingers, and also stimulates a muscle in the thumb. Symptoms, which can include tingling, numbness, pain, and weakness, worsen when there is increased pressure in the carpal tunnel brought on when the wrist is flexed or extended for prolonged periods of time.

Basal joint arthritis, or arthritis at the base of the thumb, is more common in women than in men. The joint, which is located near the wrist and at the fleshy part of the thumb, enables the thumb to swivel, pivot, and pinch, allowing you to turn a key, open a door, or snap your fingers. Basal joint arthritis is indicated by swelling and tenderness at the base of the thumb, an aching discomfort after prolonged use, and loss of strength in gripping or pinching activities.

In fact, like Ms. Ogden, many people with arthritis at the base of the thumb also have symptoms of carpal tunnel syndrome. In April 2007, Dr. Weiland performed surgery for both conditions simultaneously— releasing the transverse carpal ligament at the roof of the carpal tunnel to allow more room for the median nerve and removing then reconstructing the arthritic joint surfaces of her basal joint. The procedure, basal joint arthroplasty, involved the insertion of a tendon into the space created by removing the boney surfaces. “The tendon serves as a cushion to maintain separation between the bones,” says Dr. Weiland. “It eventually turns into scar tissue that forms a flexible connection between the bones similar to a joint.” With occupational therapy, Ms. Ogden’s symptoms subsided and, she says, the results have been excellent with no residual effects.

“I’m one of the big supporters of certified hand therapists,” says Dr. Weiland. “They make me look good.  I’ve always had great relationships with therapists because they are the ones who maximize the results we achieve for our patients. I can fix a wrist or a tendon but if the patient doesn’t attend therapy, optimal function will not be achieved. Virtually all of my post-op patients go to therapy at least three times a week.”

This past summer, Ms. Ogden came to see Dr. Weiland again for quite a different reason. While putting a glass up on a shelf,  it fell, hitting the granite counter, then bouncing up. One of the shards sliced her right hand, severing a major nerve. “My three middle fingers immediately collapsed, my whole arm collapsed really, and a geyser of blood erupted,” says Ms. Ogden. A local hospital splinted the hand and told her if the fingers were still numb to see a specialist.  “I knew it would be Dr. Weiland,” she says.  “I called and his office had me in the following Monday.  He did a sonogram and told me the nerve was severed.” That Thursday, Dr. Weiland, performed microsurgery to repair the nerve.

Dr. Weiland has several decades of experience with microsurgery, which is performed under the magnification of a microscope and used to repair or reconstruct small vessels and nerves in the hand. Microsurgery is typically used to transplant tissue from one part of the body to another, or to reconstruct arteries, veins, and nerves by placing sutures in the walls of the blood vessels and nerve coverings. Connections for blood vessels and nerves can then be made to reestablish blood flow and nerve transmission.

“Microsurgery certainly has enabled us to repair nerves and vessels that we couldn’t repair before,” says Dr. Weiland. “For example, the industrial accidents that damage the nerves, arteries and veins—we can repair those now. Technology has also advanced nerve repairs and treatment of tendon injuries. Surgeons are starting to use nerve guidance tubes to make up gaps in nerves that may perhaps be equivalent to performing nerve grafts. In the future I think biologics will be the answer. We’ll have a better handle on growth factors and how they can help us heal tissues.”

After a few weeks in a cast, Ms. Ogden’s stitches were removed. Therapy followed to reduce the scar tissue. Her dexterity has returned, and she continues to recover as the nerve regenerates. “I’m very fortunate,” says Ms. Ogden. “Dr. Weiland is wonderful, and he certainly knows what he’s doing.”

Sculpting with Surgery: Basal Joint Arthritis, Carpal Tunnel Syndrome, and Microsurgery