Artelon Spacer for CMC Joint | Arthritis Information

I'm new to this forum but felt the need to share.  I have had osteoarthritis in my R CMC for over 2 years & recently the regular cortisone injections were not working.  At my visit to  my hand specialist x-rays showed quite alot of bone spurs and inflamation on my hand indicated nerve invovlement so surgery was my only option.  I was happy my surgeon was using the Artrelon spacer instead of removal of the trapezial bone as everything I read was quite positive as well as all the literature I read.  I had my surgery April 16, recieved a nerve block (fun later on trying to keep my arm elevated on pillows, finally had to use 2" tape to tape my arm to the pillows to keep it from falling on me!!!! NBF

Thank you for sharing your experience with the spacer. I am very glad you are having such great progress and hope you continue to do so. I am having mine taken care of tomorrow and will update on progress. Please keep us updated as to how you are doing as time goes on!Had surgery yesterday. Arm block lasted 13 hours! Only used pain medication overnight, just Motrin today and pain is there, but very tolerable. Will have dressing and stitches removed in 10-14 days and then cast for four weeks. So far so good and I will update progress as I move along. Great news RD.  I am now 3 weeks out and have no pain at all. Cast comes off in 10 days and I already have almost total use of my hand- much more so than I would have thought.  I can even make an "O" with my repaired thumb and my pinkie.  Good luck to all.I am in day 3 after surgery. I used Motrin 800 to help with swelling, as well as keeping my arm in an upright position. My splint/dressing is a bit more lose now so I believe the swelling is probably gone or very minimal. Zero pain since middle of day 2. Stitches to be removed on May 19. Anxious to see what shape the hand/thumb is in!

Safetydiva
let us know how much flexibility/strength you have once the cast is removed!Hi RD- Hi Safetydiva.

Hopefully you are getting your cast removed this week.
I just had mine put on yesterday. You probably know most of this but maybe it can help others. I had virtually no swelling at all. I really kept my hand elevated at all times so I think that made a difference. My incision was very well done and only about an inch long. My hand looked a bit distorted to me but maybe that is just due to the position it has been in. We will see when the cast comes off and I am hoping it will look just fine once I do some physical therapy on it. I will be in the cast 4 weeks. The dressing I had on became very loose, probably because the swelling went down so quickly, so I am glad to have a hard cast. I am a very disaplined patient but know that I really need the restriction in movement, not only for a good outcome but because I feel it would be too easy to end up using the thumb with a wrap. I wanted to get moving on the dominant hand as soon as I could but the doctor is making me wait until my next visit to discuss it! Sadly, I cannot have the spacer done on that hand. The thumb is too unstable. He said fusing it was the best that can be done. I was really disappointed but he immediately had an O.R. Nurse come down and show me her thumb that she had fused in December. I couldn't believe how "normal" it looked and how much movement and grip she had. She said she has no problem holding surgical tools now, or doing anything else for that matter, and was back to work after 7 weeks.
Please let us know how you are doing with your rehab now that your cast is off. Let me know how your hand looks too. I hope the rotator cuff patient is recovering as well as you are safetydiva!!I just had the Artelon spacer inserted on May 7th so I do not have long term results to relate to you.  I had checked the forums first hoping to find more on long time results.  My Dr. highly recommended this surgery and did not suggest alternatives.  I did ask for the total nerve block in my arm to help with pain following surgery.  I used pain med for about 4 days.  The bandage was quite large.  I thought I had prepared myself by picking the right time and getting things done before hand but there were a few things I had not anticipated before surgery.   If it is your dominate hand, think everytime you use it - I can't do this for at least 6 weeks.  I can't write a check, sign a credit card rec, take a shower w/o protecting my hand with plastic bags, which requires help, open a med bottle just to mention a few things.  Also have loose comfortable clothes with elastic waists you can pull on yourself.  I had my stitches out after 2 weeks, my hand was xrayed and the joint looked perfect.  I now have a smaller ridgid cast which I will wear for 4 weeks before therapy.  The Dr. seemed very cautions that the cast be fitted right to protect the thumb and I could not have a water proof cast so I'll be using baggies and rubber gloves for 4 weeks.  As I said I do not have any long term results to relate at this point but hope I have given you some helpful hints.  Other than dealing with the cast.  I am comfortable and not in any pain. Hello RD and welcome jmj- I am now 4 days out from my cast removal and I am thrilled with the results!  I have full use and total flexibility of all my fingers, and nearly complete range of motion of my thumb.  I am in a rigid brace for 2 weeks, then some minimal PT.  This time was my dominant hand, so the next time around (August) should be much easier.  RD - Not sure if you are male or female but I was told fusion has better outcomes in women because we are more flexible.  Fusion would have had too much risk of being career ending for me.  Safetydiva,

Thanks so much for the update on your progress! I am so happy for you that it is so positive. Yes, I am female. I am glad you mentioned the success with fusing in females. My dominant thumb sometimes goes out of joint and I can see why a spacer will not work. I do have a small amount of cartilage loss starting, which I am assuming is why I have pain.
I did try the cast cover that you mentioned but have a very hard time getting it over the cast by myself. They said you can cut up the sides a bit but it is still quite difficult to stretch. I use it when I can get help and resort to a small garbage bag and Glad Cling wrap otherwise! Actually this is the hardesr part for me. I am not in pain and was so restricted by pain before surgery, that this is no big deal at all. I am just very anxious to get to the rehab part. I was worrying about having my dominant hand done because obviously you need it to write but realized you are absolutely correct! You can write with this cast, it may be sloppy, but definatly do-able.
Anyway, keep up the good work and update us on how the mobility and strength ae coming along!Hi Everyone.

Just to clarify, I used Glad Press and Seal wrap for the cast, along with the small garbage bag!!! Not just plain cling wrap.....sorry!!Hi Everyone! thumbsup -

You were kept in a cast much longer than I was. I had my dominant hand done Jan. 25 and my other hand done Apr. 25 (the soonest my dr. would do the second hand was 12 weeks).  My bandages were removed and I was put in removable splints at 10 days; therapy started 2 weeks later. After another 2 weeks (approx. 6 weeks postop) I was given the no restrictions order. However, I did chosoe to continue therapy and had 12 sessions on my first hand.

Because I had the second surgery so soon, my first hand is being taxed. Although it is often achy, it is holding up well and I have no pain. I am still working on strength and need to be able to stretch my thumb out and down about 1/4" more. For whatever reason, my second thumb, which was actually in worse shape, is progressing much faster. It didn't swell as much either.

Bottom line, in response to your post and in regard to my Jan. 25 surgery, I'm still tender under the thumb joint at wrist and after 6 weeks I was given permission to lift or do anything!

p.s. I am the same artteacher - but couldn't logon (faqs say they sometimes drop people) so I'm back as artteacher2


That was a total of 12 therapy sessions for my first surgery and, because the second hand is progressing faster, I don't anticipate going as many times for it. I am having Artelon spacer surgery on my left hand on July 3rd.  I have very much appreciated all the comments -- would have never thought about a nerve block.  But it will be helpful since, I, too, live alone.  My doctor said that I would have all my fingers free after suregery and would not have any problem on the computer -- my job.  But I seriously doubt the speed will keep up.

I have read all of the posts here and on other boards and need some clarification.  How is a splint different from a cast?  and what is a water-proof cast?  For you heavy computer users out there, what kind of cast/splint did you have and how did it affect pounding the keys.

Hi Koplend!
I wish you the best with your surgery. I only am experiencing a cast and do quite well typing on the computer. At first I made quite a few mistakes and was slower but it gets easier. Yes, with the cast, all of my fingers are out. I personally prefer a cast so that I do not over use the thumb at all. I want the best outcome possible. I would think that a splint would be removable and just keep the thumb rigid but someone actually using it would have to answer that question. Again, good luck!My "splint" is actually a rigid molded (to my own hand) support that wraps around and slips over my thumb. It covers the width of my wrist and inner forearm and extends from the  middle of my palm to within 2" of my elbow....wrapping around the sides of my forearm and held firmly in place with three velcro straps. My fingers are entirely mobile and I use them for everything I can. My thumb is completely immobile. My typing/word processing has had to be modified but I'm getting it done!
Welcome Koplend- I had the same splint as Artteacher2, but the tip of my thumb was out so I could bend it at the last joint, ditto for the cast.  My dr thought a cast would be best for me (after the initial splint, placed in the OR, on for about 7-10 days till the swelling went down) because I do not sit still.  His feeling was the more stable the CMC joint initially, the better it will set in place correctly.  A waterproof cast is fiberglass and is therefore much lighter than a plaster cast.  ALthough typing is definitely possible if all your fingers are out of the splint/cast, you sort of need to hold your hand at an unnatural angle to tap on the keys so I developed some shoulder pain towards the end of my cast period.  But it was minor.  I am now 6 1/2  weeks out and have gone 24 hrs with NO BRACE on.  I had a great PT session today (first one) and my therapist was so very excited as she had never seen a patient with the Artelon CMC before.  She was completely impressed by my mobility (which my surgeon acknowledged is more than most of his patients so soon).  My mobility is about 98% of what it should be, now I am working on strength of my thumb.  I think some folks are put in a cast or fulltime brace for too long as they seem to be the ones with a longer recovery.  Good luck with your surgery - I am very happy so far!!I just found this forum. SUZIEQUE, your April post sounds JUST LIKE ME. I had the spacer put in arthroscopically 10/ 12/07. I have less strength and constant discomfort at rest-pain when trying to use the thumb than pre-op. On x-ray, all looks fine. there are no signs of rejection. The Dr said possible tendonitis of the tendon running by the trapezium. He gave me a cortisone shot and needled the area to break up any scar tissue. [so far no difference.] If no improvement he recommends freeing the tendon surgically but says this won't improve strength back to what it was pe operatively. penny - What are your symptoms that brought about your tendonitis diagnosis? My thumb seems to be getting stiffer/feeling tighter. However, I am using it a lot - I am packing for a move to FL from PA and my other thumb/hand is splinted and recovering from my second surgery, Apr. 25. I do not have any of the original pain and is just feels achy after prolonged use.

p.s. are you penelope from the arthritis forum?
HI- yes i'm penelope on the arthritis forum. Hey, RD! Dr. Gupta did both of my thumbs, and I really like him a lot. I had my left thumb repaired in 2/07 and my right one done in 11/07. The left is probably at about 85% of normal and the right is probably about 60%. My thumbs both hurt a lot of the time, but they're definitely better than they were before surgery. Healing time for both of my rotator cuffs was around 18 - 24 months. I'll be happy with that time frame with both thumbs if that's how it turns out. I can do most anything I need to do, including using a chain saw and ax. I just have to be a little protective of my right thumb. OK, maybe a LOT protective of my right thumb. ;-) So far I'm still happy I had the Artelon procedure done on both thumbs. I have some doubts about the long-term results, but Dr. Gupta has assured me that this doesn't close the door on other procedures down the road. I had to cancel an appointment with Dr. Gupta for yesterday since I was out of town attending a funeral. I had about decided that I didn't need to see him again, but I do think I'll reschedule the checkup. I'm going to ask him about the possibility of getting a shot of cortisone in my right thumb. He was pretty generous with the magic elixer before surgery, so hopefully he'll be agreeable. The other reason for rescheduling is that I have a grandson in Louisville and I'll take about any opportunity to visit. ;-)Hi Elmerdorsey!
Nice to hear from someone who had the same surgeon! I will let you know how I am doing after having the cast removed, June 16. I am not feeling any of the pain from arthritis, atleast not with the cast on. I think that is a good sign. Moving my first joint in my thumb that is exposed used to be painful but not anymore. I am so glad to hear that you can use a chain saw and ax! I really want to get back to mowing, edging and trimming my lawn and painting the inside of my house. I have to believe that any soreness just cannot be as bad as the joints rubbing against each other. I had both big toes operated on for the same problem and 7 years now down the road, I am still grateful for not having that pain. I truly hope I get the same outcome with the thumbs. It sounds like you have problems in more areas too, with arthritis. My other thumb has to be fused but he had an O.R. nurse show me hers and I was so impressed that it made me wonder if I shouldn't have done it with this one instead of the spacer. I had no idea you would have so much mobility and strength with fusing. At least we know we can do that, like you said, down the road. No bridges have been burned! I hope you continue to do well and let us know how you are doing a few months from now too. Enjoy the visit with your grandson!Hi Everyone.

Had my cast removed on Monday 16th. Lots of dead skin! Anyway, it was great to finally get rid of that thing!
The doctor was amazed at the mobility of all of my fingers and thumb. I could already do the exercise, with palm up following all of my fingers from the index to the pinky with my thumb top to bottom, 100%. I had swelling at the incision sight and on the palm side in the fat of the thumb and they have already gone down somewhat. I understand this can take 6 months to a year to go away. The worst part right now is the weakness in the wrist from the cast. I actually found a hand therapist here in Tennessee who participated in one of Dr. Gupta's seminars. She said he has done more of these type surgeries than just about anybody in the United States. She feels I will have progressed enough in time to have my second surgery, scheduled in August, not with the spacer but with fusing. She still feels this surgery with the spacer is the best choice as you have more options down the road and it gives you the most "natural" movement. Also, it was good to hear that I may be able to paint some rooms in my house in just a few weeks. I was given a soft splint to use when I exercise on the elliptical or whenever I do anything strenuous with my hand. I was given 9 exercises to get the flexibility back in my wrist and also to strengthen my thumb, to be done 4 or 5 times a day. We will work on grip and pinch next week. My hand/thumb/wrist already felt more flexible after this first visit. I have no pain from arthritis anymore and only discomfort of course when I work the thumb but nothing that cannot easily be tolerated. I think that is all I can report for now. I will post again in a few weeks to report progress.

Hi safetydiva,  I am out of the cast 1 week now and have start PT.  I could not have a water proof cast because my Dr was "over cautious" and said not with an implant.  Anyway I survived (did think of cling press, I had some).  I do not have a splint or anything.  He instructed me to take it easy - no lifting with it and gave very detail instructions to the therapist for gentle therapy i.e. massage, whirlpool etc.  It felt good after therapy and the therapist was impressed in the range of motion I have compared to previous patients.  So far so good!

Hello all-  Glad to hear of everyone's experiences.  I can do most things now with my rt hand, as my Artelon was placed April 19th.  I still have weakness but it gets better every day and this week I powerwashed my dock.  Pincer strength will take a while, but the little pincer strength I have at least doesn't hurt like it did pre op.  I had one totally pain free day this week but then more pain after some more aggressive PT/strength training.  There is a nerve that runs along the dorsal surface of the thumb down to the tip that my hand therapist says often gets snagged in the incision and she thinks that is the primary source of the pain I have.  Nerve pain is searing, sharp, and lasts just seconds.  The dorsal surface is the part with the wrinkles over the knuckles.  I will be having my left thumb done July 18th.  I am back to doing 100% in the office, including procedures (I am a gynecologist) and can do minor OR procedures.  I will be out again for the other thumb but I expect to be back to the OR in the Fall hopefully.  I am very pleased I had this procedure and not the LRTI done.  Best to all.Thanks for all the information.  My surgery is Thursday -- July 3rd.  My doctor does not do "waterproof" casts according to his nurse.  I had the thumb joint repair (involving tendon for repair) surgery about 6 weeks ago at Huntsville AL. Just came out of the cast. Doc told me to start squeezing a rubber ball. gator37

Hi. I had the surgery with the spacer and started physical therapy 3 days after I got my cast off. We did not work on "pinch" and "grip" until the second week. I can tell you from my experience that it is somewhat painful. My therapist gave me clay to work with. She told me that as long as the pain does not linger after the exercise, I am ok. I only squeeze or pinch the clay right now for 60 seconds at a time. It is quite a bit frustrating, the pain, but I think it is to be expected. I do not have any more swelling when I do the exercises than I normally do. My swelling is always the same and they say it could be for a year. Perhaps you are working the ball too hard or too long. Try doing it for very short times several times a day. You didn't say if you were working with a hand therapist and I really didn't think I would need one either but I think it is helping a great deal, especially knowing what and what not to do! Good luck and let us know how you are progressing.

RDRD I had the artelon CMC spacer surgery on April 2 , 2008 and have gotten along well.  I just happened to find this doctor in Bristol, TN who would do the surgery - I was prepared to have the full surgery but he told me about it so I opted for the less invasive surgery.  I had a little trouble once I started with the putty exercises (after nearly 3 months) but went back to the hand therapist and I seem to do doing well now.   I would start calling around to orthopedic doctors and ask them if they do that surgery.  There is a great Hand Therapy Center in Bristol  TN as well.

Hi Gator 37.  sounds like you had the traditional LRTI approach rather than the artelon spacer like most of us in this forum.  Just fyi to all - I had my other thumb done with artelon 2 days ago and have less pain after this procedure thank the first - no idea why but i'll take it!

Hi Safetydiva!

Wow. I guess I forgot that you were having the second hand done!! I am so glad that you are doing well. Do you feel like you have enough strength in the first hand to get through this pretty well? Of course let us know how you progress.
I am having my dominant hand done in 4 weeks. I am very grateful to have 100% range of motion with all movement but the pinch and grip is a much slower process. I only have one more therapy session and still do my exercises 3 times a day. The pinching and gripping of the clay is the hardest. I really have no pain unless I over work the hand or if I don't exercise it. My second hand will have to have the thumb fused, as I said, but it should then be pretty strong for a dominant hand, which is good, as long as I have the same results! My therapist is so happy with my progress but warned me not to push it with the spacer thumb. She said function is most important so use two hands for things like picking up a cutting board, rather than the thumb and forefinger, as I was hoping. I guess 1 pound of pressure on the first thumb joint is 12 pounds on the CMC joint. She wants this spacer to last as long as possible, as do I. So, the advise is, use it, don't abuse it! Makes sense I guess.
Well, hang in there! I am sure you will be so glad when all of this is a thing of the past!Hi RD- Thanks for the good wishes. I am new to this forum by writing but have been reading for the last couple of weeks. I had never heard of the artelon spacer and never thought at 45 I'd need surgery on both thumbs, but I do. After having the surgery last Tues. on my right thumb which is my primary hand I am feeling better than the first few days following the surgery. I have severe stomach problems that include a history of ulcers, GERD and Irritable bowel syndrome. They put reglan into my iv to try to help the upset stomach but I was still unable to keep anything down for days. My doctor prescribed percocet for me but I only took a few as I didn't want that to upset things more. The pain is bearable and improves daily. I can move my fingers in the first wrap and will see the doctor on the 28th for post surgery and the cast. My left thumb is in worse shape than my right but being the dominant hand I wanted to do that first.


i had surgery 2 years ago for tendonitis on my right elbow and the results on that went well so I'm hoping for the same here. My job as a stocker requires me to use both arms heavily since it is a very physical job. I have been told that I will more than likely need to find another position at my company since that one will be too demanding for me. I have been with my job for 8 years and can't think of any position that won't require the use of my hands. I have had arthritis throughout my body since I was a teenager so I guess things like this were bound to happen eventually. Will post more when new symptoms occur or new doctors advice. So far, so good though.safetydiva

Sorry to bother you but I do have a question. My PT is on vacation this week but as my Artelon joint is feeling less and less pain, I am noticing much more pain with the joint just above the CMC joint. It hurts quite a bit when I squeeze the clay and is painful with other movement too. I am going to try to see another one of the PT people this week to see if I should stay away from the clay for awhile. My regular PT said I should never have lingering pain. Like you, I don't know if the joint hurts so much because of misusing/overusing it or arthritis!So, my question is, which other joint in your thumb is bothering you?? I am just curious if it is the same one that is bothering me. At first, when I mentioned the pain on this joint, we both thought it was because of the position it was in while I was in the cast, which did make sense. Since pain tends to radiate, it has taken me awhile to realize the problem with this other joint. As you said, the Artelon joint is doing very well for me too. As it gets better, I notice the other problem more, and I do not want to get behind in rehab with another surgery just around the corner!Thunder

Great to hear about another Artelon patient's progress. I hope you continue to improve and let us know how you are progressing.

Don't feel bad about your age and surgery. I am 47 and had surgery on both of my feet because of arthritis when I was 39 and also have arthritis in my neck. I am just glad we have all found methods to correct our problems. I am sure you wonder, as I do, just how functional we will be in 20 years with problems so early in life! Just do the best you can with diet and exercise and keep those joints moving. Other than that, we can just hope for the best!

Good luck and keep us posted.Gee RD sounds like we are in the same boat.  Yes, my joint pain was indeed in the joint distal to the CMC. Like you, i thought it was due to the position in the cast.  As the tip of my thumb was out, as was the final joint in the thumb, i tended to use the tip of my thumb with the fulcrum in the middle of the bone.  I still don't know what caused my pain, ?tendonitis from the PT or arthritis of THAT joint too. (Both joints above and below the CMC joint are prone to arthritis also).  My surgeon injected it in the OR and it feels much better, not 100% but better.  I was also having pain at my wrist, but i think that was from not using my hand correctly.  I got too used to turning knobs with the wrong motion that i think i got tendonitis there.  now that i purposely use my hand correctly as often as possible the wirst pain is much less.  my doc said most folks are a year before they are pain free and he is very pleased with my progress.  i will see him monday for the cast and i expect he will xray both thumbs.  And to the new person before RDs last post - welcome.  yes it is hard to believe in our mid 40's we actually have arthritis so badly it needs surgery.    But... we are lucky to have some options available.  see if you can get a waterproof cast.Safetydiva

You are so kind to answer so quickly when you are so early into your recovery! Thank you.
I am very glad to have the information so I can be better prepared with questions for the PT tomorrow. I never thought of it being tendonitis from the PT but it sure does make sense. Also, I know we were using our hand/thumb improperly before surgery and I am sure now that it is "normal" we have some adjusting to do. Thankfully, I never had any trouble with my wrist, other than the stiffness which worked its way out in the fir