If you’ve ever wondered why sometimes I seem to be a bit “anti-surgery,” you would only need to spend a day with me in clinic to find out why. We see surgery train wrecks day in and day out. What makes them so upsetting is that most of the time, the surgery could have been avoided with much less invasive, interventional orthopedics, using precise platelet or stem cell injections. This morning I’d like to go over a case I evaluated yesterday with one of our fellows. What began as a tendon transfer surgery for thumb arthritis and a fusion of a finger joint ended up as a demonstration of horrific hand surgery side effects with a failed tendon surgery and dead finger.
Tendon Interposition for Thumb Arthritis and Finger Fusion
The idea behind a tendon interposition surgery for arthritis at the base of the thumb is to take a tendon from the wrist, remove a bone, and use the tendon to cushion an unstable and arthritic joint. The idea is interesting but horribly invasive. Given that we routinely and often successfully treat this same thumb arthritis condition with a few precise rounds of platelet rich plasma (PRP) or stem cells, it’s crazy to think that a surgeon would consider such an invasive way to help a simple problem which exposes the patient to these types of hand surgery side effects.
Finger fusion is an even sillier surgery. The concept is that if the joint is locking or hurts due to arthritis, the best option is to fuse it solid so it no longer moves. Again, tough to see when an injection of PRP or stem cells often does the trick.
Hand Surgery Side Effects: You Just Can’t Make This Stuff Up!
Sometimes, based on what I see in clinic, I couldn’t make this stuff up if I tried. For example, take this woman who I evaluated this week (whose hand picture is above). She had simple thumb arthritis or texting thumb. The surgeon removed a bone in the wrist and inserted a tendon. That surgery failed which caused her carpal tunnel syndrome to flare up. Another thumb joint then locked up and became permanently stiff, leaving her with a barely functional hand. Is this surprising? Nope. The thumb surgery complication rate in one study was a whopping 22%!!! The surgeon then attempted to fix the damage from the first surgery at the same time he tried to help the carpal tunnel, only to make the thumb still worse.
However, all that paled in comparison to her middle-finger joint arthritis surgery and the horrific hand surgery side effects that ensued. Here, the joint was painful and was locking, so the surgeon tried to fuse the joint. When the dressings came off, her finger had “dry gangrene” as if she had gotten frostbite while scaling Everest, except it was 90 degrees outside. In this case, it looks like the pressure from the swelling from the surgical fusion led to a dead fingertip (picture above). Again, you just can’t make this stuff up!
The Regenerative-Medicine Approach Using Interventional Orthopedics
The patient came in for us to treat the opposite thumb, as she had had enough hand surgery side effects for one lifetime. For that thumb, we’ll use our usual protocol of precise injections around the irritated nerve in her wrist, into the arthritic joint, and into the stretched-out capsule. That last step is critical as that’s allowing the joint to be sloppy and painful. See below:
The upshot? All you would need is a few days of seeing new patients with me to understand at a gut level what a bull in the proverbial china shop of the musculoskeletal-system traditional-orthopedic surgery can be. If you then also understood how many of these patients we could have helped with precise PRP or stem cell injections with far less morbidity, you would be shocked. This is why I’m so passionate about this subject and have devoted my career to helping physicians learn how to replace elective orthopedic surgery with less invasive injection based stem cell and PRP treatments! That doesn’t mean that all elective orthopedic surgery doesn’t need to be performed, but I expect that as they years progress and as interventional orthopedics gets more advanced, that we’ll reach a time toward the end of my career where 70-80% of it is relegated to the dustbin of medical history. By then, hopefully we’ll have no more dead fingers!