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First successful thumb joint replacement in NZ

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8th August, 2002

Dear Richard,

My name is Valerie Needham and I am a pianist and piano teacher in Waipu, Northland, New Zealand. I actually emailed you recently as I was having difficulty finding your website. However, I finally managed to find you through the Google search engine. As you probably know, M himself is suffering from a finger injury (which is of great concern to us all) and so he is doing more teaching/masterclasses at the moment. He recommended your site and told us a little about you during a recent masterclass for registered teachers.

I thought you would like to hear about recent hand surgery I have had in N.Z. In fact I am the first person HERE to have a new replacement joint in the base joints of my thumbs, they have been doing these in Melbourne for 3 years and in Derby, UK for 5 years. It was a struggle to get a NZ surgeon to do his first one, but I finally managed it!

The story is, I was born with very flexible ("double-jointed") second (MCP) joints in my thumbs and it seems because of this I have completely over-used my third, base (CMC) joints to compensate (I am 53 years old). Obviously this is not solely because of my piano playing but as I practise a lot it probably was a contributing factor. All cartilage was worn away and the bones were beginning to fuse with the wrist bone (trapezium). Diagnosed as arthritis although I have no arthritis in any other joints.

I first indicated concern because of pain and the span in my right hand was decreasing as the thumb began to abduct down into the palm (threatening my octave reach). Nobody had ever suggested to me that my hyper-mobile 2nd joints could cause a problem. I had to ask for x-rays and a consultation with X in Auckland, he is a hand and upper limb orthopaedic specialist (supposedly the best!). He told me initially that there is NO replacement joint for this particular joint, a ball and socket type had been tried in the past but failed because it dislocated. He suggested the standard operation for this problem - a trapeziectomy, which is to have the trapezium bone removed and a suspension arthroplasty (they fill the gap with part of a tendon, making a false joint). He also wanted me to have a sesamoid arthrodesis (tightening tendon) to correct (?) the hyperextension of my MCP joints because he said they may cause the false joint to dislocate. The prognosis for excision of the trapezium was horrendous - a major operation with a long recovery period, requiring extensive physiotherapy, may be up to a year before gaining normal hand strength. Just what would happen to my other fingers/muscles/tendons during that time God only knows. He had absolutely no understanding of pianists' needs/feelings/requirements, nor was he particularly interested! I elected NOT to have anything done although I knew the pain and abduction would just get worse.

I went on the internet - found out a lot I didn't know! Some months later I was to visit Melbourne and on the spur of the moment went to see a hand surgeon there for a second opinion. Saw Y (plastic surgeon and pioneer in hand surgery) who opened a drawer and pulled out a chrome and plastic (saddle shaped) joint prosthesis (made by Avanta in US and developed at Mayo Clinic) saying I have been using these successfully for 3 years and you are an ideal candidate! I was gobsmacked! He said he would do them for me there but the cost would have been a considerable problem.

So, I returned to NZ and consulted with X again. He said he knew of the new implant (!) but it was experimental. He was unmoved by news of Australian surgeons efforts BUT when I told him that a Dr Chris Bainbridge had done them for 5 years at the Pulvertaft Hand Clinic in Derby, UK, he suddenly became very interested! He KNEW him and had worked in Derby with him in the past! So, swift phonecalls were made and X did a complete about-face! The story is - Mayo Clinic develops new prosthesis, won't trial it in US (afraid of being sued) so the Derby Clinic trials it for 5 years, writes it up in journals and then the procedure is begun back in US.

(Mr Bainbridge wishes it to be known that the Pulvertaft Hand Centre "did not trial the implant for Avanta," and that he has "no contractual relationship with Avanta." — R. B.)

X then had to convince me to be his guinea-pig! He had to reassure me that he was capable of doing a new procedure! Finally, I agreed he could do one thumb (the worst affected). On advice from the Aussie surgeon, he was NOT to touch my lax second joints, not necessary and there was nothing wrong with them.

Of course, all this took many weeks of agonizing and weighing up pros and cons. Should the implant not work I could still elect to have the old operation (trapeziectomy). But once the trapezium is removed, I would never be able to take advantage of any future improved implant (which I am assured is highly likely in the future). All the risk was firmly put on my shoulders and I was told the implants may only last for 10 years (before the body begins to break them down). Assured, though, that by then there would be an even better implant available.

So, in January this year I had the first thumb done under arm block aneasthetic. In plaster for 2 weeks, then removable splint for 4 weeks. I was only in hospital overnight. Saw a physiotherapist but really did my own regime of exercises, making sure the other fingers kept moving etc. By 8 weeks I could play again (with no pain) and we all deemed it to have been a great success! I spent 3 months trying to rebuild muscle tone etc. and then in June I had the second thumb done too. Also successful.

Sorry to have made this so long-winded, Richard, but I suppose my aim now is to let other pianists and teachers be aware of this problem (and solution). Should I now come across a student with "double-joints" I would, at the very least, warn them of the possible consequences of over-using sympathetic joints. Perhaps it would be wise for such pianists to find a way of protecting other joints from overuse. Maybe using a splint (?) for practising. I don't know, but all I do know is that no teacher I ever came across thought it was a potential problem.

If you want more information, feel free to contact me. Thanks for being interested - love your website and agree wholeheartedly with your opinions on competitions!!


Val Needham

Links Val found useful include:-

If you would like to contact Val for more information, send an email to info@musicandhealth.co.uk
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