Second opinion - hand surgeon

Some of you already know that my hands have taken a lot of damage. I seem to have a lot of soft tissue damage. For the big joints, I can do PT to strengthen the muscles around the joint, but that doesn't work on small joints in the hands. My feet I wear orthotics, and most of the time it helps.

Back to my hands. I have now had two surgeries on the same thumb. One was at the base of the thumb, for very painful instability and weakness, and the other was for trigger thumb. I am very happy with the surgeon that I have used, but am now starting to wonder if I need to be more proactive.

At this point, my left thumb (not operated on yet) is also very unstable, and starting to cause me more problems. The right middle MP joint has been swollen for months, and now the finger is clearly showing signs of ulnar drift. That finger has been painful this whole time.

Time for a second opinion? I am strongly considering going to the Hospital for Special Surgery in New York City. I live in the suburbs, so it's not a ridiculous thought. Am I right in thinking that they might have more proactive thoughts, instead of waiting until the pain is really bad all of the time?

Just for more information, I started my first biologic, Enbrel, in February 2014, and have been doing well overall. Less well recently though. I had to come off it for a few weeks for the trigger thumb surgery, and am still waiting for things to come back under better control. In the meantime, I am back on my NSAID.

Is it always a good idea to get a second opinion, even if I'm happy with the hand surgeon who has done the work on my hands so far?

It is always good to get a second opinion. You may learn of a new option (that you can always discuss with your current surgeon) or simply feel better about the choices in hand. More info and a fresh look by a new set of eyes is a good thing.

Go for it. :slight_smile:

Best wishes!

It's good that you're happy with the hand surgeon you have. If he/she knows you, knows your underlying problems, and you have had good results, it's hard to complain.

I've never forgotten a friend who was having hand problems. An orthopedic surgeon examined him, looked my friend in the eye, and said, "You know, there's not a hand in the world we can't make worse with surgery." If by "proactive" you mean "aggressive", that may or may not be in your best interests. Do you have a top-notch hand therapist you work with? When I had a hand surgery go sour, my OT had good, sound advice on how to proceed.

In and of itself, a second opinion is fine. I guess what I'm saying, though, is that if you're basically happy with your treatment, be careful about borrowing trouble.

Thanks Louise. Yes, I do have a good hand therapist that I have worked with. The hand surgeon that I have been using told me that his patients usually tell him when it’s time for surgery, which I definitely found true for me.

We are trouble shooting joint protection solutions for me, and working on quieting down some of the worst of it right now. I know that surgery does not solve all.

Hi Stoney. No harm in getting a second opinion. When you mentioned the base of your thumb, do you mean the joint next to the wrist? I have had horrible osteo pain in that joint and it is very noticeably enlarged. Weirdly, it isn't as painful as it had been, but still certain movements feel like a spike is being driven through it. Did you ever have cortisone injections in your joint there? I'm very slow to do anything major, but it helps to hear results others have had.
Do you think the two surgeries were worthwhile, or, if you had it to do over again would you opt not to have the surgery?
A big deterrent for me would be going off Enbrel also.
I would be afraid nsaids wouldn't get me through the PsA symptoms.

Grandma J- in fact, I have virtually no osteoarthritis. It is the basal joint, base of the thumb at the wrist. I did have cortisone shots in the first thumb, but I have pretty much given up. They have no impact on unstable joints. The surgeries that I had on that thumb, to stabilize and then for triggering were definitely the right choice. Because there was no osteo, I did not have to get a small bone removed from the base of the hand.
I am doing hand therapy, and using a splint.