For Roxanne Drake, something as simple as a high-five started to feel like torture.

The 71-year-old Thornville, Ohio, resident had spent years working with her hands, tending her 10-acre farm, driving a bus and working in food service at The Ohio State University.

But gradually, pain in her hands began interfering with nearly everything she did.

She first suspected carpal tunnel syndrome. She tried an array of remedies — from massage devices to copper-lined braces — but the pain got worse.

Even bowling became a challenge. The sport itself didn't bother her as much as the enthusiastic high-fives that followed a strike.

“When you've got this thumb [pain], it feels like they've hit you with a hammer,” Drake said of her teammates congratulatory high-fives.

Drake started to worry that the pain would force her to give up the farm she loved. Then she learned about the possibility of an artificial implant to replace the damaged joint at the base of her thumb.

The surgery, which has been performed in Europe for more than a decade, represents a new option for Americans with arthritis at the base of the thumb. For patients, it offers the chance to restore movement and grip strength while avoiding the more extensive rehabilitation associated with the traditional operation.

Ryan Schmucker, a hand surgeon at The Ohio State University Wexner Medical Center, is among the surgeons introducing the procedure in the U.S., and he believes it could significantly change how doctors treat the condition.

Surgeons at both UPMC and AHN perform this surgery in the Pittsburgh region, according to company spokespeople.

After undergoing the procedure — performed by Schmucker — in June on her left hand, Drake said she was moving her thumb the next day. She returned to driving within a week and resumed her usual activities over the following weeks without formal physical therapy.

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While thumb surgery doesn’t necessarily seem like a life-or-death procedure, it’s more “my quality of life,” she said during a recent telephone interview. “This will keep me here a little bit longer, I hope.”

Drake is now preparing to have the same procedure on her right thumb.

When the thumb becomes a liability

The thumb's remarkable range of motion is also part of what makes it vulnerable to arthritis.

At the base of the thumb, where it meets the wrist, a joint known as the carpometacarpal, or CMC, allows the thumb to rotate and move in multiple directions. Unlike a knee, which primarily bends and straightens, the thumb's saddle-shaped joint provides the mobility needed to grasp objects, pinch and manipulate small items, Schmucker explained.

That flexibility comes at a cost.

“Over time, the ligaments around the joint itself wear out and allow the bone to start rubbing together abnormally, which wears away some cartilage and eventually causes arthritis,” Schmucker said.

In addition to pain, the deterioration can lead to reduced mobility and difficulty gripping objects.

“People [often] think that their muscles are weak” when they notice themselves dropping objects, Schmucker said. “And in reality, their muscles are fine, but your body has a switch, and no matter how high your pain tolerance is, if you grab something and it really hurts, your body will make you release it.”

The condition can also be mistaken for carpal tunnel syndrome. The distinction matters because the treatments differ. Thumb arthritis typically produces pain concentrated around the joint and can limit movement, while carpal tunnel syndrome more commonly causes numbness and tingling.

An X-ray revealed the source of Drake’s trouble: The cartilage in the thumb joints of both hands was gone, and her left hand also had two bone spurs.

The pain had become particularly troublesome when she was gripping tools, pulling weeds, gardening or handling the heavy equipment needed to maintain her property. Even opening jars and tightening the lids on her home-canned food had become difficult.

For someone who wanted to remain active, the limitations were more than an inconvenience.

“I didn't want to have to give up my farm,” Drake said.

Replace rather than rebuild

Until recently, the standard surgical treatment for thumb arthritis was to remove a small wrist bone called the trapezium. Surgeons then either used a piece of tendon to fill the resulting space or allowed scar tissue to develop there, creating a cushion between the bones, Schmucker said.

The operation works great for relieving pain, but it changes the joint's structure to the point where it can be difficult for patients to regain their original grip strength and mobility. Recovery typically involves wearing a splint and weeks of physical therapy.

With the newer procedure, surgeons instead preserve most of the existing bone and replace the damaged joint with an artificial implant, similar to a hip replacement.

The surgeon removes a small portion of the base of the thumb's metacarpal bone, inserts a stem into the bone and places a cup into the trapezium. A ball-and-cup mechanism connects the two sides.

The implant's dual-mobility design allows it to accommodate the thumb's many directions of movement.

“This joint, in general, has been a little bit of a mystery on how to successfully replace it in the past,” Schmucker said, explaining that earlier implants often failed because they couldn't withstand the joint's complex movements.

The newer implant, he said, has a track record of more than 10 years of use in Europe, where more than 40,000 implants have been placed.

It became available in the United States after receiving Food and Drug Administration approval last year, Schmucker said.

The procedure's potential advantages extend beyond the implant itself, Schmucker said.

With the artificial joint, patients typically wear a soft wrap instead of a splint and begin moving the thumb on the day of surgery or the following day. They receive basic exercises to practice at home, such as touching the thumb to each fingertip.

Formal physical therapy is not routinely required, although some patients may benefit from seeing a therapist for help managing swelling or massaging the surgical scar.

Patients still must protect the joint while it heals. Schmucker advises avoiding heavy lifting for eight to 10 weeks.

But the prospect of regaining movement sooner can be a major advantage, he said.

For Drake, the difference was immediately apparent.

She was moving her thumb the day after surgery. Within a week, she was driving again, and by about eight weeks, Schmucker told her she could remove her brace and resume her usual activities.

Today, she’s back to maintaining her farm, which is home to horses, three dogs, lots of fruit trees and a vegetable garden. She has hauled hay, operated a tractor and used a chainsaw to cut down fallen trees.

She said she is amazed by the ease of her recovery and by how little evidence of the surgery remains.

“I have absolutely zero pain in it right now,” she said.

Her right thumb, however, continues to bother her; she plans to have that joint replaced in December.

Schmucker said an active lifestyle can make someone a particularly good candidate for the artificial joint, provided the arthritis is confined to the appropriate part of the thumb joint.

Patients with extensive arthritis affecting the wrist side of the trapezium may not benefit, because replacing only the thumb side would leave the other source of pain untreated. Surgeons also must consider patients who place extreme loads on their hands, such as competitive powerlifters.

Schmucker also cautioned that surgery is not the first step for everyone with thumb arthritis. Patients can initially explore nonsurgical approaches, and surgery becomes a consideration when pain and loss of function prevent them from doing the activities they value.

For Drake, the decision came down to whether she could continue living the life she wanted.

The prospect of another surgery is no longer daunting, Drake said. It is an opportunity to get back to work.

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