Map of life expectancy at birth from Global Education Project.

Sunday, June 01, 2014

Progress report

For anyone out there contemplating arthroplasty of the thumb,  I can tell you that after nearly 8 weeks I am slowly regaining good use of my left hand. Wednesday and today I used the weed wacker, which actually doesn't require a contribution from the left thumb -- you pretty much grab the handle with the fingers -- but even so, that would have put unbearable pressure on the sore spot not long ago. I also used a chainsaw, briefly, yesterday and today, but decided not to resume major combat operations just yet.

So yeah, I'm hopeful that this will work in the long run. Still, it's a really violent intervention. They remove the trapezium -- the bone at the base of the thumb -- and stuff the cavity with tissue harvested from a wrist tendon. There has got to be a better way, but I'm guessing they figured out how to do this by experimenting with trauma reconstruction. You would never inflict it on someone with a useable hand, no matter how painful, purely on spec. That means they started out with people whose trapeziums were destroyed, so that's what they know how to do. There is, obviously, no animal model for the human hand so PETA will be glad to know that's out.

There are some slightly different approaches to this surgery but they've never had head-to-head trials. My surgeon does it his way and that's that. Unfortunately, this is true of many medical interventions. That's why there's a lot of emphasis these days on comparative effectiveness research but we have a decades long agenda ahead of us. I expect few people are really aware of how much we are still struggling with an insufficient evidence base for medicine. Obviously, we've learned a lot and medicine is getting more effective, but we still don't know, in many cases, how to make the best use of the technology we already have, nor do we necessarily understand what we're doing.

In the case of osteoarthritis, why is bone-on-bone contact painful in the first place? There are no nerve endings in bone. Yet we can only fix it by removing and replacing entire joints. I think we're missing something here.

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