In good hands

Surgery restores the tools of the trade for Muscatine artist

Humans aren’t the only mammals with opposable thumbs – monkeys and chimpanzees have them, too – but we are the only ones with the ability to move all of our fingers to our thumb, making it easier to hold smaller objects and carve out the tiniest of details.

Losing that pinching movement would make life difficult for most people. For Linda Ayers, it made everything she does come to a grinding halt.

Linda relies on her hands quite a bit. As an artist, she paints and draws, crochets, and embroiders. Her hands have done intricate work like making jewelry and cake decorating, and they’ve known hard labor, like laying rock for a wall or tanning a deer hide.

“These hands are my tools,” says Linda, 69, of Muscatine, Iowa. “I would like to have the full use of these hands for another 30 years.”

When severe cases of osteoarthritis in both of her thumbs made even the simplest of tasks painful, she took immediate action – first to see her own doctor and then to consider surgery at University of Iowa Hospitals & Clinics.

She had surgery first in her right hand, then in her dominant left hand. Surgeons removed her trapezium bone at the base of each thumb, and then placed a tendon as a spacer to allow her to continue using those fingers.

“She was a very well-informed patient,” says Ericka Lawler, MD, a UI Hospitals & Clinics orthopedic surgeon specializing in hand and wrist injuries. “She had done her research and was interested in talking about different treatment options.”

Osteoarthritis – or “wear and tear” arthritis – is the most common chronic condition of the joints and generally occurs in older adults. Though there’s no specific cause, overuse is a contributing factor. That, Linda says, is likely what led to the pain in both of her thumbs.

Though some pain had been ongoing, Linda says the problem really became evident in August 2014. She was helping a friend get ready for a baby shower by making 150 finger sandwiches. She also stayed up late finishing a crocheted baby blanket gift.

“My hand just ‘blew up,’” Linda recalls. “It was swelled up all the way up to the elbow, with fingers like sausages.”

She researched the symptoms online and found something that matched hers, an injury common among mothers with young babies. She later went to see her doctor, who treated her with anti-inflammatory medication.

Things went fairly well until close to Christmas, when her arm swelled again – this time after making some jewelry for a friend as a gift.

“We decided to get some X-rays, and the images were pretty alarming to my doctor,” Linda says.

Linda’s doctor told her she had severe osteoarthritis and outlined several treatment options, including cortisone injections, physical therapy, and surgery. Wanting more specifics, she came to Lawler’s office at UI Hospitals & Clinics. Though Lawler told her much of the same information she’d already heard from another orthopedic specialist, Linda says the way she was treated by Lawler made all the difference.

“I had been around a bunch of people asking, ‘What did you do?’, as if it were somehow my fault,” Linda says. “But when I saw Dr. Lawler for the first time, she was very self-possessed, and she touched my hands very gently and said, ‘Oh, you’ve really used your hands,’ then asked if I was an artist or a musician.”

“It was like, ‘Well, this is what happens with artists, and we can fix this,’” Linda says. “It was her demeanor. I didn’t feel ashamed or like this was my fault. I felt I could trust her with my hands.”

Linda and her husband, Tom, began to prepare for surgery. She wanted to remain as independent as possible, so they went about making parts of their home more accessible for her.

She had surgery on her right hand on Feb. 12, 2015. Following surgery, she was not able to drive for 80 days and didn’t start physical and occupational therapy until early April.

Linda’s right hand was allowed to heal before she underwent surgery on her left hand. That one was Dec. 17, 2015, and came with 129 days of no driving.

“That second one was a nightmare,” Linda says. “The surgery was more difficult because it was my dominant hand, and there was a bit more damage.”

Lawler agrees.

“Linda clinically had more pain in that hand, but then based on the X-rays and what we saw in the operating room, there was a lot more destruction of the cartilage on that hand,” Lawler says.

Following the second surgery, Linda had to wait two months before she could begin occupational and physical therapy, which lasted until late July 2016.

“I am not good at sitting quietly – the last surgery was very difficult,” Linda says.

Now, she says, she respects the surgeries, and she understands what it took to get her hands to feel better.

“I am making a concerted effort to pace myself,” she says. “All my life I was just used to getting the job done, now I’m parsing things out a bit. I try not to do it all in one fell swoop.”

Still, she’s enjoying getting back to the things she loves.

“I got my hands back,” she says. “I couldn’t be happier.”