Through rain, sleet, snow or hail, the postal worker always delivers. But one cold and rainy October day five years ago, 53-year-old postman Kenny Grayson of Pasadena, MD, considered being an exception to the “golden rule” of the U.S. Postal Service. Sharp pains were stabbing his right thumb joint, where the base of his thumb connected to his wrist. Every time he grabbed envelopes out of trays, or turned a key to open cluster mailboxes at apartments, he felt pain.

Grayson’s doctor diagnosed osteoarthritis (OA) and referred him to an orthopedic surgeon. He took cortisone shots and nonsteroidal anti-inflammatory drugs (NSAIDs), did exercises to improve the strength in the joint, wore splints and tried resting his hand. But about a year later, Grayson had a decades-old surgical procedure done on his right thumb to relieve his pain.

While his right thumb was healing, Grayson increasingly relied on his left thumb. Before long, it, too, became painful and immobile, and Grayson needed surgery on it. For this second thumb surgery, in 2005, he chose a different option that was still experimental at the time. Grayson hoped the newer option would shorten his recovery.

Four years after his second surgery, he’s not so sure the newer procedure was the better choice.

Arthritis: When It Gets A Grip

When OA of the thumb strikes, many people discover, as Grayson did, how much they depend on their thumbs to get through the finest movements of their days. But as cartilage between the bones wears away, pain can become excruciating and bring those movements to a grinding halt. Erosion can shift alignment of the bones so much that the thumbs become deformed and unable to grasp, pinch or move.

What are the options when it’s no longer possible to pick up a set of keys, let alone turn the key to start a car?

That’s not an easy question to answer, according to L. Andrew Koman, MD, a hand surgeon at Wake Forest University Baptist Medical Center in Winston-Salem, NC, and president of the American Society for Surgery of the Hand.

“We don’t know the ideal operation for arthritis of the basal joint,” Dr. Koman says. “There are no level-one studies to tell you which procedure is better than another.”