Trapeziectomy: Surgery for Thumb Base Arthritis

Trapeziectomy: Surgery for Your Thumb Base Arthritis

Please also read my page about Thumb Base Arthritis.

 

What is the technique for surgical treatment of thumb base arthritis (Trapeziectomy)?

This operation is usually performed under general anaesthetic, meaning you will not be awake during the procedure. First, I will make an incision on top of the thumb or the outer side of the fleshy part of your thumb base. Then, I will gently remove the small bone at the base of the thumb (the trapezium); this bone is the cause of your pain. The surrounding joints are inspected at the same time.

Occasionally if there is arthritis at the base of the trapezoid (a neighbouring carpal bone), then I will remove the arthritic part of this bone as well. The wound is closed with dissolving sutures.

 

After your trapeziectomy

I will administer local anaesthetic at the end of the operation and provide you with lots of oral pain relief to make you as comfortable as possible. There will be a large bandage, including a small plaster cast, on your hand. It is important to keep this clean and dry until your follow up appointment. You will usually go home the day of surgery. Elevate your hand as much as possible, as having your hand dangling down will cause swelling and make your hand more uncomfortable.

About two weeks following surgery, the bandage and cast are removed, and your hand therapist will make a small lightweight splint for you to wear all the time. You will be guided through a regime of exercises to maintain movement but prevent excessive force through the healing wound. Your hand can be washed briefly at this point. At the six-week mark, you can begin to remove the splint during the day for light activities, but I like you to wear it at night and for protection for eight weeks after your operation.

If you do not have a hand therapist yet, let me know during our initial consultation. I will be happy to recommend a therapist near you. Please read about expert Hand Therapists near you.

 

About your recovery

A trapeziectomy is excellent at removing the pain of the arthritis, and with a reduction in pain, you will notice an increase in grip and pinch strength and overall function. However, the recovery from this procedure is slow. It takes most patients 4-6 months to return to all their normal activities.

 

When can I drive?

It will be at least 8-12 weeks before you can consider driving. You may start driving again when you have regained full range of finger movements and have the power to control a motor vehicle.

 

When can I return to work?

This depends on your occupation, but as general guidance:

• Supervisory, managerial: 4-6 weeks
• Light manual e.g. clerical: 6-12 weeks
• Medium manual e.g. nurse: 12-16 weeks
• Heavy manual e.g. labourer: 4-6 months

 

Possible complications of a trapeziectomy

Wound complications

Possible problems include swelling, bruising, bleeding, blood collecting under the wound (haematoma), infection and splitting open of the wound (dehiscence).

Scar

Depending on the size of your hands, you will have a scar over the thumb base about 5cm in length. The scar may become a little thickened and red as it heals, but this will settle with time. The scar will be tender, and this will also resolve. Firm massage with a plain cream or oil will help heal the scar.

Incomplete relief of pain

90 % of patients notice a good amount of pain relief following the recovery period

Persistent weakness of pinch grip

Before your operation pinch grip is usually reduced due to pain from the arthritis. While your grip strength should be improved following the operation (as the pain is resolved) it will not be returned to it’s pre-arthritis state.

Nerve damage

There are small nerve branches that run in the area of the incision. The nerve can be damaged during the operation and this may leave either a numb patch on the back of the thumb, or a small tender point that may need another small operation to excise the tender spot.

Further surgery

Should there be a complication that requires another operation, then I will discuss this with you. Sometimes arthritis develops at neighbouring joints and needs treatment. Very occasionally there is some instability after the bone is removed; a ligament reconstruction can take care of this instability and secure the thumb.

Complex regional pain syndrome

This is a syndrome of pain, stiffness and swelling that occurs in about 5% of people following surgery. The symptoms are out of proportion to the nature of the operation. At the moment, we are not sure why it happens and we cannot predict whom it will happen to. I will monitor you for this after the operation, and the treatment involves special forms of pain relief and physiotherapy. Please read about complex regional pain syndrome.

Read more about possible complications from hand surgery.