Trapeziectomy

Summary

This operation is performed for thumb base arthritis.  The aim of the operation is to remove the trapezium which is one of the wrist bones at the base of the thumb. This removes one side of the arthritic joint to improve the pain.  

Factors to Consider

Symptoms from thumb base arthritis vary significantly between patients.  Many people will have pain on pinch and heavy grip.  The severity and duration of your symptoms will dictate whether you should proceed to surgery.

It is likely that you have already tried non-surgical treatments for your thumb base arthritis such as pain killers, activity modification, splints and injections.   The next logical step would be to consider surgery.  A trapeziectomy release has a good chance of improving your symptoms although it will typically take a while before full recovery.

If the joint above the thumb base bends backwards significantly it may be that a fusion of this joint at the same time will be 

Description of Surgery

The operation can usually be performed as a daycase procedure but you will need to ensure that there is someone to drop you off and pick you up from the hospital.  You will also need to have a responsible adult at home with you on the night of the operation.

The operation is performed through a small incision on back of the thumb base.  The surgeon will then identify the trapezium and remove it.  The joint is then stitched closed.  The operation itself takes up to 60 minutes.

Anaesthetic

The operation is usually performed under a general or regional anaesthetic and so you will be given instructions as to when you need to stop eating and drinking (normally the night before) before you come into hospital.  

Your pain can be well controlled with local anaesthetic given during the operation.

What are the risks?

All operations involve an element of risk.  The risks for this particular operation are small but it is important that you are aware of them.

The risk of infection is very small and is thought to be less than 1%.  Most infections will settle simply with antibiotics.

Damage to nerves and blood vessels around the thumb can occur but this is rare.

Surgery seems to be effective in most patients, but persistant symptoms may occur.

Some stiffness and swelling is common and usually resolves rapidly with elevation and movement of the fingers. Complex regional pain syndrome is a rare complication that may cause more prolonged pain, stiffness or swelling.

Instability at the base of the thumb is very rare.

Grip strength is usually better than with a painful thumb, but may not return to normal. 

After Surgery

Pain

Local anaesthetic will be used during the operation and so you will feel comfortable when you first wake up.  This can last up to 12 hours but the elbow may be sore after it wears off.  You will be given a combination of pain killers to go home with.  It is important that you take regular pain relief so that you can start moving your arm early.  

Dressings

You will wake up with your arm in a bulky bandage with a plaster cast underneath.

The wound is closed using dissolvable stitches.  They will be trimmed by the therapists when the cast comes off. 

You may be given a sling to help keep the hand up whilst walking about. This helps reduce swelling, but you can come out of it to move the shoulder and elbow.

Physiotherapy

The cast will be removed at about 2 weeks by the hand therapy team.  A splint will then be made for you for the next 4 weeks. The therapist will help you come out of this to mobilise the hand.

Driving

You can drive when you feel you are safe to drive.  This means that you feel confident that you have full control of your car and are able to swerve out of the way of something in the road.  This will vary between patients but normally will be after 6 weeks.  

Return to work

This depends on what your job is.  You should be able to return to a “desk job” within a few weeks of your surgery.  If you have a heavy manual job it can take up to 3 months before you feel ready to return to work.  Please discuss this further with your surgeon or physiotherapist if you feel unsure.  A sick note can be given to you at the time of your surgery if required.  Please ask the nurses on the ward if you need one.

What to expect

Your symptoms should be improved by 6 weeks, though it may take 3 months with the majority fully recovered.  It can, however, take up to a year for some patients to fully improve.