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What is a trapeziectomy?
Trapeziectomy is a surgical procedure used to treat arthritis at the base of the thumb. Arthritis in this area is very common and occurs between the long bone of the thumb and the trapezium, which is a small bone in the wrist.
What are the symptoms?
The progression of symptoms varies from person to person and symptoms include:
- Pain related to activities when the thumb is pinched, such as opening packets or peeling vegetables
- A weaker grip due to pain
- Swelling at the base of the thumb
- Pain when resting
- A thumb which appears twisted or crooked
When will I need a trapeziectomy?
You should see your GP if the pain is not lessened through the use of over-the-counter pain relief such as ibuprofen or paracetamol, and if the condition is adversely affecting your normal activities. They may recommend a range of measures including physiotherapy, splints or steroid injections. If your GP deems it appropriate they may refer you for a trapeziectomy, which is the surgical removal of the trapezium bone.
What does a trapeziectomy involve?
Trapeziectomy is the most common form of surgery. It is usually carried out as day surgery using a general anaesthetic, which means you can go home on the day of your surgery once you have recovered from the anaesthetic. The surgeon will remove the trapezium, and some will fill the remaining space using a piece of tendon from your wrist. Other options involve inserting an artificial metal and plastic joint, or a silicone rubber spacer.
How long does a trapeziectomy take?
The operation lasts between 60 and 90 minutes and patients are advised to keep their hand elevated for 48 hours after their operation. Between two to four weeks after the procedure the dressing/cast will be removed and replaced with a light plastic splint. The splint can be removed during the day to exercise the thumb and wash it according to instructions given at discharge from hospital. The splint can also be removed during the day four to six weeks after the operation and used at night for a further two weeks. Physiotherapy will begin at about this time so that the thumb gets back to its full range of movement. If pain is experienced, stop.
What happens after a trapeziectomy?
The operation results in a great change to the way in which the thumb works and your body needs time to rebuild the structures around the base of your thumb and get used to a new way of operating. It can take up to six months for the strength of the thumb pinch to return. Around six to 12 weeks after surgery you can return to driving if you feel confident you can control the vehicle – but driving is not advised if you are still using a rigid splint. You can return to work in the same period, but if your job is manual and involves heavy lifting you may have to wait for six months. It can take up to a year for the soreness to subside.
What are the risks and complications of a trapeziectomy?
Risks are minimal. Potential risks are those related to all types of surgery including infection, thumb pain, a blood clot and weakness and/or stiffness in the thumb. Nerve damage is a rare possibility, and complex regional pain syndrome can occur following hand surgery.
A pre-operative assessment is our opportunity to ensure that the procedure for which you have been referred is right for you. We’ll explain your treatment to you and makes sure that you are well enough to go ahead with it. It is also your opportunity to meet the team who will care for you and to ask any questions.
We carry out all the necessary tests and examinations in one outpatient session. While this may take several hours, everything is done in one go to save frequent visits before surgery.
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