Trapeziectomy

Wrist bones illustration with trapezium removed

Procedure

In this procedure, the Trapezium is removed, and one of the ‘spare’ tendons around the base of the thumb is used to stabilise the thumb. This is the mainstay of treatment of thumb base arthritis and is a time-proven procedure.

Around 80% of patients will have complete relief of pain, and the majority of the remainder will be much better off than before surgery.

The operation itself takes around an hour and can be done under general anaesthesia – with you asleep; or under regional anaesthesia – with a numb arm. There will be a scar on the back of the thumb, typically around 4-5cm.

Aftercare

After the operation, you will be in a cast for a total of six weeks. After the first two weeks, you will come back to have your stitches taken out and be put into a new cast for the remaining period. After this you will be given exercises to get the thumb moving. You may be referred for hand therapy if needed. It typically takes around three months from surgery to be comfortable, and it will continue to improve up to a year.

Risks

Any procedure carries risks, and whilst every care is taken to minimise the chances, the following are some of the more common - but still rare - complications that can arise:

Infection - Significant infection is very rare.

Tender Scar - The scar is always a little tender, but occasionally it takes longer and requires more treatment to settle.

Stiffness, Swelling and Pain - A degree of stiffness, swelling and pain following surgery is normal. Some people react badly to an operation and develop more of this. This is called complex regional pain syndrome (CRPS) and requires specialist treatment.

Nerve Injury - it is not uncommon for some of the small skin nerves around the scar to be damaged, leading to a small numb patch on the back of the thumb or a sore area.

Loss of Thumb Column Length or Instability - Because a bone is removed, sometimes the thumb can shorten slightly and become less stable.