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Trapeziectomy

Painful arthritis affecting the thumb base is extremely common. The joint affected is that between the metacarpal of the thumb and the bone it rests upon within the wrist, which is called the trapezium. Typical symptoms are of pain produced by gripping and twisting actions such as undoing the tops of tight jars and bottles, turning taps and many other activities.

Surgery for symptomatic thumb base arthritis consists of excision of the trapezium bone (trapeziectomy) which I combine with a soft tissue interposition using a strip of one of the tendons on the palmar aspect of the wrist. It is not uncommon to do other adjunctive procedures too to deal with arthritis in adjacent joints (for example resection of part of the trapezoid bone). Surgery can be performed under general or regional anaesthetic and is typically carried out on a daycase basis. Through a dorsal incision over the thumb base the trapezium is removed and an addition 1cm incision is made on the palmar aspect of the wrist 10cm proximal to the wrist crease. At the end of the surgery, the hand is wrapped in a bulky dressing and the thumb supported with a splint to keep it still and comfortable.

Early mobilisation of the fingers is encouraged and the thumb can be used for gripping within the constraints of pain.

The wound is typically inspected at 2 weeks after surgery, when sutures are removed and a fresh splint is applied, typically one that can be removed for bathing purposes and which would allow some additional mobilisation.

The splint is removed in the day after 4 weeks and is used only at night for a further month. Recovery after the first 4 weeks involves working towards establishing full range of motion, supported by the hand therapist, and also strengthening the thumb i.e. using it for greater and greater loads in normal daily activities or living. Driving is typically unsafe for the first month to 6 weeks. Recovery from surgery is normally excellent in terms of regaining mobility, improving strength and relief of pain but the process is slow and takes approximately 4 months on average. About 1 in 20 patients require further surgery. Most patients are very happy with their outcomes.