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Trapeziectomy

If you have arthritis in the base of your thumb, it probably causes a lot of pain, particularly when opening jars, perhaps changing gear, twisting door knobs and holding cups and saucers. It is the second most common joint to be affected by arthritis in the body and as your thumb is a very important organ it can be very debilitating.

ANAESTHETIC

General or regional anaesthetic.

OPERATIVE PROCEDURE

An incision is made over the back of the thumb and potentially two small incisions over the front of the wrist. The trapezium, which is the bone that sits under the thumb, which is affected by arthritis is excised and we sometimes fill the space with a piece of tendon that comes from the front of the wrist, which we get through the two small incisions. We also sometimes perform a new suspension-type of ligament at the base of the thumb from this tendon. There will be a plaster put on the wrist post-operatively and this needs to stay on for two weeks. It is half plaster to allow swelling. The thumb is then put in a complete cast for another two weeks before physiotherapy commences.

RESULTS

The operation is about 90% successful however it takes a long time to recover from. I generally say that it will take a year before you can forget that you have had an operation on your hand.

COMPLICATIONS

  1. Infection. This is uncommon but when it occurs can involve prolonged use of antibiotics (six weeks). Most of these tend to resolve.
  2. Pain. This is a painful operation and the thumb will be painful for at least three months afterwards.
  3. Algodystrophy / Complex regional pain syndrome. A rare complication (1%) but one that can give symptoms that are worse than the original symptoms. This involves the hand becoming stiff, painful, swollen and changing colour. Symptoms may not completely resolve.
  4. Precipitation of carpal tunnel syndrome. Sometimes if you have mild carpal tunnel syndrome before the operation surgery will make it worse. If necessary you may need to have your carpal tunnel decompressed at the same time or soon after your operation.