Trapeziectomy

What is a Trapeziectomy?

The Trapezium is a small wrist bone that lies at the base of your thumb. Trapeziectomy is the removal of this bone. It is commonly affected by wear and tear, otherwise known as arthritis. Arthritis affecting this bone is very common. It can be related to age, activity, injury or can be inherited. With time the joint becomes worn. Progressively it leads to increasing pain, weakness in grip, stiffness and eventually it may cause deformity at the base of the thumb.

Trapeziectomy is the removal of this bone.

What does a Trapeziectomy entail?

In Trapeziectomy procedure the trapezium bone is removed completely. The gap fills with scar tissue on which your thumb will sit to reduce the pain of the bone on bone rubbing.

In some cases a tendon sling procedure is also carried out to support the base of thumb after removal of the trapezium bone. In this a part of a tendon of your thumb or wrist is used to wrap around the thumb bone and roll up into the gap to support the thumb during healing (you will not notice a functional problem by loss of your tendon). No clear advantage is shown comparing this option with simply removing the bone in most cases.

Objectives of a Trapeziectomy

When all non-operative treatment options have been exhausted, surgery gives the best chance of reducing your pain. This may consequently improve your hand function.

After the procedure 85% of patients have a significant pain improvement.

What are the risks?

As with any other procedure there are complications which can happen with a trapeziectomy. Some of these can be serious. You can ask your doctor if there is anything you do not understand. Your doctor may be able to tell you if the risk of any complication is higher or lower in your case.

• There are risks with anaesthesia and your anaesthetist will discuss these with you.
• Pain: It is common to have pain after a trapeziectomy procedure. This can last for several weeks. It is important that you take regular analgesia provided to you and follow instructions to do hand exercises as advised.
• Bleeding: This can happen during well after surgery. This generally stops by itself.  The risk of bleeding is higher in patients who take blood thinning medication. Your doctor will advise you if you need to stop any of this to reduce the risk before surgery. The risk of damage to artery in the base of thumb is possible but if identified at the time of surgery is unlikely to cause any noticeable problems in future.
• Infection: The risk of infection is less than 1 to 2%. He will have regular visits for dressing change and therapy appointments to monitor this. Inform the     healthcare team if you have a temperature, have increasing pain, increased swelling and discomfort or notice any smell from the dressings.
• Scarring: This can be tender or unsightly. Your therapy team will teach you how to massage and soften the scar as it heals.
• Damage to superficial nerves: Damage to small skin nerves can lead to tender scar or numbness around the scar. Damage to small nerve running through the     region of where the surgeon is operating may form a painful spot on/near the scar (a neuroma).
• Continued pain and weakness: A large portion of patients experience a decrease in pain following the surgery however, a small portion experience little to no change in pain and function. Some are worse than before they had     surgery. This can occasionally happen because of the thumb bone sinking down a little. Pain can also be because of surrounding arthritis in the wrist and other joints.
• Complex regional pain syndrome (a malfunction of the nervous system that controls your brain): Pain, stiffness, loss of use of hand. The exact cause remains     unknown and it varies in severity and is treated by means of painkillers and physiotherapy. This can take several weeks to months to improve.
• Problems with tendon: If the tendon is used for suspension or a sling procedure it can snap or move from its position leading to increased pain in few patients.
• A Large portion of patients experience a decrease in pain following the surgery however, a small portion experience little to no change in pain and function. Some are worse than before they had surgery. 
• Risk of reflex sympathetic disorder (RSD). Can also be known as Chronic Regional Pain Syndrome (a malfunction of the nervous system that controls your brain)

What is the recovery timeline?

You cannot drive until you feel you can safely grip the steering wheel in both hands to control the car. This is normally 6 weeks at the earliest. Sometimes it can take longer to get full function. It is always recommended to speak to your insurance provider before you start driving again. Light household work can be started at 4-6-week mark. If you have a desk based job with no major physical activity, you can can return to work 6 weeks post operation. If you do a lot of physical work with heavy lifting then it can take up to 3-6 months. Heavy lifting is not recommended until 3 months after surgery. Grip strength and pain can continue to improve up to 1 year after surgery. Occasionally pain may persist due to other causes. 85% of patients will notice an improvement in their pain as compared to preoperative level 6-8 weeks after surgery. At 3-6 month mark you should see a good return to routine daily activities and hand function.

How to prepare for Trapeziectomy

This procedure is done as a day case meaning you will be allowed to go home the same day with no overnight stay in hospital. Very occasionally, social or medical conditions require an overnight stay.

Before you come into the hospital remove any rings from the hand and if you are unwell or have any cuts on your hand or arm then please inform us before the day as this may require your operation to be delayed. 

If you smoke it is best to stop or reduce as much as you can. 

f you are diabetic you will reduce your risk of infection and poor wound healing by keeping your blood sugars stable. 

You must starve for your surgery. You may have a general anaesthetic where you go to sleep, or a Nerve block (this is where you are awake but have a numbing injection in your armpit and the whole arm is numb for 12hours), this block can be done with or without sedation. You must not eat, drink or chew gum for 6 hours before you come to the hospital. 

You will be seen by the anaesthetist who will check your current health, ask specific questions about medications and when you have last eaten or drank. They will then discuss the details of the anaesthetic including the process, risks and answer any questions you have. 

Surgery can take 30-90 min. Your surgeon will make a cut a few centimetres long base of thumb. They will carefully isolate the trapezium bone before removing it. The wound will be closed with stitches. You will have a plaster cast or a bulky dressing around your thumb at the end of the procedure, and an arm sling to elevate your hand.

You should have someone to take you home and be with you overnight after the operation.

Please attend all dressing, doctor and hand therapy appointments after surgery and follow instructions on hand exercises to get the best function and recover following surgery.

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