Having a Trapeziectomy

Is this procedure always necessary?

When surgeons discuss operations for this type of problem, the risk of having an operation has to be considered alongside any potential benefit. Most operations have a consequence for the body. Having the trapezium bone removed has a knock on effect on how strong the thumb feels, and although the operation can improve pain, it does not restore normal activity. It is always a good idea to consider:

• Doing nothing – arthritis at the base of the thumb is very common, particularly as we get older. The vast majority of people with this problem adapt and live with the nuisance symptoms that it gives. In most cases, it is very safe to do nothing.
• Other types of operation – You can read about these on our base of thumb arthritis webpage.

What happens on the day of surgery?

On the day of the operation, you will be asked to report to XXXXXXXXXXXXXl. Please be aware that you will need someone to pick you up from the hospital after your operation.

What should you do to prepare?

Read about Having an operation on your hand or arm. This runs through most of the risks involved with the surgery, and it is really important that you are aware of this risk before agreeing to the surgery.

Planning for when you get home is also important. You can help make things easier by:

• Making sure you have a good weeks supply of food and provisions in the house
• Having some ready meals or easy prep meals available
• Planning to wear loose fitting clothing such as joggers and t-shirts for the first few days

What type of anaesthetic is used?

We do this type of surgery under a general or regional anaesthesia as a day-case procedure. General anaesthesia means that you will not be awake for the operation. Regional anaesthesia is when your arm is made completely numb, but you are awake during the surgery. Patients who are not medically suitable for general anaesthesia will be offered a regional anaesthetic. You will be seen by our pre-assessment team before your operation who will discuss these options with you.

What exactly does the surgeon do?

The surgeon’s job is to remove the bone at the base of the thumb known as the trapezium. The surgeon will cut over over the bone, and retract or divide the tissue between the skin and the bone to get a good view of the bone. The bone is then split into several pieces and removed.

The wound is closed with a stitch that runs under the skin and can’t usually be seen. There is no need to have any sutures removed.

After the operation

After a trapeziectomy, you will have a plaster or rigid splint on your hand for around 6 weeks. It is usually quite difficult to manage initially, but after the first week or two you will be able to use your hand for some things, even with the plaster on.

Rehabilitation

After the procedure, you will be advised to keep your hand elevated above shoulder height, to ease pain and swelling over the first 2 days after surgery. This is most easily done by lying out on a sofa and resting the arm up on pillows.

It is really important to keep your hand, elbow and shoulder all working as well as possible over the first few weeks after surgery. A plaster is usually on for 6 weeks, but you should be able to use the fingers and tip of the thumb as soon as possible.
Most people do not need any special physiotherapy after trapeziectomy, but our therapists are usually on hand to give advice if necessary.

Follow-up

You will be seen in the hand clinic at around 10 days after the operation. The nurse will check your wound, make sure you are moving well, and arrange for you to have a fresh plaster cast put on.

• Your next visit will be at six weeks after the operation, when the cast is removed.
• At this point we usually put you in charge from here on in – if you need to see us, you can contact us as you feel necessary.

Are there any complications of a trapeziectomy?

The main reason that people are unhappy after this operation is because they can’t use the thumb well for pinch grip. This can make every day things like filling a kettle or lifting a pot difficult. Complications of this operation are:

• Infection – Infection is a complication of all operations. A course of antibiotics is sometimes required.
• Damage to nerves – There are many small skin nerves around the area of the operation, and the surgeon usually divides some of these to allow access. Mostly, this will result in a bit of numbness around the wound, which settles with time. Sometimes, there is permanent numbness of an area around the wound.
• Damage to the radial artery – The radial artery can potentially be damaged during this operation. This does not usually give any symptoms in most people.
• Scar problems – It is common for the scars to become raised, lumpy, red and tender for several months after surgery. This will gradually settle but sometimes be a nuisance.
• Stiffness – It is usually very safe to mobilise the hand straight away, but sometimes stiffness sets in if the hand is not moved regularly.
• “Proximal migration” of the thumb – This is a term used by surgeons to describe a complication where the thumb bone ‘sinks’ and starts to rub against the wrist bone. It can be sore, and there is no good solution to this problem, although further surgery is an option. Luckily, it is not very common for this to be an issue.

There is further guidance on general issues in our ‘Having an operation‘ guide. .