Trapeziectomy

This leaflet aims to help you understand and gain the maximum benefit from your operation. If after reading this leaflet you have any questions, please get in touch with the surgical team.

What is the trapezium?

The trapezium is a small bone in the hand which is joined to the base of the thumb. The bone is responsible for aiding the stability and movement of the thumb. It is a common site for osteoarthritis in the hand.

Osteoarthritis can lead to pain, swelling and tenderness at the base of the thumb. Pain is often worse moving the thumb and you may have reduced movement. Grip and pincer grip can be reduced due to pain.

What is thumb Osteoarthritis (OA) and how can it be treated?

OA at the base of the thumb is very common. It can come on gradually and be caused by the demands placed on the thumb during day-day activities. Base of thumb OA tends to be more common in women and may run in families. It can be managed with:

• Conservative management – while there are arthritic changes in the base of thumb joint, pain can still be managed with pain medication, activity modification and using thumb splints. If you decide to have an operation at a later stage, the operation will not be more difficult to perform, and the chance of success should remain the same.
• Steroid Injections are discussed on an individual basis and maybe offered to patients when pain is the main symptom. Often adequate pain relief is sufficient to maintain good function. Pain relief can be temporary, and this does differ from patient to patient.
• Surgery is recommended to improve pain and function. This is offered to patients when more conservative methods have failed. 

What is a Trapeziectomy?

A trapeziectomy is the surgical removal of the small trapezium bone at the base of the thumb joint. There are two different surgical options, and the consultant or member of the team will discuss the appropriate surgery for you.

• Trapeziectomy (with silicone spacer, tightrope or tendon sling/spacer) – trapeziectomy is the most common procedure with the aim to achieve an improvement in pain.  This may be combined with either a silicone spacer or tightrope.  With a tightrope, the thumb is given extra stability when the base of the index finger and thumb are secured together with a ‘tightrope’. Think of it as a tough internal suture. Sometimes part of a tendon is used to fill the gap or create a supportive sling to stabilise the thumb. This is obtained through a small incision on your forearm.
• For younger patients or those who are very active, it may be better to have an arthrodesis or fusion (where the thumb bones are permanently fixed/fused together using screws). This is less common and has higher complications with no proven benefit in the long term of impacting grip strength.

What is the surgical procedure of a trapeziectomy?

The surgery is a day case procedure which means you go home the same day. It is usually done under a regional anaesthetic (nerve block but you remain awake). It may also be performed under a general anaesthetic (you go to sleep). It can take up to 24 hours before the nerve block completely wears off, during this time, you will not be able to move your arm and you may have altered sensation of the arm or hand that persists for some weeks.

Your surgeon will make a small incision at the base of the thumb posteriorly. You may also have an incision at the top of the hand. Using this incision, they will remove the trapezium bone. This involves cutting the tissues around the bone to free it as far as possible to assist in the removal of the bone. This removes the arthritic joint. On average the operation takes 60-90 minutes to complete and approximately 85 percent of patients have significant improvements.

Every surgeon will have a different approach in managing your recovery. You may be placed in a plaster cast for 6 weeks following surgery. You will be advised of this prior to the operation and what your recovery will entail.

What are the benefits of surgery?

The aim of surgery is to provide pain relief. You may still find that you have weakness in the thumb; with your grip and pinch strength although you should be able to use your hand more easily due to the improvement in pain.

Are there any complications with this operation?

All surgical procedures are associated with a degree of risk.

General complications:

• Pain levels felt after surgery vary for everyone. You will be advised on pain relief after surgery.
• Bleeding/bruising/swelling during or after surgery. This is common.
• Scarring & scar tenderness (<3%) – this should settle within a few months after surgery.
• Wound complications including Infection (<1%). Please get in touch on the telephone number below if you suspect you have an infection or any wound complications following surgery.

Specific complications:

• Persistent pain or stiffness – although your symptoms should improve with surgery you may not have full relief of pain or stiffness.
• Nerve pain, neuroma or hypersensitivity (<16%) you may have continued numbness or pain caused by damage to sensory branches of the radial nerve during the operation. This usually improves over a few months. You may get a neuroma (painful lump) and may need further surgery or treatment.
• Weakness – both your grip and pinch strength may remain weak after surgery (common).
• Revision surgery or further surgery (uncommon)
• Complex regional pain syndrome (CRPS) (<5%) very rarely you may develop CRPS which can cause swelling and severe, debilitating pain. This is a difficult condition to treat and may last for serval years.
• Anaesthetic complications – the anaesthetist will discuss this with you.

What happens before the operation?

Pre-admission assessment

This is an assessment of your health to make sure you are fully prepared for your admission, treatment and discharge. Please bring a list of all your current medication including a list of allergies and the type of reactions.  Before the date of your admission please, read closely, the instructions given to you by the pre-admission assessment and your confirmation appointment letter.

Planning ahead

Once you have your date for surgery you can do several things to aid preparation for your operation and to improve your recovery. You may wish to stock up your freezer with easy cook items (particularly if you live alone), as you may find daily tasks such as cooking more difficult initially after your operation. If you have family or friends who can stay with you or visit regularly this may make your recovery easier both for helping with household tasks and moral support.

Smoking

Smoking has been shown to delay wound healing and increase complications after surgery. Patients who stop smoking benefit from long term improvements to general health, decrease the risks associated with anaesthetic and have a better outcome from surgery. If you are interested in stopping smoking please speak to your pre assessment nurse or GP for advice and services available.

Weight

Even though you may feel fit and healthy at your current weight, patients with a higher body mass index are most likely to experience potential serious complications both during and after surgery. If you are keen to lose weight, please speak to your GP or pre assessment nurse for services available.

Cancellation

If you are unable to attend your appointment, please contact us immediately.

Recovery after surgery

The trapeziectomy is usually performed as a day case. There are different types of anaesthetics used and the anaesthetist will see you before your operation and discuss these with you.

Day of surgery

You will be given specific instructions about when to stop eating and drinking, please follow these carefully as otherwise this may pose an anaesthetic risk and we may have to cancel your surgery. You should bath or shower before coming into hospital. The anaesthetist, surgeon or a member of the team will visit you and answer any questions you may have. You will be asked to sign a consent form.

Post-surgery

After the operation you will spend a short time in the recovery room. You will go home the same day and you will be advised on pain relief. Some people may be placed in a plaster cast to be worn for 6 weeks after the operation; you will be advised of this prior to surgery.

Swelling

It is important to keep your hand raised above your heart in a sling or pillow for 2 weeks after surgery to assist with swelling

Pain

Significant pain and discomfort are common after surgery and residual pain can last up to 4-6 months post trapeziectomy. If you feel you are unable to manage your pain, please discuss this with your GP or consultant.

Wound and scar care

You will have a wound check around 10-14 days after surgery. Keep the wound dry until it is fully healed. After the dressings are removed, you will be placed in a suitable splint/cast, to be worn as instructed.

Once the wound has fully healed, you can start to massage the incision with unperfumed cream (E45, aqueous or Vaseline) to soften and flatten the scar.

Daily activities

Once you are out of the back slab/cast and have had an assessment by the team, you will be placed in a suitable thumb splint. You will be advised how long to wear this for, but it should be worn for functional activities initially but can be removed for exercises, hygiene, and scar care.  Once the pain improves, the support use can be reduced as pain allows.

You will need to gradually increase the use of your hand guided by your therapist. Light activities are advised for 3 months. The goals for recovery are to regain function, range of movement, reduce pain and manage the healing of the scar.

Driving

You should always be in complete control of your car. We advise you that do not drive until the splint is removed and you are comfortably able to grip the steering wheel. It is wise to discuss this with your insurance company before you return to driving.

Exercises

If your thumb has not been put in a cast, you can remove the thumb spica splint to exercise as pain allows. The removable splint can be worn for comfort for 3-6 weeks and gradually wean from this.

If you have been placed in a cast, you can start to exercise the thumb, wrist, and hand once the cast has been removed. Continue to wear the splint for comfort until around 6-8 weeks following surgery date or as guided by the physiotherapist/surgical team.

You can start returning to light activities with your thumb spica splint on. Avoid any tight gripping, pinching or heavy lifting/loading through the thumb for at least 12 weeks.

It is advisable to repeat the exercises regularly 3-5 times throughout the day, repeat x 10 repetitions.

Try to avoid pushing into pain. You may feel a discomfort or a stretching sensation.

These exercises can be started around 1 week after surgery or as soon as you come out of cast.

Scar Management

Once the stitches have been removed and the wound has fully healed, you can start scar massage around 4 x per day. You can use non-perfumed moisturising cream such as E45, aqueous or Vaseline.

If your scar is sensitive to touch, you could try touching it with the other hand, exposing it to different textures and tapping it.

Physiotherapy locations

Should you be referred to physiotherapy, depending on the location of your GP, the physiotherapy provider may be different.  Please contact the relevant number below if you have not received your appointment within 2 weeks of having surgery.

• If you have a Gateshead / Newcastle GP, your physiotherapy provider will be Tyneside Integrated Musculoskeletal Service (TIMS). If you have a query about your first appointment with TIMS, please contact the booking team on 0191 445 2643
• If you have a Durham GP, your physiotherapy care will come under Durham. Please contact the Queen Elizabeth hospital, physiotherapy department should you not receive your first appointment on 0191 445 2320
• If you have a GP that is outside of the Gateshead / Newcastle or Durham area and you have had elective surgery, your physiotherapy will be at the Queen Elizabeth hospital. Should you not receive your first appointment, please contact physiotherapy reception on 0191 445 2320

Telephone numbers