Excision Of Trapezium

The Condition

You have wear and tear of the joint at the base of your thumb. The base of the thumb moves on a small box-shaped bone called the trapezium.

This bone in turn articulates with another curved bone – the scaphoid.

There can therefore, be wear and tear above the trapezium or below, but surgical treatment is the same in that, we remove the trapezium bone. This operation has been used for 30 years or so, and the results of surgery are excellent. The space where the bone was fills up with a dense mass of scar tissue. This acts like a “cushion” and allows the thumb to move quite normally and freely with good pinch grip and power grip.

The Operation

The operation is done as a “day case” and you will be able to go home the same day as the operation. The operation is done whilst you are asleep – a general anaesthetic. The wound is filled with local anaesthetic after the bone is removed. Your hand will be numb after the operation – this lasts for 8 hours or so. The wound will be aching after that but not acutely painful. The wound is closed with glue or stitches.

After the Operation

The operation is carried out as a day case. You are kept in a large bandage, which reduces thumb movement for a period of 3 weeks in total. The bandage keeps the thumb in the best position for healing.

After removal of the bandage at 3 weeks, we will remove stitches (if they have been used). You will be encouraged to exercise on your own. The thumb is often uncomfortable after surgery for 6 – 12 weeks, but bit-by-bit the pain settles and strength and movement improve.

Pinch grip and power grip, which are very weak before surgery will steadily improve, after the operation for up to 9 – 12 months after the date of surgery. You will be encouraged to exercise the hand in warm to hot water as soon as the bandage is removed. You will not be able to do any harm to your hand and can use it for any activity you like as soon as the bandage is removed.

Patients who have this wear and tear problem in both hands almost always want the same operation carried out on the other hand after we have done the first one, because the operation is so successful !

You will not be able to drive while you are in the big bandage for a period of 3 weeks. You should be able to drive by 4 weeks after surgery.

If you do heavy manual work, you will be unable to work for 6 – 12 weeks after surgery.

If you do light office-type work you will be able to get back to work after 5 or 6 weeks.

Risks of Surgery

1. Stiffness of the thumb – occurs in about 2% of all operations
2. Weakness of pinch and power grip – occurs in about 2% of all operations
3. Infection can occur – as after any cut in the skin, this occurs in about 1% of all operations.
4. Sensitivity of the wound – seen in about 1% of all operations.
5. Circulation disturbance (sympathetic dystrophy or regional pain syndrome) can occur in approx 1% of all operations. Prompt treatment with medication or injection is usually very effective. You will be reviewed regularly after surgery so this or any other complication is treated promptly.