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Trapeziectomy Trapeziectomy What is arthritis of the Trapeziometacarpal symptoms are. You can avoid certain activities joint? that cause you pain or take painkillers. Your The Trapezium is a small wrist bone that lies at hand therapist can provide or make splints for the base of your thumb. It is commonly affected you to rest your thumb in. Your doctor may also by wear and tear, otherwise known as arthritis. inject the joint with steroid (cortisone). This can be done under ultrasound or X-ray guidance Your surgeon has recommended an operation usually on a different day from the outpatient called trapeziectomy. It is the removal of this appointment. The injection only provides bone. However, it is your decision to go ahead temporary relief of symptoms (3-6 months) with the operation or not. or may not be successful at all. Repeated This leaflet gives you information about the injections often last a shorter duration each benefits and risks to help you to make an time. They do not cure the condition. informed decision. If you have any questions Surgical options: this leaflet does not answer, please ask your surgeon or the healthcare team. 1. Trapieziectomy – This is where the bone is removed completely. The gap fills with scar There is more than one way this surgery is tissue on which your thumb will sit to reduce carried out and if you research the internet you the pain of the bone on bone rubbing. will find a lot of information about it, some of 85% of patients have a significant pain which may not be relevant to you. The website improvement. of the British Hand Society (www.bssh.ac.uk) is a useful resource. 2. Trapeziectomy with tendon sling – The bone is removed and part of a tendon of How does arthritis happen? your thumb or wrist is used to wrap around Arthritis affecting this bone is very common. the thumb bone and roll up into the gap to It can be related to age, activity, injury or can support the thumb during healing (you will be inherited. With time the joint becomes not notice a functional problem by loss of worn. Progressively it leads to increasing pain, your tendon). No clear advantage is shown weakness in grip, stiffness and eventually it may comparing this option with simply removing cause deformity at the base of the thumb. the bone in most cases. Initially, the symptoms may be related to certain 3. Joint fusion – A screw, plate or staple is activities such as opening jars and strong placed across the joint to stiffen it and stop gripping. As the condition progresses, the the bone on bone rubbing which causes symptoms can become more pronounced and pain. Often reserved for young manual permanent. laborers. What are the benefits of surgery? 4. Joint replacement – like a hip or knee, some surgeons replace the joint in very specific Surgery gives the best chance of reducing your patient cases. pain. This may consequently improve your hand function. What will happen if I decided not to have the operation? What are the treatment options? You may wish to try non-surgical options first. It There are several non-surgical treatments does not stop the progression of your arthritis. available depending on how severe your First choice for orthopaedic care Version 081/01 Review: May 2022 www.roh.nhs.uk | 0121 685 4000 Page 1 Trapeziectomy If these treatments are not affective, you may asked to change into a theatre gown and walk wish to consider surgery. If you do not have with a member of the theatre team or porter to surgery your pain and disfunctions are likely to the theatre if able. continue but in some cases the joint actually If you are having a general anaesthetic, you becomes stiffer and less painful with time. will go into the anaesthetic room instead, here What happens on the day of surgery? your details will be checked again and the Remove any rings before you come to hospital anaesthetist will perform the anaesthetic. and if you are unwell or have any cuts on your If you are staying awake for your surgery there hand or arm then please inform us before the is the option to listen to music or watch a video day as this may require your operation to be on the tablet screens and headphones we have delayed. in theatre. Alternatively you can bring your own You must starve for your surgery. You may have device to listen to music on but you must have a general anaesthetic where you go to sleep, or headphones. an axillary block (this is where you are awake Once you have a general anaesthetic, the next but have a numbing injection in your armpit and thing you will remeber is waking up in recovery the whole arm is numb for 12 hours), this block after the surgery. If you have an axillary can be done with or without sedation. You must block, this takes 20-30 minutes to work and not eat, drink or chew gum for 6 hours before therefore you will spend this time waiting in the you come to hospital. Up to 2 hours before you anaesthetic room. Both the anaesthetist and can drink clear water only. surgeon will check the arm is fully numb before On the day of surgery you will come to the surgery. Admissions and Day Case Unit (ADCU) and Surgery time varies from 30-90 mins depending will be seen by the nurse who will check on the specific surgery being undertaken. your details, medications and past medical Your surgeon will be able to tell you the rough conditions and put a wrist band with your details operative time on the day of surgery. on the arm we are NOT operating on. Your surgeon will make a cut a few centimeters You will be seen by the anaesthetist who long over the trapezium either on the back or will check your current health, ask specific the palmar side of your hand. They will carefully questions about medications and when you isolate the bone before removing it. The wound have last eaten or drank. They will then discuss will be closed with stitches. You will have a the details of the anaesthetic including the plaster cast or a bulky dressing around your process, risks and answer any questions you thumb at the end of the procedure, and an arm have. They will then mark your arm with an ‘A’ if sling to elevate your hand. you are having an axillary block. You may go back to the ward straightaway You will then be seen by one of the surgical however in some cases you may be sent to team who will go over your procedure, consent recovery for one hour if you have had a general form and answer any questions about the anaesthetic. surgery or recovery. They will then draw a mark Once you are back in the ward the nurses will on the arm you are having on operation on. make sure that you are sufficiently recovered When it is your turn to go to theatre you will be from the operation before you are allowed First choice for orthopaedic care Version 081/01 Review: May 2022 www.roh.nhs.uk | 0121 685 4000 Page 2 Trapeziectomy home. You should have someone to take you you follow the instructions so you can do hand home and be with you overnight after the exercises as advised. operation. The % values given cover a range from simple Almost all patients will go home on the day to complex cases. of surgery. Very occasional, social or medical Bleeding - during or after surgery. This generally conditions require an overnight stay. stops by itself. The risk of bleeding is higher in What should I do about my medication? patients who are on blood thinning medications Let the doctor know about your medication in and your doctor will advise on when to stop the clinic. For all procedures other than local them before the operation to reduce the risk. anaesthetic procedures you will be seen in Injury to an artery near the base of thumb is the preassessment clinic before surgery who possible but if identified in surgery is unlikely to will advise exactly what to do regarding any cause any noticeable problems. medications which you will need to reduce or Infection - The risk of the wound becoming stop. infected is less 1-22%. Your wound will be reviewed in the dressing clinic. Inform the What can I do to make the operation a healthcare team if you have a temperature, success? have ‘increasing’ pain or swelling beyond 3 If you smoke it is best to stop or reduce as days or notice any smell from the dressings. much as you can. If you are diabetic you will reduce your risk of infection and poor wound Scarring - This can be tender or unsightly (3- healing by keeping your blood sugars stable. 20%). Your healthcare team will teach you how to massage and soften your scar as it heals. Please attend all dressing, doctor and hand therapy appointments after surgery and follow Skin nerve damage - Damage to a small skin instructions on hand exercises to get the best nerve may lead to a tender scar or numbess function and recover following surgery. over the back of the hand between the thumb and first finger. (3-16%) What complications can happen? Continued pain or weakness - (36%) This may The healthcare team will try to make the be mild or rarely similar to before the operation.
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