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What Are the Pros and Cons of a Trapeziectomy?

A thumb with osteoarthritis.
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  • Written By: H. Colledge
  • Edited By: Heather Bailey
  • Last Modified Date: 11 October 2014
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Trapeziectomy is a type of hand surgery used to treat arthritis of the lower end of the thumb. The procedure involves the removal of a bone called the trapezium, which forms the thumb's base. Potential benefits of the operation include improved thumb function and relief from stiffness and pain. Possible negative effects, while uncommon, can include infection, loss of skin sensation and, very rarely, chronic regional pain syndrome, where the hand become severely painful and swollen. Recovering from the surgery takes time, and it could be three to six months before strenuous activities are possible.

The kind of thumb arthritis that is treated with this procedure is known as osteoarthritis. Osteoarthritis generally results from gradual wear and tear affecting joint surfaces. As the thumb is used so frequently in daily activities, osteoarthritis of the thumb is a common condition. Symptoms of stiffness and pain are typically experienced, and the thumb may become deformed. The main benefit of a trapeziectomy is that, when other treatments such as painkillers, splints, and steroid injections fail to work, this surgical procedure may provide relief.

In order to carry out a trapeziectomy, a general anesthetic may be required, although a regional anesthetic, which numbs only the arm, may be used. A cut is made near the thumb's base and the trapezium bone is extracted through it. The resulting space in the joint means that damaged bone surfaces are no longer moving against one another.

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A drawback of this surgery is that it is not possible to use the hand normally for a while after the operation. Sometimes, the thumb is held in position using a wire, which sticks out through the skin and is typically removed a few weeks following thumb surgery. A plaster dressing is applied to the thumb for the first few weeks while healing takes place. This is then replaced by a splint, which is worn for about six weeks, and hand exercises are generally carried out under the supervision of a physiotherapist. It may be necessary to wear a softer splint later while recovery continues.

While risks associated with trapeziectomies are low, it is possible that the operation site may become infected, requiring treatment with antibiotic medication. Rarely, bleeding may occur under the skin, or nerves may be damaged leading to numb areas of skin developing over the thumb. Chronic regional pain syndrome, also known as complex regional pain syndrome, is an extremely rare complication that can occur following any type of hand surgery. The hand is affected by extreme pain, swelling, and loss of movement, and it can take several months to treat the condition using a combination of painkilling drugs and physiotherapy.

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middleforker
Post 20

I had surgery in early April. I'm in a splint now and enjoy being able to take it off occasionally. The pain has been tolerable to this point, and the only real issue has been pain and numbness along my little finger and edge of hand. I've read that this can be a side effect of the nerve block. Has anyone else had this problem?

anon947401
Post 19

I had my trapeziectomy surgery in mid April and the plaster removed two weeks later, no dressing put on after and I was given an instruction sheet for exercises to do.

I am back driving, cooking and cleaning, just with a little care taken. Now it does ache if I overdo things, but I am sure another couple of weeks and I will be back to normal.

la4est
Post 18

It has been five weeks and two days since I had the "tight wire" surgery on my left thumb. I am still in a lot of pain. My surgeon said it would take four to six weeks for the pain to leave. Well, it's five more days until the six weeks mark. I see him in two days. I am a 60 year old guitar-mandolin-harmonica player. I fear that this surgery was a mistake.

anon946523
Post 17

I am 5 weeks and 2 days after the "tight wire" surgery on my left thumb. I am still in a lot of pain. My surgeon said it would take 4 to 6 weeks for the pain to leave. Well, 5 more days until the 6 weeks mark. I see him in 2 days. I am a 60 year old guitar-mandolin-harmonica player...I fear that this surgery was a mistake...

anon937452
Post 16

I got my left thumb done in mid January and had a cast on for six weeks. I've now been out of my cast for two weeks. All my fingers were a bit stiff to begin with, but just gently moving and stretching has worked wonders. I'm now going to get my right thumb done in the next two months. It may not be as easy coping with as I'm right handed, but will be worth it to be pain free at last.

anon929197
Post 15

I had surgery on my dominant hand this month, and tomorrow will be three weeks.

I went home with a splint wrapped with an ace bandage until the stitches came out. Then I got a fiberglass cast for four weeks.

I usually have three jobs, but until I heal I only have two days a week when I work. I have been able to mop, vacuum, do dishes, laundry, cook, etc. without much problem beginning three days after surgery. I also drove right away. I only used one pain pill every four hours (like clockwork) instead of the two pills that were prescribed. I might be lucky, or I might be determined by necessity -- either way I just want others to know that you can still be productive.

My main issues have been the inability to twist lids off! Do you realize how many lids you take off on a daily basis? A lot! The other issue is taking care of my hair. My hair is very long and I like to braid it, but all I can manage is brushing it and I can use a spring loaded type hair clip to keep it tidy. I need the same surgery on my left hand and I think I will shoot for next winter as the cast isn't so rough in winter time. No itching, and less odor too. I hope this helps those who are considering a trapeziectomy. My surgeon in La Grande, Oregon "rocks" this procedure in my opinion.

anon358243
Post 14

@Melsta57: It has been eight weeks since my surgery and my hand is beginning to feel my own again. I still have limited movement in my thumb and fingers, but everyday things get better.

Before surgery the pain in my thumb was unbearable and stopped me from doing the most simplest of tasks. I feel at this point the surgery has been a successful and well worth the pain and discomfort that all surgery comes with. I know the recovery is long (12 weeks minimum) before you can do the simplest of tasks, but you can then do them free of pain.

Thanks to a great surgical team at the R.O.H. B'ham.

anon355149
Post 13

I am three weeks post-op. Having a cast on is very annoying and very limiting. I will have a full cast on now for four more weeks. I'm feeling pressure now which I'm sure is the cast pressing on the wound. If I use my hand too much then it aches.

You just have to learn how to pace yourself. I'm looking forward to a thumb with a lot less pain than I went into hospital with. It is going to take a while to get there. Let's hope it is all worthwhile. --Ginger Ginny

anon351535
Post 12

My surgery was done early in May 2013 and although it has been almost six months since the operation, I am still experiencing severe pain at the base of the thumb. I also cannot lift heavy objects without pain and am still taking painkillers. Has anyone else had this problem?

Gb50
Post 11

I have been told that when undertaking a Trapeziectomy, it is common practice to leaves shell of bone behind as it is not necessary and virtually impossible to remove the Trapezium in its entirety. Could someone please confirm this? I was of the understanding when I had my operation that the complete bone should have been removed?

anon346683
Post 10

I am seven weeks post trapeziectomy. Being in a cast for six weeks was a breeze compared to the past several days. My wrist is swollen, stiff, and almost all movement is painful. I am doing physical therapy now. I'm feeling reassured by the posts that this pain is normal and it'll be worth it in the long run.

anon338304
Post 9

I had a trapeziectomy about two and a half years ago and it was life changing. I was only 49 years old and had gotten to the point where I could not even make the bed without being in intense pain. The recovery does take a while, but after I was out of the hard cast (about 10 days), I had a removable splint that allowed me to do most things, including typing.

I will say that I was offered two options: either to fuse the remaining bones or go with the tendon placed where the trapezium used to be. The advantage of the fuse method was better strength, while the tendon method offered more dexterity. I opted for the dexterity, as I don't do a lot of heavy lifting at work. Even today, I cannot lift nearly as much weight at the gym without some pain. Same goes for doing other heavy lifting, like yard work projects. However, overall, I am so happy I had the procedure done. My day to day activities are pretty much pain free, unlike before the surgery.

anon334094
Post 8

I'm having this surgery done in June. I am an RN and draw labs from portacaths, PICC lines, and hickman catheters. I also do arm draws for labs. How long before I can go back to my RN duties?

golf07
Post 7

@John57-- The decision to have a trapeziectomy should be between you and your doctor. If you are at the point where the steroid shots don't help, I think you may want to consider the surgery.

Yes, it takes awhile to recover and there is pain involved with the process, but it is a different kind of pain. Once you work through it, you can get to the point where your thumb doesn't have the constant pain. I have been very happy with mine and love being able to do all the little every day things without pain anymore.

John57
Post 6

How do you know when it is time to have a trapeziectomy? What started out as a little bit of wrist and thumb pain has turned into pain that never seems to stop.

At first over-the-counter medications would help alleviate the pain, but it got to the point where this didn't work anymore. I have received several steroid injections, but these are only a temporary fix. My thumb is starting to look deformed and isn't straight like it should be.

I am really trying to avoid surgery as I don't want to be out of commission for so long, but I think it is getting to the point where I need more relief. For those of you who have had the surgery, have you had good results?

Mykol
Post 5

It is amazing how something as small as the thumb joint can cause so much pain and discomfort. I am right handed and the arthritis in my right thumb was the worst. This affected so many things I did like writing, typing, getting dressed, baking, etc.

I finally got tired of fighting it and decided to go ahead with the trapeziectomy. The recovery time was about 4 months before I felt like I had full use of my thumb again, but I sure wish I had the procedure done sooner than I did.

andee
Post 4

fBoyle-- Doing the exercises and physical therpay after any kind of surgery or injury is always the hardest part! Not only does it take discipline to even do the exercises, but it usually hurts at first which makes it even more difficult. Even though I eventually felt a lot better after my trapeziectomy, it wasn't easy being diligent with the exercises.

fBoyle
Post 3

The worst part about a trapeziectomy surgery is the hand exercises they make you do ten times a day, so boring! I also hated going to the regular appointments with the therapy nurse.

donasmrs
Post 2

@alisha-- Do you still have your cast on?

I did experience that kind of pain after my surgery but it basically went away once my cast was removed. I think what happens is that the cast can put pressure on the incision area and that makes you feel more pain than you would have otherwise. I think you will be okay once the cast is removed.

I have no complaints about my trapeziectomy. I had severe arthritis and my thumb had become completely stiff. I really couldn't move it and therefore couldn't use my hand before the surgery. Five months after the surgery, it was as if I got a whole new thumb. There is no stiffness nw, no pain, everything is just wonderful. I wish I had gotten the surgery sooner.

discographer
Post 1

It's been three weeks since my trapeziectomy surgery and I'm still in a lot of pain. The pain started as soon as the anesthesia from the surgery wore out. First it was a dull ache and now it's more of a throbbing pain.

Is this normal?

I know it takes a long time for recovery, but to be honest, I was not expecting pain like this. The surgery went great, everything was easy, post-surgery is a lot harder it seems.

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