The trapezium is one of the eight carpal (wrist) bones and lies at the base of your thumb. Arthritis in this joint is very common and is contributed to by instability of the joint and a natural vulnerability to wearing of the joint surfaces.
Other common names
Who does it affect?
Patients with advanced disease or who fail non-surgical treatment may be candidates for surgical reconstruction. A variety of surgical techniques are available that can successfully reduce or eliminate pain.
It is a progressive condition that leads to increasing stiffness and deformity in the thumb. If neglected, the joint tends to stiffen. The methods for relieving discomfort in an arthritic joint include (i) activity modification, (ii) pain-killers, (iii) splints, (iv) steroid injections and (v) surgery.
Surgery is the only definitive treatment for persistent symptoms. The usual indication is pain and consequent functional difficulties.
Trapeziumectomy is removing the trapezium bone (the one that sits under the thumb and is affected by arthritis) and reconstructing the thumb with a tendon transfer (a piece of tendon that comes from the front of the wrist, which we get through two small incisions).
An incision is made over the back of the thumb and potentially two small incisions over the front of the wrist.
It is an outpatient procedure that can be performed under regional or general anesthesia and requires significant rehabilitation to maximize the function of the hand.
After the surgery, there will be a plaster put on the wrist and this needs to stay on for 2 weeks. It is half plaster to allow swelling. The thumb is then put in a complete cast for another 2 weeks before physiotherapy commences. When hand therapy begins, a removable splint is applied.
Hand therapy usually starts about 4-6 weeks after the surgery and may take several weeks, depending on the patient.
Normal activity with the hand usually starts about 3-4 months after surgery.
The operation is about 90% successful. However, as in any surgery, comlpcations can occur. Risks include:
- Infection. This is uncommon but when it occurs can involve prolonged use of antibiotics (six weeks). Most of these tend to resolve.
- Pain. This is a painful operation and the thumb will be painful for at least three months afterwards.
- Algodystrophy / Complex regional pain syndrome. A rare complication (1%) but one that can give symptoms that are worse than the original symptoms. This involves the hand becoming stiff, painful, swollen and changing colour. Symptoms may not completely resolve.
- Precipitation of carpal tunnel syndrome. Sometimes if you have mild carpal tunnel syndrome before the operation surgery will make it worse. If necessary you may need to have your carpal tunnel decompressed at the same time or soon after your operation.