This leaflet provides general information to help you understand trapeziectomy surgery for painful thumb base arthritis.
This day-case procedure removes the worn bone and stabilises the thumb with a tendon.
At the heart of my practice is Shared Decision-Making. Whether we pursue conservative management (Plan A) or surgical intervention (Plan B), the goal is to create a tailored treatment plan that aligns with your lifestyle, values, and functional goals.
This leaflet provides general information and does not replace individual medical advice.
The Anatomy of the Thumb Base
The thumb base is a mobile joint that lets you pinch and grip, relying on several structures working together.
How the Joint Works
A saddle-shaped joint gives the thumb its range:
- The thumb bone meets the trapezium wrist bone
- It works like a 'universal joint'
- This lets the thumb swivel, pinch and grip
The Cartilage
A smooth, slippery coating cushions the two bones so they glide over each other without friction, for pain-free movement.
What Goes Wrong
Cartilage gradually wears away:
- The smooth surface thins over time
- The bones begin to rub together
- This causes pain, swelling and weakness
- Bone spurs and a 'bump' can develop
As It Advances
- Pinch and grip become weaker
- A visible bump appears at the thumb base
- The thumb can take a 'zig-zag' shape
- It often coexists with other hand problems
The Result
Everyday tasks like opening jars, turning keys and pulling zips become painful, though many people have X-ray changes with little pain.
About the Operation
Trapeziectomy removes the worn trapezium bone at the thumb base to relieve pain, and a tendon reconstruction (LRTI) stabilises the thumb. It is a reliable, durable day-case operation, suited to painful thumb base arthritis, particularly with more advanced wear or heavier hand use.
Why It's Done
The operation aims to:
- Relieve pain by removing the worn joint
- Stabilise the thumb with a tendon reconstruction
- Restore comfortable, durable hand function
The Procedure, Step by Step
The operation, step by step:
- Anaesthetic: general anaesthetic, often with a block
- Trapeziectomy: the worn trapezium bone is removed
- Reconstruction: an APL tendon slip stabilises the thumb (LRTI)
- Closure: stitches, dressing and a supportive splint
Before, During & After Surgery
Before Surgery
- Fasting: no food for 6 hours, no drinks for 2 hours before
- Smoking: avoid for at least 12 hours before, to aid healing
- Medications: continue as advised by the pre-op team
On the Day
- Admission: check in at main reception, then to your room
- Consultation: meet your surgeon and anaesthetist
- Preparation: timing and instructions are reviewed
Anaesthesia
- A general anaesthetic is usually combined with a block
- The block numbs the arm and eases pain after surgery
Recovery & Results
Recovery is a partnership. The timeline below is a guide — I will adapt it to your healing and your goals — this shared decision-making process ensures you are fully informed and involved in your care.
Recovery Milestones
- Splint: supports the thumb, changed at about 2 weeks
- Hand therapy: a custom splint and exercises for 6–8 weeks
- Stitches: removed at about 14 days
- Good recovery: over 3 months; strength builds up to a year
Results
Trapeziectomy with LRTI is a durable, reliable operation giving lasting pain relief. Strength continues to build for up to a year, and it copes well with heavier hand use.
After Surgery — The First Weeks
- Dressing & Splint: a splint supports the thumb and is changed at about 2 weeks
- Pain Relief: the block lasts several hours; start painkillers before it wears off for 24–48 hours
- Hand Therapy: a custom splint and exercises for 6–8 weeks, guided by a therapist
- Scar Care: gentle scar massage with cream once healed
Risks & Complications
Uncommon, but possible
- Infection: uncommon; treated with antibiotics if it occurs
- Scar / Nerve: scar tenderness or temporary numbness near the wrist
- Weakness: pinch strength builds slowly and may take up to a year
- CRPS: rare (about 1 in 20); prolonged pain and stiffness needing therapy
- Stiffness: some early stiffness that improves with hand therapy
Return to Activity
This can be extremely variable and discuss with the surgeon. These are just guidelines.
- Desk work: 4–6 weeks
- Light manual work: 8–10 weeks
- Heavy manual work: 12–16 weeks
- Driving: once the splint is manageable and you can do an emergency stop
Strength builds for up to a year.
Red Flags — When to Seek Urgent Help
Spreading redness, discharge or increasing pain, fever, or a thumb that turns pale or numb — seek urgent assessment.
If you experience any of the above, contact the practice, your GP, NHS 111, or attend your nearest Emergency Department.
Key Points to Remember
- A durable, reliable operation for thumb arthritis
- Removes the worn bone and stabilises the thumb
- Hand therapy and splinting are important
- Strength builds up over several months
Questions You May Wish to Ask
- When can I use my hand normally again?
- When can I drive and return to work?
- How much improvement can I expect?
- What are the signs of a problem?