Trapeziectomy LRTI

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.

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

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.

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?