A 4 – 5 cm incision is placed over the thumb base. The trapezium bone is removed taking care of the arteries, nerves and tendons. I then use a slip of tendon supporting the thumb (APL) and then loop it around the Flexor Carpi Radialis tendon which in front of the wrist. The rest of the tendon is formed in an anchovy and inserted into the space where the bone has been removed. The wound is then closed in layers with absorbable skin sutures under the skin which is tied over the skin. Butterfly stitches, splash proof dressing and a back slab (half cast) is applied to support the thumb.
Questions that are often asked
Is the surgery necessary?
This depends on the severity of symptoms. If after a trial of non operative treatment your symptoms are persisting and cause pain and difficulty in your activities surgery may be considered.
Before Admission:
- No food for 6 hours, or drink for 2 hours, prior to surgery.
- Please avoid smoking for 12 hours prior to surgery.
- Please continue to take all your medication as advised by the preassessment team.
What happens on the day of surgery?
You will need to report to the main reception on arrival. You will be shown to your room where you will be checked in by the nurse and also see Prof. Singh and the anaesthetist. This will give you chance to ask any questions before surgery. You will also be given an approximate time of your procedure. Please read the instructions on ‘Preparing for Surgery’.
What are the possible complications?
Complications are not common after trapeziectomy, but it takes a good 3 – 4 months to get over the procedure. You will not be very happy for the first 6 – 8 weeks as the thumb does not feel much better by then, but with time things get better.
- Scar tenderness, in about 15 – 20% of patients. This usually improves with scar massage, over 2-3 months.
- Stiffness may occur in particular in the fingers. This is usually short-term and only infrequently requires physiotherapy. But it is very important that it is resolved quickly to avoid permanent stiffness. This occurs rarely but can do associated with CRPS
- Numbness over the base of the thumb, caused by damage to a branch of the nerve, happens in less than 5% of patients.
- Wound infections occur in about<1% of cases. These usually quickly resolve with antibiotics.
- Chronic Regional Pain Syndrome (CRPS). This is a rare but serious complication, with no known cause or proven treatment. The nerves in the hand “over-react”, causing swelling, pain, discolouration and stiffness, which very slowly improve. The best advice to reduce the chance is to do the exercise as advised.
- Neuroma: A small nerve running near the scar can occasionally be damaged during the surgery and either cause numbness on the back of the thumb or form painful spot in the scar (neuroma) and may sometimes require further operation to correct it.
- Any operation can have unforeseen consequences and leave a patient worse than before surgery. This is uncommon after trapeziectomy.
Before Admission:
- No food for 6 hours, or drink for 2 hours, prior to surgery.
- Please avoid smoking for 12 hours prior to surgery.
- Please continue to take all your medication as advised by the preassessment team.
What kind of anaesthesia is used?
The operation is most commonly performed under General Anaesthesia i.e you will be put to sleep. At the end of the surgery a nerve block is performed to give pain relief. The procedure can also be performed with awake anaesthesia – please discuss with your surgeon if you wish to consider.
How long will I be in the hospital?
The surgery is done as a day case and you should home within a few hours.
After hospital care:
- Sling: After your surgery, you will be fitted with a Bradford sling, which is to be used for 48 – 72 hoursor longer if required.
- Wound care& Removal of Stitches:You will have butterfly stitches, a small sticky plaster dressing and back slab (half plaster) on top of your shoulder. The dissolvable will be trimmed around 12 -1 4 days either by the hand therapist or nurse.
- Medication: The local anaesthetic lasts between 4 to 8 hours. Patients are encouraged to start taking painkillers before the pain starts i.e. on return home and for at least 24 hours from there.
- Follow-up orthopaedic clinic: You will need to be reviewed in clinic after your operation. This is usually 2 – 6 weeks after
- Hand Therapy At the time of your surgery you will be referred to a hand therapist who will help your recovery. They will also make a splint to keep the finger straight. This will need to be worn for about 6 – 8 weeks after surgery.
- Return to Work: Managerial or Supervisory: 2 – 3 weeks, Light Manual: 4 – 6 weeks (e.g. clerical, secretarial), Heavy Manual: 6 – 10 weeks (ground worker, HGV). Please discuss with your consultant / therapist if you have any queries.
- Driving:Usually between 3 – 4 weeks after surgery, as long as the pain is under control. Please let your Motor Insurance Company aware of your procedure.