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.
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.
What To Expect Before, During, and After a Trapeziectomy?
When considering any type of surgery, it is worthwhile to know what to expect at every stage of the procedure.
Before the surgery, the patient must follow the surgeon's directions, including stopping any noted mediations, fasting, and getting plenty of rest. During pre-operations, the nurse will conduct a brief physical and ask about medical history.
The patient will need to change into surgical gowns. The nurses and the surgeon will answer any questions the patient might still have.
As stated above, anesthesia is administered to the patient, and the surgeon will remove the trapezium. If other adjustments arise during the procedure, such as bone spurs removal or ligament reconstruction and tendon interposition (LRTI), the surgeon will complete that at that time. The surgeon might also need to replace the trapezium with an implant.
The patient and the surgeon will make most of these decisions before the surgery, but some unexpected things might happen. A typical trapeziectomy can usually last around 60 minutes but may take 90 minutes or more to complete.
Immediately after surgery, a nurse will monitor the patient's vital signs in the recovery or post-operation room. Once the anesthesia has worn off and the surgeon has cleared the patient, they are free to leave and go home for recovery.
Patients will need to arrange a ride to drive them home from the surgery since the patient was administered anesthesia and pain medicine during the surgery.
Other Risks or Complications After a Trapeziectomy
While a trapeziectomy isn’t invasive, some complications may still arise after having the procedure done.
After surgery, there will be a scar. The patient's hands and thumb size will determine the scar size. The scar may be red and tender as it heals and sometimes be itchy, but during the physiotherapy sessions, the therapist will advise on how to help the scar heal.
Since nerves run throughout the body, there is a chance that the removal of the trapezium during surgery can damage nerves surrounding the area in the thumb. Nerve damage can result in a numb or tender spot on the thumb. The patient may need another surgery to correct the nerve damage.
Reoccurring or Returning Symptoms
Although not typical, there is a chance that the trapeziectomy will not eliminate the pain entirely or that the pain may reoccur after a time. Being sure to complete all the physiotherapy sessions and exercises, making lifestyle adjustments, and following all the directions provided by the surgeon, will go a long way to prevent this from happening.
What Can You Expect During Physiotherapy for a Trapeziectomy?
A few weeks after surgery, the patient will need physiotherapy sessions to ensure proper wound healing and that the thumb can achieve the full range of motion, flexibility, and strength again. The physiotherapist will provide a list of exercises to strengthen the muscles and advise on handling swelling.
The physiotherapy will also offer tips for scar management. These exercises may include activities such as: squeezing a stress ball, opening and closing a screw-top bottle and stretches for the thumb and wrist. These exercises will not only help to increase the movement of the thumb but will also aid in pain management and finger function.
The physiotherapy sessions typically last only two to four months but could take up to six months or more for complete recovery.
What Conditions Need To Be Followed During the Recover Time From Trapeziectomy?
It is essential to follow the surgeon's advice and all the post-operative instructions to guarantee the success of the surgery. It is also essential to attend all the physiotherapy sessions and do all the exercises. Other provisions could include:
- Keeping the thumb elevated when sitting or laying down to decrease swelling,
- Monitoring activities not to overexert, and
- Use caution with daily activities until fully recovered.
What Lifestyle Adjustments Will Be Required After a Trapeziectomy?
What Lifestyle Adjustments will be Required after a Trapeziectomy?
While 94% of patients reported that removing the trapezium reduced the pain in the thumb, some lifestyle adjustments might still need to occur to guarantee complete and lifelong recovery.
These adjustments could include: exercising the thumb and wrist will help with mobility, strength, and flexibility, and switching to an anti-inflammatory diet that includes fatty fish, fruits, leafy vegetables, and nuts also helps keep inflammation and swelling associated with osteoarthritis at bay.