A trapeziectomy is a surgical procedure that involves removing the trapezium, a small bone in the wrist, to address conditions affecting the base of the thumb. Its primary goal is to alleviate discomfort and improve hand function.
Conditions Requiring Trapeziectomy
The primary condition necessitating a trapeziectomy is osteoarthritis affecting the carpometacarpal (CMC) joint at the base of the thumb, known as basal joint arthritis. This degenerative disease causes cartilage to wear away, leading to pain, stiffness, and grinding.
Individuals often experience pain at the thumb’s base, worsening with gripping, pinching, or twisting motions. Swelling and tenderness are common. Over time, thumb strength may decrease, making daily tasks challenging.
The Surgical Approach
A trapeziectomy begins with anesthesia (local, regional, or general). A small incision is made near the thumb’s base. The surgeon then removes the entire trapezium bone.
To fill the void and stabilize the thumb, a common technique is tendon interposition arthroplasty. A small section of a forearm tendon is harvested and rolled into a ball. This tendon ball cushions the space where the trapezium was. The remaining tendon may suspend the thumb metacarpal.
After the Procedure
Immediately following a trapeziectomy, the hand is immobilized in a cast or splint for four to six weeks. This period allows healing and settling of the tendon cushion. Patients can expect pain and swelling, managed with medication and hand elevation.
Rehabilitation begins after immobilization, often with a physical or occupational therapist. Therapy focuses on regaining range of motion through gentle exercises, followed by strengthening to restore grip and pinch strength. Full recovery can take three to six months.
Understanding Potential Risks
While generally safe, a trapeziectomy carries general surgical risks, including infection, bleeding, or adverse reactions to anesthesia. There is also a risk of nerve damage, leading to numbness, tingling, or weakness.
Specific risks include persistent pain or stiffness. Some individuals may experience weakened grip or pinch strength, or thumb base instability. Complex regional pain syndrome can also occur in a small percentage of patients. These complications are relatively uncommon.
Alternative Treatment Paths
Before considering a trapeziectomy, non-surgical options for thumb basal joint arthritis are explored to manage symptoms and improve function. These include activity modification, supportive splints, and anti-inflammatory medications. Corticosteroid injections can also provide temporary pain relief.
If conservative approaches are insufficient, other surgical options may be discussed. These include joint fusion (arthrodesis), which eliminates pain but also movement, or joint replacement (arthroplasty). A trapeziectomy is often favored for its balance of pain relief and preservation of thumb mobility.