The initial treatment of base of thumb arthritis is always non-surgical. A course of splinting, targeted hand therapy and possibly steroid injection will always be the first step in the treatment plan. When it comes to surgery, trapeziectomy or removal of the trapezium bone, is the most common and effective treatment.
Trapeziectomy is performed for patients with painful base of thumb arthritis that does not sufficiently respond to conservative measures.
Trapeziectomy is usually a day-only procedure and you will be admitted on the morning of the surgery. The hospital will discuss the time of arrival and fasting arrangements. You would normally have to stop anticoagulant medication prior to this procedure but Dr Stewart can advise you about your specific requirements.
Trapeziectomy is performed under general or regional anaesthetic. The trapezium, one of the carpal bones in the wrist, is removed. This takes away one half of the painful joint to provide pain relief. Usually the base of the thumb is then stabilized with sutures or by using a strip of a wrist or thumb tendon.
The thumb is immobilized in a plaster for the first week, and then once the dressings are changed there is usually another 5 weeks of partial or complete immobilization. There is often quite a lengthy rehabilitation after trapeziectomy guided by the hand therapists for several months.
There is a small risk of persistent pain after trapeziectomy which could require a revision surgical procedure.
There are different surgical treatments for base of thumb arthritis such as fusion or joint replacement. These have a limited role and are for specific situations only, and Dr Stewart can discuss these with you.