Trapeziectomy + Suspensionplasty
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What’s the Problem?
The joint at the base of the thumb commonly becomes arthritic with age. Essentially, the cartilage which normally allows for smooth movement at the joint wears out, leaving bone on bone articulation. This leads to pain and stiffness when using the thumb for daily activities
How can you treat it?
In some instances, non-surgical treatment is appropriate. This includes taking pain relief, steroid injections or a splint of the thumb to reduce movement. Ultimately, surgery is only reserved for patients who have symptoms (pain, stiffness, difficulty grasping objects) that are not resolving with non-operative measures.
The Operation
The trapeziectomy part of the operation involves an incision over the front fleshy part of the thumb. The bone at the base of the thumb is then identified and removed entirely. This decompresses the base of the thumb, and removes any ongoing pain with movement. However, because this decompression also can result in shortening of the thumb, and therefore reduced strength, Mr Lau also performs a suspensionplasty, which helps to prevent this subsidence or shortening. This involves taking half of one of the tendons of the wrist (flexor carpi radialis) and weaving it through the bone of the thumb to help “suspend” it in its more anatomical position.
The Anaesthetic
Most patients will be asleep for the duration of the operation. Mr Lau will place local anaesthetic into the area to prevent any ongoing pain for 24-48 hours after you wake up.
What are the Risks of this Operation?
- Infection: Usually only a superficial wound infection to the top-most layer of the skin. In rarer cases a deep infection can develop and this is a serious complication that may require further surgery. Rare but serious, <1%.
- Complex Regional Pain Syndrome (CRPS): This is a chronic pain response that develops after an insult (like trauma or surgery) which we don’t have a full understanding of. It usually presents as ongoing burning or stinging to the hand, with change in sensation as well. Some factors increase the risk of developing this such as injury to the hands or feet, middle age and female gender. Mr Lau routinely prescribes Vitamin C post operatively, which has been shown in some studies to reduce the development of CRPS, but if it does develop, then a prolonged rehabilitation with hand therapy may be required.
Benefits
If Mr Lau recommends a trapeziectomy and suspensionplasty, it is because he feels you will have a better outcome with surgery. The main focus of surgery is to reduce the pain at the base of your thumb, which will allow for a more functional use of the hand. Some patients may experience some mild loss of thumb flexion strength.
What can I expect?
When you wake up, your hand and wrist will be dressed and there will be a plaster over the wrist and thumb. You will have had local anaesthetic to the area which takes 24-48 hours to wear off entirely. The nurses will provide you pain relief in the recovery area.
Some patients recover reasonably quickly and are able to have their surgery as a day stay procedure. However, some need an overnight stay, particularly to help with pain relief. You will be discharged with pain medication and an appointment for a wound check at approximately 2 weeks will be made for you. A hand therapist will also make a removable plastic splint for you to allow some gentle range of motion of the fingers and elbow, as well as washing of the hand. Hand therapy exercises will be commenced early, and involves the fingers and wrist over the next few weeks to months. Mr Lau will then see you around 8 weeks after surgery.
What should I avoid doing?
- In the first 2 weeks: keep your wound dry. Try to mobilise your fingers and elbow as much as possible
- Between 2 and 6 weeks: wean use of the plastic splint over these 4 weeks. You can come out of it to do various finger, wrist and elbow exercises with guidance from the hand therapist. It is fine to lift lighter objects like a phone or cup only.
- From 6 weeks: full range of motion without use of the splint. No lifting restrictions
Return to…?
- Work: Depends what you do. Desk based work can be done from ~10 days post operatively, if you can do these tasks single handedly.
- Drive: In Australia, you can’t drive unless you are in full control of both your arms. Therefore, whilst your hand is in the splint you cannot drive. Approx 6 weeks
- Sports/Hobbies: No restrictions after 6 weeks once the splint has been removed.
Concerns or questions?
If you have any concerns post operatively, or you would like further information, please contact Mr Lau through the VBJS on 03 5752 5020 or via email at admin@vbjs.com.au
If you need urgent medical help, call 000 or go to your nearest emergency department.
Rehabilitation protocol
These notes have been prepared by Mr Simon Lau. They are general overviews and information aimed for use by his patients. They reflect Mr Lau’s views, opinions and recommendations. They do not constitute medical advice. The contents are provided for information and education purposes only. Please seek Mr Lau’s specific advice with any questions regarding medical conditions and treatment.