About Trapeziectomy / CMC Arthritis

Also known as Thumb CMC Joint Arthritis, Trapeziectomy / CMC Arthritis is commonly diagnosed as arthritis.

Signs & Symptoms

Trapezium arthritis occurs when the bone is worn. It progressively leads to increasing pain, weakness in grip, stiffness and eventually it may cause deformity at the base of the thumb.

As the disease progresses, such difficulties as opening a jar/strong gripping activities or even daily tasks can become increasingly difficult, as the pain intensifies.

Treatment Options

What are the non-operative treatment options for CMC Arthritis?

There are a few non-operative options that may be offered to you, dependent on the severity of your condition. Some of the options are as follows;

You can avoid certain activities that cause your pain i.e. opening jars. A hand therapist can provide or make splints that immobilise and rest your thumb. A/Prof Matthew Lawson-Smith may recommend steroid injection/s performed by a radiologist under ultrasound guidance.

What are the surgical options for CMC Arthritis?

Trapeziectomy
This is where the bone is resected or removed completely. The gap fills with scar tissue on which your thumb will sit, to reduce the pain of bone on bone rubbing.

Trapeziectomy +/- Suspension Sling
This is where the bone is removed and a part of the tendon of your thumb or wrist is used to wrap around the thumb bone and roll up the gap, to support the thumb during healing.

What happens during the procedure?

A/Prof Matthew Lawson-Smith will make an incision over the trapezium on the palmer sider or back of the hand. The bone is isolated before it is removed and the base of the 1st metacarpal is trimmed. A thumb tendon may be inserted into the gap as part of your surgery. The wound is closed with sutures.

A plaster cast is applied and a referral for a hand therapist is given to you on discharge for hand therapy and splinting. Your surgery is normally a day case. You will be required to be picked up from the hospital, you are then discharged.

What happens after the procedure?

Keep the hand elevated for the 24 – 48hrs after your surgery to reduce swelling. Maintain any pain relief that has been prescribed by the anaesthetist. Any further pain relief medications (other than paracetamol) will need to be prescribed by your GP.

A plaster cast is normally applied at surgery. You will be referred to a hand therapist (at discharge from the hospital) to remove this cast and a splint will be applied. The splint needs to be worn day and night. The hand therapist will also check your wounds and give you rehabilitation exercises. This is imperative for your progress and the success of the procedure. You will be in a splint for approximately 6 weeks. You will need to keep the wound, clean and dry.
A post-operative booking is allocated to you when booking the procedure. This appointment usually occurs around 2 – 3 weeks after your procedure. Our practice nurse and Mr. Lawson – Smith will check on your progress and remove any sutures.

You can normally drive around the 8 – 10 week mark.
The joint can continue to settle from around the 6 month mark and beyond.
You will not be able to lift anything heavy until given clearance to do so.

For any return to work enquiries, these must be discussed with A/Prof Matthew Lawson-Smith or with your GP.

Risks & Concerns

The associated risks of surgery include;

Infection
Scar
Pain
Stiffness
Swelling
Complex Regional Pain Syndrome
Need for further surgery

Failure to relieve symptoms
Worsening pain
Bleeding
Neurovascular deficit or injury
Risk of anaesthetic
Recurrence

If you experience any problems or have any concerns following your surgery, please do not hesitate to contact the office. A/Prof Lawson-Smith’s staff with ensure that A/Prof Matthew Lawson-Smith is kept informed of what is occurring and will advise you the best course of action.

If you are unable to reach the office, please do not hesitate to contact your GP or if it is an emergency, please present to your nearest Emergency Department.