Trapeziectomy and joint replacement for Osteo Arthritis of the basal thumb joint

How do you know whether you have basal thumb Osteo Arthritis?
You typically have pain at the base of the thumb at the wrist level, it gradually gets weaker and you cannot pour from a kettle, turn the key in the lock etc. the 1st webspace (the space between your thumb and your index finger) gets progressively narrower and and  to compensate the middle joint of your thumb gets hyper extended.

How do I know whether you have basal thumb Osteo Arthritis?
By examining you with specific tests and by taking specialist xrays I can determine whether this is your problem and exclude other causes for your pain and weakness.

What can be done about it?
You can take regular analgesia like Paracetamol, Ibuprofen or Voltarol and have a special splint fitted which supports the joint.
A steroid injection in the joint gives you temporary relief, but does not cure the problem.
Surgery is a permanent solution, but requires that you wear a splint for 4-6 weeks.

What does the surgery involve?
The surgery gains access to the bone at the base of your thumb called the Trapezium through an incision over the snuff box (the little hollow area on the thumb side of your wrist which appears if you extend the thumb as much as you can), the bone (Trapezium) is then removed. Sometimes the hole which is left behind is filled with a tendon from the wrist and the thumb bone secured with a wire which is removed after 4 weeks (it comes out very easily without pain).

Alternatively a thumb joint replacement (CMI) can be insterted. This is formed as a little tak which is inserted in the thumb base whilst a cup is cored out of the trapezium for it to sit in.

What happens after surgery?
You see the Therapist for the fitting of a splint, and thereafter on a regular basis throughout the next 6-12 weeks for exercises.

Recovery
You should take first 6 weeks off work at least depending on your work. If you are involved in heavy manual labour, then it is probably more like 3 months before you can work again and the total recovery time is around 9 months.

Possible complications of surgery:
Infection
A bleed under the skin
Decreased range of motion of the thumb
Collapse of the basal thumb joint
Altered sensation over the back of the index finger and the thumb
Complex Regional Pain Syndrome (pain disproportionate with the procedure, needs urgent attention) – very very rare

contact  0207 483 5090 for consultations      

Any inquiries please email: plasticsurgeryjemec@gmail.com