Trapeziectomy is the most common operation for thumb base arthritis. The arthritic small bone (trapezium) at the base of the thumb is removed, often with reconstruction of nearby ligaments to support the thumb.
Pre-assessment is usually 2-4 weeks before surgery. Trapeziectomy is more involved than other hand operations and recovery takes several months.
You will meet members of the nursing and anaesthetic team. Baseline observations are recorded and your medications reviewed.
Blood tests if required; blood pressure, pulse, and weight recorded.
Anticoagulants may need adjustment. Anti-inflammatory medications are sometimes stopped a few days before surgery.
Options include regional nerve block (brachial plexus block) with sedation, or general anaesthesia. The block provides excellent pain relief for the first 12-18 hours.
Hand therapy after surgery is essential. A custom-made splint is usually worn for 4-6 weeks. Confirm arrangements before surgery.
You will be in a cast or splint and unable to use the thumb for several weeks. Arrange help with daily tasks, especially for the first 1-2 weeks.
You will be given a specific arrival time. Have no food from 2am on the day of surgery; you may drink clear water until 6am, unless your team gives you different instructions. Bring your medication list and any documents from the hospital.
You will be admitted to the day surgery unit, change into a gown, and be seen by the nursing, anaesthetic, and surgical teams before theatre.
Your surgeon will confirm the procedure, mark the operative side, and you will sign a consent form before going to theatre.
You will meet the anaesthetist. Many hand procedures are done under local or regional anaesthetic; some require general anaesthesia.
After surgery you will spend time in the recovery area where nurses monitor your vital signs until you are stable and comfortable.
Arrange for a family member or friend to collect you. You must not drive on the day of surgery if you have had a general anaesthetic or sedation.
Important: Numbness or tingling in the thumb can occur from temporary nerve stretching during surgery and usually settles. Persistent severe pain, signs of infection, or skin that is white, cold or dusky should be reported urgently.
Avoid getting the wound wet until it is fully healed - usually 10-14 days. Use a waterproof cover when showering. Follow the dressing instructions you are given.
Keep the hand raised above the level of your heart as much as possible for the first 48-72 hours. This significantly reduces swelling, pain, and stiffness.
Do not wait until pain is severe before taking medication. Regular simple analgesia (paracetamol, and ibuprofen if appropriate for you) is more effective than waiting.
Unless told otherwise, gently bend and straighten all fingers regularly. Early movement helps prevent stiffness and reduces swelling.
Seek urgent advice if you develop spreading redness, increasing pain, swelling, discharge from the wound, a temperature above 38°C, or any new numbness - these may indicate infection or nerve problems.
Recovery timelines vary between patients and depend on the operation, the demands you place on the hand, and any other health conditions. The timeline below is a general guide - your surgical and hand therapy team will give you personal advice.
Bloods, medication review, hand therapy referral, home support arranged.
The operation takes about an hour. Most patients go home the same day.
The thumb is supported in a cast or thumb spica splint. The hand is elevated to reduce swelling.
Splint progressively reduced. Active range of movement and gradual strengthening exercises with a hand therapist.
Pain relief is the most reliable outcome. Pinch strength continues to improve for 6-12 months. Heavy or repetitive thumb activities may need permanent modification.
Usually 4-6 weeks in a cast or rigid splint, followed by a softer supportive splint for daytime use during the next several weeks. Your hand therapist will guide progression.
Pinch strength typically improves substantially but may remain slightly weaker than the unaffected side. Pain relief is the most reliable and consistent benefit of the operation.
Most patients return to driving at 8-10 weeks, once the splint is removed and the thumb is comfortable and strong enough to control the wheel. Check with your insurer.
Desk-based work is usually possible at 2-4 weeks with the thumb supported. Manual work typically requires 3-6 months off.
A week-by-week guide to recovery. Individual timelines vary, so always follow the advice of your surgical and hand therapy team.
The aim of surgery is to relieve the pain at the base of the thumb caused by worn-out arthritis by removing the small wrist bone (trapezium) that forms the arthritic joint. Most patients get good, lasting pain relief and a strong, useful thumb, although recovery takes several months.
The operation is usually done under regional or general anaesthetic. Through an incision at the base of the thumb the trapezium bone is removed. Some surgeons also reconstruct a ligament or place a rolled-up tendon into the gap (ligament reconstruction and tendon interposition) to support the thumb, although a simple trapeziectomy alone gives similar long-term results. The thumb is supported in a splint or cast afterwards.
A thumb base splint and joint-protection techniques can control symptoms well, particularly in the earlier years.
An injection into the joint can give good relief, sometimes for many months, and can be repeated occasionally.
Alternative operations. A joint replacement can give faster recovery in selected patients; a fusion is occasionally chosen for young, heavy manual workers who prioritise strength.
Reasonable while symptoms are tolerable. The arthritis is not dangerous, so surgery can be deferred until pain is no longer controlled by simpler measures.
A small number of patients have ongoing aching, particularly if the space where the bone was removed settles (subsidence) and the thumb bones rub on the scaphoid.
Branches of the radial nerve cross this area and can be bruised or injured, leaving numbness or a tender area near the scar.
Pinch grip is weak for the first few months and gradually recovers, though it may not return to the strength of a normal thumb.
A reaction causing prolonged pain and stiffness of the hand. Most cases settle with hand therapy.
Usually a superficial wound infection that settles with antibiotics.
This operation has a longer recovery than many hand procedures. It commonly takes three to six months to feel the full benefit.
The scar and thumb can be tender and stiff for some weeks. Hand therapy is an important part of recovery.
Swelling of the thumb and hand is expected in the early weeks and settles gradually.
Thumb base arthritis can almost always be managed without surgery in the early years using a splint, activity changes, and the occasional steroid injection, and many people never need an operation. The condition is not dangerous, so surgery is reserved for when the pain is no longer controlled by these measures. Delaying does not make the operation harder, so the timing is very much a matter of how much the pain is affecting you.