How can Trapeziectomy help with Arthritis?

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Trapeziectomy.

The most common medical procedure performed for thumb base arthritis is Trapeziectomy. This involves the removal of the bone adjacent to the base of the thumb and is a very successful operation. It is not minor surgery and it can take six months for a person to carry out heavy tasks. The trapezium is one of the eight carpal bones located at the base of the thumb. Arthritis in this joint is very common. Any condition that irritates or damages a joint is called 'arthritis'. It is a progressive condition that leads to increasing stiffness and deformity in the thumb. Pain is common especially in ladies over the age of 50yrs. Trapeziectomy involves the total elimination of the trapezium You do not have access to view this node, as it is very important if the joints both above and below the trapezium are arthritic. This is a preferred treatment in most patients.

 

What is osteoarthritis of the thumb?

Osteoarthritis is a disease of the You do not have access to view this node. Once the joint loses cartilage, the bone grows to attempt and fix the damage. Nevertheless, the bone grows unusually and makes the condition worse. Osteoarthritis (OA) at the base of the thumb (or trapezio metacarpal You do not have access to view this node) is responsible for the pain, stiffness and weakness in the thumb. This can affect the movement of the thumb, a person's grip in holding things, and affects a person’s everyday tasks.

 

Why is Trapeziectomy important?

At the base of the thumb, there is a small bone called the “trapezium” which, together with the metacarpal bone above forms a joint called “carpo metacarpal joint (CMC)”. Arthritic changes caused by wear and tear, trauma or rheumatoid arthritis can affect this joint and cause pain on use of the thumb in daily activities. Reconstruction of this joint will help to reduce the pain and make it easier to use the thumb. There are different kinds of surgery for the base of the thumb. The simplest surgery is 'Trapeziectomy'. Other surgeries use this simple approach but will also work on ligaments and tendons at the thumb or replace the thumb joint. For example, trapeziectomy with ligament reconstruction and tendon interposition uses this approach.

 

How is Trapeziectomy done?

  • Trapeziectomy will be performed under general anesthetic or regional block, a local anesthetic method, where the whole arm is numbed.
  • A tourniquet is applied to the affected arm. Tourniquet is identical to a blood pressure cuff. It is filled with air.
  •  This allows the surgeon keep up a dry, blood-free surgical site throughout the procedure.
  •  The trapezium is detached and the thumb base either supported by stitching the joint tissues (capsule) or by using a part of one of the adjacent tendons to form a supporting ligament.
  •  The wound is closed with a dissolvable stitch.
  •  After that, a dressing and a splint are applied to hold the patient’s hand in the best comfortable position.

 

What is the post-surgical process?

  •  The patient is discharged the same day.
  •  Patient’s hand will need to be elevated for at least the first 48 hours to prevent excessive swelling.
  •  The hand will be painful. If the patient had a local anesthetic block, pain will be most noticeable 12-18 hours from surgery as the block wears off. Pain medication will be given.
  •  After 10 days of the You do not have access to view this node, a removable splint will be made for the patient’s hand.
  •  Patient is expected to do the exercises taught to by the hand therapist.
  •  Usually, after 6-12 weeks, the patient will be able to return to driving when he/she can safely control a vehicle.
  •  The Patient may return to work when he/she experiences sufficient strength and movement in your hand to safely perform the daily tasks.
  •  However, it is usually about six months before the patient will be able to commence heavy tasks.
  •  The pain will continue to settle for 12-18 months after the You do not have access to view this node.

 

What are the complications?

  •  Pain may persist if there is arthritis somewhere else in the hand.
  •  There are chances of the wound getting infected.
  •  If the wound doesn’t heal it needs regular dressings.
  •  A tender or painful scar may indicate a swelling of one of the fine skin nerves (neuroma) which may require an additional You do not have access to view this node.
  •  A stiff wrist joint may occur.
  •  In rare cases, there is a modification in the way the hand sweats. This can be accompanied by swelling, intense stiffness and discomfort from the hand. This condition is called “reflex sympathetic dystrophy or complex regional pain syndrome”.
  •  For most patients, the surgery does not involve these complications and they are satisfied with the outcome of the You do not have access to view this node. 
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