Trapeziectomy for Thumb Arthritis - Procedure, Risks, and Complications

Introduction:

During the aging of an individual, thumb arthritis is the most common type of arthritis. In the base of the thumb, a carpometacarpal joint (CMC joint) forms between the thumb, metacarpal nine long bones), and trapezium (minor bone present in the wrist). It is commonly called the basal joint of the thumb, also known as a saddle-shaped joint, because it helps the thumb have an extensive free range of motion. When the cartilage is damaged, thumb arthritis occurs at the end of the bones in the CMC joint.

What Are the Symptoms of Thumb Arthritis?

A few signs and symptoms might include:

• The base of an individual's thumb shows swelling, stiffness, and tenderness.

• The joint has an enlarged or bony appearance at the base of the thumb. During pinching or gripping, individual strength is decreased.

• There will be a decrease in the range of motion.

How to Diagnose Thumb Arthritis in Individuals?

Usually, general practitioners can recognize the typical features of this form of arthritis, or they may refer you to a hand therapist or hand surgeon to make the diagnosis and begin treatment. People can take X-rays but do not always show abnormalities in the early stages.

What Are the Treatment Choices for Thumb Arthritis?

Based on the appearance of the joint on the x-rays and the severity of symptoms, treatments for thumb arthritis vary. These treatments are available in different forms, which include:

• Use of painkillers.

• One should give steroid injections into the joint.

• Splints usage.

Given below are three types of surgeries done to treat thumb arthritis:

Trapeziectomy:

• It is the most common type of surgery involving the complete removal of a trapezium.

• Few doctors or surgeons use a piece of tendons from an individual's wrist to fill the gap left while removing the bone.

• And also, one can fill the void left with a metal, a plastic joint, or a silicone rubber spacer. Generally, the treatment has two surgical options:

Arthrodesis:

• It is the much less common type of surgery, which is suitable for a few people, for example.

• Individuals who need to do heavy manual work and who have developed arthritis under the age of 40 years need this type of surgery.

• It can happen only when bones sufficiently provide both strength and health.

• But in a few cases, sometimes there may be a failure to solve this problem, and one should remove the trapezium from the individual body.

Hand Surgery:

• Hand surgery usually takes place within a day by giving general anesthesia or numbing the whole arm (an overnight stay is unnecessary).

• People can receive information about surgery from their surgeon about the side effects, potential risks, and expected recovery time.

• And after the surgery, individuals are referred to a hand therapist.

What Preparations Should an Individual Follow Before the Surgery?

Given below are the instructions an individual should follow before the surgery:

• Individuals should stop smoking because it can reduce the risk of developing complications and improve their long-term health.

• Individuals should maintain a healthy weight because overweight individuals will likely develop complications.

• People should exercise regularly to prepare for their operation because it helps them recover and improve their long-term health.

• But individuals should take advice from their healthcare team or general practitioner before starting an exercise.

What Is the Procedure of Trapeziectomy for Thumb Arthritis?

• Preoperative Evaluation: Before the procedure, patients will undergo a thorough evaluation that includes a review of their medical history and imaging tests to determine the severity of arthritis and confirm the diagnosis.

• Anesthesia: Either general anesthesia or local anesthesia with sedation can be used to accomplish trapeziectomy. The type of anesthetic patients receive depends on several things, including the complexity of the treatment, the surgeon's preferences, and their general health.

• Incision: Over the thumb's base, usually on the dorsal side, the surgeon will create an incision. Depending on the surgeon's method and particular circumstances, the incision's length and placement may change.

• Exposure and Trapeziectomy: The trapeziometacarpal joint will be properly exposed by the surgeon after carefully cutting through the tissues. Then, using sophisticated surgical tools, the trapezium bone is located and eliminated. To improve joint alignment, a piece of the nearby bone (metacarpal) may occasionally also be removed.

• Ligament Reconstruction: The surgeon may undertake a ligament reconstruction treatment after trapeziectomy to strengthen the joint and stabilize the thumb. This may include adding new ligaments or enhancing existing ones using synthetic materials or adjacent tendons.

• Closure: The surgeon will carefully cover the incision with sutures or staples after the trapeziectomy and other subsequent treatments. Then uses a bandage or sterile dressing to close the wound.

• Postoperative Care: Until the patients are awake and stable, they will be observed in a recovery area. Painkillers will be given, along with guidelines for wound care, activity limitations, and rehabilitation activities. To immobilize and safeguard the joint during the first healing phase, the thumb might be placed into a cast or splint.

• Follow-up and Rehabilitation: To keep track of the development, patients should frequently visit the surgeon for follow-up appointments. To assist regain thumb strength, mobility, and function, physical treatment or occupational therapy may be suggested. Various individual characteristics will affect the duration that rehabilitation requires.

What Exercises Should the Individual Follow After Surgery During Their Recovery Period?

To advise people, below are exercises to do as part of their recovery after surgery.

Exercise 1:

While opening out the palm, one should support the thumb below the end joint (also called the IP joint nearest the nail), and the thumb tip should be bent and straightened to avoid firm pressure (while wearing the splint, one should do this exercise every hour).

Exercise 2:

Fingers should be straight while making a fist. If an individual cannot make a fist, one can use the other hand to help push the fingers into a fist.

Exercise 3:

Individuals should bend their thumb, touch the base of their little finger, and then back again. one should straighten their thumb so that there will be a level along the backs of all three thumb bones and then bend across their palm towards the little finger.

Exercise 4:

Individuals should place the side of their hand on a flat surface, bring the thumb away from in front of the index finger, and then go back again, or they can do it another way by opening and closing the thumb.

Exercise 5:

Individuals should touch each fingertip with their thumb.

What Are the Complications of Trapeziectomy?

The complications of trapeziectomy include:

• Infection in the chest.

• Continuous pain or numbness on hand.

• Infections occur at the site of surgery.

• Bleeding occurs.

• Sometimes allergic reactions occur due to the usage of equipment materials or medications.

• In some instances, damage occurs when the arteries pass near the trapezium.

• Hand scarring.

What Risks Are Faced by an Individual After the Surgery?

Given below are a few risks seen in individuals after the surgery:

Damage to the Nerves:

• In rare cases, there is a possibility of numbness occurring along the side of the thumb. But it happens for a short period.

• A nerve supplying the skin at the back of an individual thumb can show irritation. But by the usage of therapy techniques, there will be an improvement.

Scar Tenderness:

• After the healing procedure, the scar on the skin will remain in a state of tenderness.

• The scar should be encouraged to become soft so the tendons can move freely and easily when tendons move the joint below the spot.

• People can get frequent treatment by massaging themselves on a regular basis.

• Cream or oil usage can be helpful to people.

Infections:

• There is a chance of infection occurring in most of the conditions.

• One can treat it with antibiotics.

Complex Regional Pain Syndrome:

• It is seen during surgery and also occurs following any hand trauma.

• After the treatment, around five percent of persons may experience pain or stiffness in their hands.

• Based on severity, the treatment varies with therapy.

Conclusion:

People with osteoarthritis can have pain at the base of their thumb. While using their thumbs, individuals cannot perform their everyday activities. By undergoing trapeziectomy, individuals can relieve pain and improve their thumb work. And also as soon as possible one should do regular exercises because it helps to return to their normal activities. But before starting a workout, an individual should ask their healthcare team or general practitioner for advice. The individual thumb should continue to improve over the next year as they get back a good range of movement