•     What Is It? The Joint where the thumb connects with the wrist involves a bone called the trapezium (See Picture). The

      joint gets arthritic as we age, the cartilage wears down and the bones rub together. This causes pain, deformity and

      reduced movement

•     Non Surgical Treatment . After X-Rays to assess the extent of the arthritis you will be advised to try:

•     Rest and activity modification.

•     Anti Inflammatory medications (only if advised by your doctor).

•     Thumb Splint.

•     Steroid Injections under X- Ray Guidance

Surgical treatments

Commonly performed include Trapeziectomy which involves removing the bone (See Picture). Sometimes a tendon from the wrist is harvested to stabilise the joint.This procedure is called a Trapeziectomy with ligament reconstruction (See picture) however there is no evidence that it improves outcomes. I reserve it for cases where the base of thumb is very slack to sit securely in the new joint created by removal of the trapezium. After this procedure your hand is placed in a bulky dressing and Plaster Cast. It is important to keep it elevated to reduce swelling in the post operative period. Stitches are removed at 2 weeks and you will see a Hand Therapist who will give you instructions to exercise the thumb and wrist daily.

Another less invasive operation I offer is Thumb Base Denervation. In this procedure the nerve supply to the joint is removed to reduce pain.

What are the complications?

Pain

Infection

Nerve Injury (rare) - A small nerve running in the region can occasionally be damaged resulting in a painful spot over the scar.

Continued Weakness

Painful or raised scar

Recurrence

Complex regional Pain Syndrome (rare)

Trapeziectomy /- Ligament Reconstruction

Anaesthetic : Regional or General Anaesthetic

Operative time : 60-90 minutes

Hospital Stay : Day Case

Time off work : 3 - 6 months ( Depends on Occupation)

Recovery Time : Up to 6 months

Thumb base Denervation

Anaesthetic : Regional or General Anaesthetic

Operative time : 60 minutes

Hospital Stay : Day Case

Time off work : 2 weeks

Recovery Time : 1-2 weeks