KEMBLE WANG - Upper Limb & Trauma Surgeon
MBBS (Hons), FRACS, FAOrthA
Thumb arthritis surgery (trapeziectomy and LTRI - ligament reconstruction tendon interposition)
Gripping and pinching objects can become quite painful when osteoarthritis develops at the base of the thumb joint. The supportive ligaments around the joint weaken, resulting in an increased movement of the joint and a subsequent wearing down of the cartilage resulting in painful osteoarthritis.
The carpometacarpal joint at the base of the thumb is one of the most common sites of painful osteoarthritis. Routine treatment involves a trapeziectomy where the trapezium bone at the base of the thumb is surgically removed, providing space for the thumb and to stop arthritic bone surfaces from rubbing together.
During surgery, the ligament of the metacarpal of the thumb using a part of the tendon of the Flexor Carpi Radialis (FCR) is also recreated and stabilised. This stops the metacarpal dropping into the void left by the removed trapezium, reduces ongoing pain and improves and strengthens long term function.
location of base of thumb arthritis, and xray of a patient who had undergone trapeziectomy with LRTI
Post-operative rehabilitation (developed in conjunction with Melbourne Hand Therapy)
On the day of surgery, some or all of a patient’s fingers may feel numb or tingly due to the anaesthetic. Patients can safely move their fingers and the tip of the thumb before leaving hospital.
Day 1-7 after surgery:
The post-operative dressing needs to be kept clean and dry.
7-10 days post surgery:
At this stage, a hand therapist will remove the post-operative dressing and place a protective, custom-made thermoplastic splint that includes the thumb over the wrist. This splint will be worn full-time for approximately 6 weeks post-surgery.
Patients can use their hand for light daily living activities such as eating, writing, typing and getting dressed. The thumb will remain protected within the splint. Heavy lifting, gardening or carrying items with the healing hand is to be avoided.
Two weeks after surgery:
The splint can be removed for basic hand hygiene only such as washing the hand in the basin. However, no thumb movement or thumb exercises are recommended at this time. The splint needs to remain on at all other times.
Six weeks after surgery:
Gentle exercises of the thumb should be commenced to regain full range of movement (active exercises only). Exercises to be encouraged include: opposing to each finger, thumb extension / abduction, and full wrist movement.
Scar massage should commence.
Encourage the patient to bring any softer splints or protective wear used prior to surgery to the hand therapists as these are often utilised at this stage instead of the thermoplastic splint. The softer splints can be used for more active tasks.
Three months following surgery:
Cease all splints and braces.
Strength and comfort of the thumb will continue to improve over a 12-month period.
Driving after surgery:
Patients must be able to safely control their car, including in an emergency situation, in order to return to driving.
Generally, it is considered safe to resume driving around the 6-week post-operative mark when the thermoplastic splint is removed.
However, Kemble or the hand therapist will advise when driving is considered safe.
Example of a thermoplastic splint used following base of thumb arthritis surgery with Kemble