Surgery

Surgery for thumb base osteoarthritis can be pain-full. I use a general anesthetic with a regional anesthetic block. Immediately after induction of anesthesia a long acting local anesthetic is injected around the nerves to the arm. This usually gives at least twelve hours of comfort after surgery and avoids the need for an over night stay.

For primary surgery I almost exclusively carry out a trapeziumectomy.

The trapezium is the saddle shaped bone at the base of the thumb. Removal of this bone is a relatively straightforward operation that reliably reduces the pain of thumb base osteoarthritis.

There are other more complex operations, which can be appropriate for patients needing revision surgery. The medical literature suggests that more complex operation are not routinely more successful at improving patients symptoms. Trapeziumectomy is effective at reducing the pain of thumb base osteoarthritis in at least 90 % of appropriate patients.

Risks

The risks of surgery include infection, stiffness, weakness and pain.

Non-surgical measures to reduce the pain

Change the way that you use your hand, change your door-handles or kitchen-appliances to those that do not require a tight grip from your thumb. Ice, paracetamol, non-steroidal anti-inflammatory drugs (such as Ibuprofen tablets or ibuprofen gel), and an appropriate splint, can help.

Aftercare

Patients are in a bulky supportive bandage for the first two weeks, after which the patient switches to a splint for a further four weeks.
Patients with significant stiffness or swelling will benefit from out patient hand therapy.

The recovery period varies between individuals, most patients feel confident to drive at six weeks.