Hand Therapy
What is a Trapeziectomy?
You have had an operation to remove a bone at the base of you thumb called the trapezium. This bone was part of the osteoarthritic joint that was causing you a lot of pain and problems with daily activities. The space left by the bone then fills with dense scar tissue. The main aim of the operation is to reduce your pain, but it can take some time before you experience this. You may notice that you thumb is not as strong after your operation.
Complications
A small number of patients may experience the following:
- Stiffness
- Prolonged swelling
- Inflammation
- Prolonged pain
- Nerve irritability
- Infection
Pain Management
It is common to have pain after your operation. This should improve over time. You may need to take regular pain relief to help you complete your exercises and slowly start to use your hand more. If you take other medicines, for other health conditions, you may need to speak to your GP for advice on what pain relief you can safely take.
Swelling
It is normal to experience swelling to your hand after your operation. This can take many months to settle. You can help control this swelling by keeping your hand raised as much as possible. It is also important to do your exercises as recommended to prevent any swelling, which can cause your fingers and thumb to become stiff. If you are having problems with swelling your hand therapist can give you further advice.
Recovery
Following the removal of your cast you may be given a removable splint. It is important to remove this splint regularly for exercises and to wash your skin, allowing it some air. It may be necessary to wash your splint. Your hand therapist will give you advice on when you can start to reduce the support of the splint and stopping its use altogether.
You will find that you will slowly regain the use of your hand, and you will be guided on what activities you can start by your hand therapist. In general, light use of the hand is recommended for up to 3 months, with no heavy pinch activities (such as tearing open packets) for the first 10 to 12 weeks. It may take between 6 and 12 months to reach the main benefits of surgery, which are pain relief and improved function.
Driving
Your hand therapist can advise you when you can drive again. This typically can happen between 6 and 12 weeks, when you feel comfortable and confident to drive. Driving can feel easier if a soft thumb splint is worn.
If you choose to wear a splint whilst driving, you must inform your insurance company.
If you choose to wear a splint whilst driving, you must inform your insurance company.
More information on driving after surgery can be found here: Miscellaneous conditions: assessing fitness to drive – GOV.UK
Working
The time taken to return to work depends on the type of work you do and if the operation has been on your dominant hand. In general, you can return to work once you have enough strength in your hand and you can make a fist without experiencing any pain. Return to light work is usually between 6 to 8 weeks. More demanding work will take longer, and heavy tasks may take anywhere up to 6 months.
Joint Protection
It is important to protect the base of your thumb whilst it is recovering from surgery. The space from which the trapezium has been removed will need time to fill with scar tissue and become stable. Remember no heavy pinch for at least 10 weeks.
Each time you experience thumb pain when doing an activity, stop and consider whether the way you are doing it is causing stress to the thumb base. Think about whether there is a different way you can do it that is better for your joints, such as spreading the load over several joints. For example, by carrying items with two flat hands rather than gripping with your thumb.
When carrying out tasks that involve a ‘pinch grip’ position, keep in mind the ‘O’ position and avoid allowing the thumb to collapse, see below.
Scar Management
You may notice that your scar feels tight as it forms. It may also feel very sensitive to touch. It is recommended that you massage your scar 4 times a day, using a non-perfumed moisturiser or oil. You can apply firm pressure in circular (A), vertical (B) and horizontal (C) direction. For older scars, it might be helpful not to use cream or oil anymore. This would increase skin movement during the massage, helping to loosening it more if it is tight. If your scar is sensitive, in addition to massaging it, you could touch it more often with your other hand and try tapping. Gently rubbing the area with different textures may also help.
Exercises
2 to 4 weeks after surgery
The following exercises will help you to regain your range of movement and can be started straight away after your cast has been removed. They should not be painful but may feel slightly uncomfortable. Try to do the exercises three times a day, gently and slowly, repeating each one 10 times.
Start with your wrist straight, move it back and forth as pictured above.
Start with your hand palm down, move it from side to side as shown above.
Start with your palm down, turn you hand into a palm up position, without moving your elbow, as shown above.
Start with your wrist and fingers straight, make a fist with your hand, as shown above.
Support your thumb under the joint as pictured above, bend and straighten the tip of your thumb.
Start with your palm down, gently move your thumb out to the side, keeping a ‘C’ shape, as shown above
Start with your hand resting on the little finger side, gently move your thumb out to the side, maintaining a ‘C’ shape, as shown above.
Touch the finger tips with your thumb keeping an ‘O’ shape, as shown above.
Place your palm up on a table, try to move your thumb towards the table top without twisting your hand, as shown in the above images.
It is normal for the exercises to feel uncomfortable, but they should not be painful. If you do experience pain, try gentler or smaller movements, with less repetitions that can be built up slowly. If safe to do so, you could also try warming your hand up prior to exercise with warm water or a heat pack. You can also try massaging your thumb webspace to help with muscle tightness and pain as shown below.
6 weeks after surgery
You can add in these exercises at 6 weeks if comfortable to do so. They may be uncomfortable but should not be painful. Complete each exercise ten times, three times a day.
If you can, take your thumb to the tip of your little finger, and then gently slide your thumb down the finger towards the base.
Take your thumb to the first finger, and add a little pressure to make a gentle pinch, maintaining the ‘O’ shape as pictured. Repeat the same exercises between the thumb and middle finger.
Hold a comfortable sized ball between your fingers and thumb, gently rotate the ball towards your thumb, keeping a ‘C’ shaped.
Place your operated hand across your chest and place the fingers of your non operated hand over the fleshy part of the thumb (A). Press your operated hand into your chest as you gently pull the operated thumb away from your chest (B).
Contact us
Your hand therapist will be able to advise you on progression of exercises, but if you have any questions regarding your hand therapy, please contact the hand therapy team:
Telephone: 01642 835595 or 01642 854453
Email:[email protected]
Patient Experience
South Tees Hospitals NHS Foundation Trust would like your feedback. If you wish to share your experience about your care and treatment or on behalf of a patient, please contact The Patient Experience Department who will advise you on how best to do this.
This service is based at The James Cook University Hospital but also covers the Friarage Hospital in Northallerton, our community hospitals and community health services.
To ensure we meet your communication needs please inform the patient experience department of any special requirements, for example; braille or large print by emailing: [email protected]