Mr Jeremy Read, Consultant Orthopeadic Surgeon, performs trapeziectomy surgery at One Hatfield Hospital. He also offers one-stop hand procedures to treat carpal tunnel, trigger finger, DeQuirvains and Dupuytrens (percutaneous needle fasciotomy) in his out-patient clinic for patient clinic for self-funding patients. The fixed fee includes an initial consultation, the procedure and follow up.
No that’s not true. There are options for treating arthritis of all of the joints of the hand and wrist. The treatment will depend on which joint is affected and the severity of the symptoms.
For all joints, when symptoms are not too debilitating, injections or splints may be worth trying before considering surgery. Splints may be off the shelf or custom made, and injections can normally be done in the clinic.
We’ve tried non operative treatments, what are the surgical options?
This is very dependent on the joint affected. With small joints like the DIPJ’s the only realistic option is to fuse the joint. This gives good stability and pain relief so function and the appearance is better but at the expense of movement.
For larger joints like the PIPJ’s and MCPJ’s fusion is still an option and for some people is definitely the right thing to do, but other options such as joint replacement or sometimes denervation can give good pain relief and function whilst preserving movement.
OK, but you can’t do anything for the thumb can you?
The base of the thumb is one of the more common hand arthritis problems I see and can present at quite a young age. Often it causes pain with gripping then progressing to a more constant pain, deformity occurs a bit later. For thumb base arthritis there are several options and they will depend on the stage of wear and the activities that the patient wants to do. Fusion is an option but usually reserved only for people doing heavy manual work. In earlier cases a capsular denervation can give pain relief.
When there is moderate wear and the joint below (the scaphotrapeziotrapezoid joint) is preserved, carpometacarpal (CMC) joint replacement is an option and can give good pain relief and function.
When the arthritis is advanced, or involves more than just the CMC joint, a trapeziectomy remains a very good option to give good pain relief and restore function. This involves removing the trapezium and using part of a tendon to reconstruct the ligaments that support the thumb.
The arthritis is very advanced, so it’s too late isn’t it?
Fortunately in most cases a trapeziectomy can still be performed though some additional procedures may be required.