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Four Months On and the Thumb Base Still Aches. Normal, or a Complication?
Most trapeziectomy complications are minor and settle with time: swelling, a tender scar, a numb or tingly patch near the scar, and a thumb that feels weak for months. Serious problems are uncommon.
The ones worth catching EARLY are infection, a hand that gets more painful, swollen and sensitive instead of less, and fingers stiffening while the thumb sits in its splint.
Judge the final result at about a year. Not at month 3.
Key takeaways
- A weak thumb at month 3 is the expected shape of trapeziectomy recovery. Pinch strength keeps improving for up to a year.
- Irritation of a small skin nerve that crosses the operation site is one of the more common problems. It causes numbness or burning on the back of the thumb and often settles over months.
- Complex regional pain syndrome (CRPS) is uncommon after trapeziectomy, and it responds best to early treatment.
- Fingers that stiffen while the thumb is protected are far easier to fix in the first weeks than at month 6.
- Some people still have mild pain or weakness at a year. A smaller number need further surgery.
Where are you right now?
- First 2 weeks, worried about the wound or swelling: read “Problems by week” and the red flags at the bottom.
- Weeks 2 to 12, numb patch or stiff fingers: “Problems by week.”
- Months 3 to 12, still weak or sore: “Is this normal?” then “If it isn’t going to plan.”
- Over a year and still painful: “Still painful after a year.”
Problems by week
Protocols vary. Your surgeon may give you different dates. Use theirs.
- Weeks 0 to 2 (OPEN, unless it’s infected): throbbing, bruising into the palm and wrist, and puffy fingers are expected. Infection is uncommon, but spreading redness, heat, discharge or fever is a same-day call. Spreading redness is never a wait-and-see. See wound healing or infection.
- Weeks 2 to 6 (CLOSING for the fingers): the thumb is protected. The fingers aren’t meant to be. If you can’t make a full fist by now, that stiffness is far easier to fix now than at month 6. See stiff hand after a cast or surgery.
- Weeks 2 to 12 (usually OPEN): a numb, tingly or burning patch on the back of the thumb or around the scar. A small skin branch of the radial nerve crosses the operation site and irritates easily. Most settle over weeks to months. See the trapeziectomy scar and the numb patch.
- Weeks 2 to 8 (CLOSING): pain getting WORSE instead of better, with a shiny, swollen, sweaty or color-changed hand that hates being touched. That’s the pattern of CRPS. This is the one I most want people to catch early. See CRPS.
- Months 3 to 12 (OPEN): weak pinch, aching after heavy days and in cold weather. Expected. See trapeziectomy recovery week by week.
- After 12 months (SHUT for waiting): thumb-base pain that’s still there at a year rarely settles by waiting longer. The goal changes from waiting it out to finding the cause.
How common are the complications?
Figures vary a lot between studies. These are the ranges one NHS hospital gives its patients. Ask your surgeon for their own numbers.
| Problem | How often (that leaflet) | Usual course |
|---|---|---|
| Ongoing pain or weakness | About 1 in 3 | Usually mild. Strength can keep improving for up to a year |
| Irritated skin nerve: numb or tender patch | 3 to 16 in 100 | Often settles over months |
| Tender or unsightly scar | 3 to 20 in 100 | Scar massage is taught as it heals |
| Pain where a tendon strip was taken, if one was used | 10 to 19 in 100 | An ache along the forearm. See trapeziectomy with suspensionplasty |
| CRPS | 2 to 8 in 100 | Treated with pain relief and therapy. Can take weeks to months to improve |
| Further surgery | Up to about 1 in 10 | For problems that don’t settle |
Is this normal?
Usually part of a normal recovery:
- A thumb that looks a little shorter.
- Pinch at month 3 that’s WEAKER than before surgery.
- Aching after heavy days and in cold weather for the first 6 months or so.
- A numb patch near the scar that slowly shrinks.
- A scar that stays tender or a bit lumpy for a few months. See lump in the scar after hand surgery.
Not part of it: pain that climbs after week 2, numbness that spreads, or a hand that changes color.
Still painful after a year?
If the thumb base still hurts at 12 months, these are the usual suspects:
- The joint next door. Arthritis between the scaphoid and trapezoid, the bones just above the old trapezium, can keep aching after the trapezium is gone.
- The thumb sinking. The thumb metacarpal settles into the gap. In most people that’s painless. Occasionally it rubs against the scaphoid and hurts with pinching.
- A nerve caught in scar. A tender spot that sends a zing down the thumb when you tap it can be a neuroma, an irritated nerve end.
- Tendon irritation, especially where a tendon was used for a sling.
Your surgeon sorts these out with an exam and often an X-ray or ultrasound. Options run from splinting and injections to further surgery for a small number. Strength can still improve after a year with targeted work. The shorter look of the thumb doesn’t change.
Weakness runs on a long clock. Stiff fingers and CRPS run on short ones.
If it isn’t going to plan
It’s month 4. The thumb base hurts less, but you still pass the kettle to your other hand…and the jar lid waits for whoever’s home.
Everyone says give it time. For weakness at month 4, that’s mostly right. The trouble is that in the early months, the problems that DON’T settle with time look a lot like the ones that do. A stiff index finger. A numb patch that’s growing instead of shrinking. Pain that’s changed character.
Your pain is better. Has anyone actually measured your pinch? And your next surgeon review might still be six weeks away.
Month 3 isn’t the season finale. It’s also not the time to sit and hope.
The difference is which window each problem runs on. Weakness has a long, open window. Finger stiffness and CRPS have short ones. The Closing Window Chart maps 15 hand conditions to open, closing or shut, with the red flags for each, so you can see which one you’re on before your next review. It’s free.
Call your local emergency number or go to the emergency department if
- Your fingers turn white, blue or cold and don’t recover when you loosen the dressing and raise the hand.
Call your surgeon or doctor today if
- Redness spreading from the wound, heat, discharge or a fever.
- The wound opens.
- Pain escalating after the first two weeks, with a shiny, swollen, color-changed, very sensitive hand.
Get it checked soon if
- A numb or burning patch on the back of the thumb is spreading or getting worse.
- You can’t make a full fist by weeks 4 to 6.
- A tender spot in the scar sends a zing down the thumb when touched.
- Thumb-base pain is still there at a year.
Weak at month 3 is the middle of the story. Worse at week 3 is a phone call.
Written by Nigel Chua, hand occupational therapist in practice since 2005. Thousands of hands, wrists and elbows assessed and treated. My credentials are here. This article explains; it doesn’t examine. If your pain is climbing instead of settling, call your surgeon today.
Part of: Recovery after hand, wrist and elbow surgery: every week-by-week guide
Every article on this site is written using the Closing Window Method: name the window your condition runs on, find where you are in it, and act while it’s still open.