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The Bone Comes Out. The Sling Holds the Thumb Up. The Next 12 Weeks Decide How It Works.
A trapeziectomy with suspensionplasty removes the trapezium, the arthritic bone at the base of your thumb, then slings the thumb metacarpal with a strip of tendon or a suture so it doesn’t sink into the gap.
Recovery runs on the same clock as a plain trapeziectomy: about 4 to 6 weeks in a cast or splint, light use from week 6 to 8, everyday tasks back by month 3 to 4, and pinch strength still climbing at 6 to 12 months.
Some suture-button techniques start movement earlier, around week 2 to 3. Your surgeon’s protocol decides that, not the name of the operation.
Where are you right now?
- Booked for surgery, reading the consent form: start with “What the suspension actually does.”
- In the cast or splint, weeks 0 to 6: go to the week-by-week timeline.
- Out of the splint, thumb feels weak and loose: read “If it isn’t going to plan.”
- Wanting dates for driving and work: the “When can I…?” table near the end.
What the suspension actually does
Take the trapezium out and the thumb metacarpal has nothing underneath it. Over the following weeks the gap fills with blood, then scar, and that scar becomes the new cushion the thumb moves on.
The suspension is there to stop the metacarpal dropping too far into that gap while the scar matures. Think of it as the thumb’s Spider-Man web…it catches the bone before it falls.
There are three common ways to do it:
- LRTI (ligament reconstruction and tendon interposition): half of a wrist tendon, usually the FCR, is split off, looped around the metacarpal and often rolled up to fill the gap.
- APL suspensionplasty: a slip of the tendon on the thumb side of the wrist is used as the sling.
- Suture-button suspension: a strong suture runs between the thumb and index metacarpals, held by small buttons on the bone. No tendon is harvested, and some surgeons let movement start earlier.
Here’s the part the internet argues about. Studies comparing trapeziectomy alone with trapeziectomy plus a sling show long-term pain relief and function that are much closer than the debate suggests. So if your surgeon chose one method over another, that’s judgment, not a shortcut. See the full trapeziectomy recovery guide.
Trapeziectomy with suspensionplasty recovery, week by week
Your surgeon may give you different dates. Use theirs.
- Days 0 to 3 (OPEN for swelling): bulky dressing or plaster slab, thumb held out. Hand above your heart. Bend and straighten all four fingers fully, 10 times every waking hour. Take pain relief BEFORE the nerve block wears off.
- Weeks 1 to 2 (OPEN): wound check, stitches out around day 10 to 14 unless they dissolve. Most people move into a cast or a custom thumb splint. If tendon was harvested, the forearm can ache too.
- Weeks 2 to 6 (CLOSING for finger and wrist stiffness): the thumb stays protected, mostly full time. The fingers, wrist outside the splint, elbow and shoulder are your job every day. See thumb spica splints.
- Weeks 4 to 6: gentle thumb movement usually begins out of the splint. Scar massage starts once the wound is fully healed. See the trapeziectomy scar.
- Weeks 6 to 8 (CLOSING for the thumb web space): the splint comes off for light daytime tasks. Work on opening the thumb away from the index finger. That web space tightens quietly while you’re splinted.
- Weeks 8 to 12: gentle putty and pinch work once your surgeon says go. Control first, force later.
- Months 3 to 6: pinch and grip start climbing properly. Aching after heavy days is still common.
- Months 6 to 12: this is where you judge the operation. Not before.
No hard pinching before you’re cleared. Squeezing hard on a thumb whose sling is still healing loads exactly the structure that’s meant to be resting.
The sling holds the thumb up while the scar grows strong enough to do the job itself.
Is this normal?
Usually expected:
- The thumb looks a little shorter than the other side.
- Out of the splint, the thumb feels loose, wobbly and weak.
- An ache along the forearm, if a tendon strip was taken from there.
- A numb or tingly patch on the back of the thumb, from a small skin nerve irritated near the scar. Usually settles over weeks to months.
- Pinch strength LOWER at month 3 than before the operation.
Check with your surgeon if the pain is getting worse week on week instead of slowly easing, or if a new click or clunk appears at the thumb base.
If it isn’t going to plan
It’s month 3. The arthritis pain has gone…but you still can’t open a jar, the thumb won’t open wide enough to hold a bottle, and your fingers feel stiff every morning.
Weakness at month 3 is expected. Stiffness isn’t the same thing. A tight thumb web space and stiff fingers are changeable now, and they get harder to change every month after about month 4. Waiting fixes weakness slowly. It doesn’t fix stiffness.
So measure. Can the thumb open as wide as the other side? Can the fingers make a full fist? If either has stalled for 2 to 3 weeks, ask for a hand therapy referral now. See stiff hand after a cast or surgery and thumb base exercises and joint protection.
When can I…?
Typical ranges. Your surgeon’s protocol comes first.
| Activity | Typical timing |
|---|---|
| Type and do desk work | 4 to 6 weeks for two-handed typing. Earlier if you can work one-handed |
| Drive | Usually 6 to 8 weeks, once the daytime splint is off and you could control the car in an emergency. See driving after a hand injury |
| Light cooking, dressing, buttons | Around 6 to 8 weeks, splint off for light tasks |
| Open jars, turn keys, wring a cloth | Month 3 onwards, with gadgets helping at first |
| Heavy manual work, gardening, lifting pots | Usually 3 to 6 months. See returning to work after a hand injury |
Call your surgeon today if
- Redness spreading from the wound, heat, discharge or a fever. See wound healing or infection.
- Fingers turn pale, blue or cold, or the dressing feels like a tourniquet.
- Pain escalating after the first two weeks, with a shiny, swollen, color-changed, very sensitive hand. See CRPS.
Get it checked if
- Burning or numbness on the back of the thumb that’s spreading or getting worse after week 6.
- Fingers or wrist that have stiffened while the thumb was protected.
- The thumb web space is getting tighter, not wider, after the splint comes off.
- A firm lump in the scar. See lump in the scar after hand surgery.
The suspension holds the thumb up. The 12 weeks after it decide what that thumb can hold.
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. Follow your own surgeon’s protocol where it differs from anything here.
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.