Removing the Trapezium Bone to Help Thumb Arthritis?

In the truth is stranger than fiction category this morning is a patient who discussed that her surgeon was planning on taking out an important wrist bone to solve her thumb CMC arthritis problem.  Arthritis at the base of the thumb (blackberry or texting thumb) is a common problem these days.

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The trapezium bone is in the yellow dashed circle above (‘E”) in the diagram above, and lives at the base of the thumb joint (CMC).  The theory is that removing this bone out will remove 1/2 of the painful joint and the area will fill in with scar tissue.  This surgery can be done in such a way as to spare the surrounding ligaments.  The problem is that the carpal bones are needed to help coordinate proper hand function and the wrist joint is one of the body’s most complex areas. Removing an important piece of the wrist may help with a short-term reduction in pain, but will permanently alter the biomechanics of the wrist and likely lead to more arthritis in more of the wrist.  In addition, once the bone is removed, there is no going back.

While this surgery may help reduce pain, I’d have to put it in the same category as many surgeries that try to improve upon the body’s function by removing critical parts, a bad idea. Think about if your mechanic came to you with an extra part in his hand after “fixing” your car.  He tells you that you really don’t need this part and that you can get an extra 1,000 trouble-free miles out of it as a result of him removing the part.  You ask him what happens after that?  He tells you that he’s not exactly sure, but he thinks that as a result of removing the part, he’ll have to perform a major rebuild of your engine.  I think it’s clear that most of us wouldn’t take the trade-off.

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Chris Centeno, MD is a specialist in regenerative medicine and the new field of Interventional Orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for a large amount of the published research on stem cell use for orthopedic applications. View Profile