Development and implementation of a trapeziectomy rehabilitation protocol

Abstract

Introduction

The purpose of this study was to evaluate a newly developed trapeziectomy rehabilitation protocol. Variability in trapeziectomy rehabilitation protocols and the arrival of new surgeons in our hospital required a uniform protocol.

Methods

Fifty hands in 44 patients (32 women/12 men) were immobilised for 4 weeks in a plaster cast after a trapeziectomy. A carpometacarpal splint immediately followed for 2 weeks, taken off for exercises and self-care. Patients were assessed preoperatively and at 3, 6 and 12 months using: a pain visual analogue scale (VAS), grip, tip pinch and lateral pinch strength, goniometry, the Modified Kapandji Index (MKI), the Quick Disabilities of the Arm, Shoulder and Hand questionnaire (Q-DASH, Dutch version) and the Short Form 36 (SF-36, Dutch version). At 3, 6 and 12 months, patient’s satisfaction with the operation was rated on a satisfaction VAS.

Results

The correlation between pain and patient satisfaction was significant (ρ = −0.80). VAS pain improved from a median of 75 mm preoperatively to 20 mm at 12 months (p < 0.01). The Q-DASH improved from a median of 48 preoperatively to 20 at 12 months (p < 0.01). Median grip, tip pinch and lateral pinch strength increased at 12 months by 19%, 8% and 24%, respectively from the baseline measurement.

Conclusions

Patients participating in a standardised protocol after trapeziectomy with 4 weeks immobilisation demonstrated improvements in pain, Q-DASH, grip strength, tip pinch and lateral pinch grip. They were satisfied with the results. Further research into the optimal immobilisation time after trapeziectomy surgery is needed.