Cmc arthroplasty this publication sets forth detailed recommended procedures for using stryker devices and instruments. Thumb carpometacarpal joint arthroplasty page 1 of 3 regional orthopedics 2479 e colorado blvd spearfish sd 57783. Postoperative therapy for chronic thumb carpometacarpal. Thumb arthritis may be surgically treated with a procedure called excision arthroplasty. Bandagesplintsurgical dressing care o please keep your hand elevated as much and as often as possible for 34 days after surgery. In general, it is a progressive instability or degenerative arthritis that occurs at the base of thumb, that over time fails. A small amount of clear drainage or bleeding is normal.
At week 6, gentle strengthening is begun with discontinuation of the splint. Cmc arthroplasty protocol week 1 remove post op splint and dressing. Indications for surgical intervention include cmc joint arthritis, degenerative joint disease, pain andor instability with rest andor with daily activities, and patients who have failed conservative management for 23 months each variable should be considered when formulating a post operative therapy plan, and. Klika cmc arthroplasty when conservative treatment of thumb osteoarthritis fails to control pain surgical treatment may be indicated. Rom, stretching and manual therapy to address rom limitations general conditioning i. Thumb cmc joint arthroplasty surgical technique depuy synthes mitek sports medicine 5 7 optionally, a 0. Thumb, textbook of hand and upper extremity surgery. Cmc arthroplasty rehabilitation protocol orthopedic specialists of. Arthroplasty is a surgical procedure to restore the function of a joint. Total shoulder arthroplasty hemiarthroplasty protocol.
With the pain getting so bad that it interferred wdaily. This device has been a game changer for me because instead of immobilizing my patients for four weeks with or without an external kwire, i am able to accelerate the postop protocol by starting it 57 days following surgery. Lrtithumb cmc joint arthorplasty arthroplasty of intercarpal or carpometacarpal joint is generally ligament reconstruction and tendon interposition lrti or burton lrti is a procedure in which the surgeon inserts a prosthesis or grafted tissue e. Postop instructions for cmc arthroplasty and ligament. Arthroplasty techniques have ranged from simple partial or complete trapeziectomy to various implant and ligament interposition. Larson, md to see if thumb cmc arthroplasty is right for you. Purpose of the study to present a rehabilitation protocol used in a series of patient cases after suspension arthroplasty and to evaluate outcomes. Was to do it this october, but so afraid of how long the recovery period would take. As with any surgery, there are risks of complication.
Lrti arthroplasty for surgical treatment of basal joint arthritis of the thumb. Postop instructions for cmc arthroplasty and ligament reconstruction. In this surgery, the surgeon takes out a small bone at the base of the thumb and fills in the space with a rolled up section of tendon. Exercises that improve basal joint mobility include thumb abductions involving the abductor muscles, flexions using the flexor muscles and extensions. After an arthroplasty, your doctor can suggest physical therapy exercises to help regain strength and mobility in your thumb. Debilitating joint pain at the thumb can also be managed quite successfully with nonoperative methods, such as bracing, exercise regimen, medications, and injections, but sometimes the pain. Post operative guidelines initial surgical dressing the initial surgical dressing consists of a nonadherent gauze on the wound, squares of white gauze held in place with a roll of gauze, a beigecolored wrap, and on the surface, an ace bandage see instructions on management of the postoperative dressing. After complaining all these years, my primary dr did blood test for arthritis and sent me for hand xrays a year ago. The cmc joint an abbreviation for carpometacarpal joint of the thumb is where the metacarpal bone of the thumb attaches to the trapezium bone of the wrist. It offers guidance that you should heed, but, as with any such technical guide, each surgeon must consider the particular needs of each patient and make appropriate adjustments when and as required. A joint is comprised of two bones, each covered with cartilage.
Pinching or grasping causes severe pain in the thumb. The individual may be sedated for surgery or remain alert with anesthesia that temporarily blocks the feeling in the hand. Thumb cmc arthritis with ligament reconstruction and tendon interposition michael s. Patient education on postoperative protocol, adl, hip precautions and ambulation with walker or crutches. The goal of fusion arthroplasty of the cmc joint is to fuse the bones together in the thumb so that they do not rub on each other and cause pain. Removal of post op dressing, application of steristrips, instruction in suture care and edema management. Feb 20, 2017 this retired fireman talks about his experience one day post cmc arthroplasty. The cmc joint should be supported during self passive exercises. Swelling of hand and fingers is still quite apparent.
Would be happy for new discussion with current patients. During cmc thumb surgery your doctor will either fuse the cmc joint or add a spacer between the joints. Arthroplasty replaces or reconstructs part of the basal joint, using tendons from you or a donor. Rehabilitation protocol after suspension arthroplasty of.
Keep postoperative dressing clean, dry, and in place until postop visit. Rehabilitation protocol after suspension arthroplasty of thumb carpometacarpal joint osteoarthritis. Background thumb arthritis at the carpometacarpal cmc joint is one of the most common sites of arthritis, especially in women. It is important to protect your surgical repair for best results. Right after surgery, you may begin gentle finger exercises. This joint is sometimes referred to as the basal joint of the thumb. The cmc is the joint that allows you to move your thumb into your palm, a motion called opposition. One type of surgery, called cmc arthroplasty, involves reconstructing the joint. Remove the bulky dressing and apply a short arm cast that maintains. A randondized, doubleblinded clinical trial benton e.
Ligament reconstruction with tendon interposition dan cerniglia mary beth flynn thomas quinzi abstract severe arthritis of the 1st carpometacarpal cmc joint often results in laxity of the anterior oblique and dorsoradial ligaments. Immediately after the operation, you will be placed within a macular pucker surgery post op recovery area. On 102612, i had a cmc joint arthroplasty with a tendon transfer. This article describes postoperative treatment after arthroplasty for a chronic thumb cmc joint dislocation.
Postoperative rehabilitation following trapeziectomy and. After the surgery you will lose some mobility in the thumb, but you are still able to grasp objects. Sr mcp system metacarpophalangeal rthroplasty operative technique this publication sets forth detailed recommended procedures for using stryker devices and instruments. Physical therapy exercises for basal joint arthroplasty. A cast or splint which immobilizes the wrist and thumb is worn. Have had to ask for vicodin as ibuprofen doesnt cut it. This retired fireman talks about his experience one day post cmc arthroplasty. Thumb cmc arthroplasty is a treatment option for thumb arthritis, a type of osteoarthritis found at the carpometacarpal cmc joint located at the base of the thumb. This surgery is done for patients who have a lot of pain in the joint of their thumb due to arthritis. The doc used a tendon in my lower arm and placed it in the space between the boneonbone thumb joint.
During your surgery, we may use a gas bubble or silicone oil to help close a macular hole or seal a retinal tear from a retinal detachment. Thumb carpometacarpal joint arthroplasty page 2 of 3 restore stable arom of thumb cmc and mp joints and wrist within tolerance precautions. This particular procedure can be painful, especially after one day, but majority of my patients share this experience. The intent of this protocol is to provide the therapist with a guideline for the postoperative rehabilitation course of a patient that has undergone a total shoulder arthroplasty tsa or hemiarthroplasty humeral. Sep 08, 2014 im post op day 5 from left cmc thumb arthroplasty. Revision of thumb trapeziometacarpal arthroplasty sciencedirect. When it wears down, it looses the smooth surface and the bones rub against each other and you feel pain with movement. In general, it is a progressive instability or degenerative arthritis that occurs at the base of thumb, that over time fails conservative treatment, which includes bracing, therapy, antiinflammatory medications and. S blackmore 2016 learning objectives identify factors to consider in the post operative.
This helps reduce swelling, and your hand may throb and feel worse if it is hanging down. Although several previous reports have indicated that excision arthroplasty has been effective in the treatment of basal joint arthritis of the thumb by relieving pain and preserving motion, 1,2,3,4,5,6,7 others have indicated that arthroplasty of the thumb by excision of the trapezium alone causes a substantial loss of thumb strength and stability. Cmc suspension arthroplasty protocol days 35 remove surgical dressing, clean and dress wound fabricate shortarm thumb spica splint with the mp at 20 degrees or as pinned. Materials and methods qualitative and quantitative outcomes were assessed clinically and radiographically in 58 patients 66 thumbs with thumb basal joint arthritis limited. I was given a nerve block which numbed my shoulder, arm and hand. Arthritis of the first carpometacarpal cmc joint of the hand is a common and often debilitating disease. Arom thumb ip and mcp with the cmc supported in abduction 2. I was taking percoset every 4 hours up until the eighth day post op then i called the surgeons office and asked for oxycodone instead because i was concerned about taking so much tylenol. Post op instructions for cmc arthroplasty and ligament reconstruction. When conservative modalities and therapies fail to control symptoms of thumb carpometacarpal cmc joint osteoarthritis, surgery may be indicated.
To stabilize the thumb base and address the trapezial void, a ligament reconstruction and tendon interposition lrti, also called. Diagnosis can be readily made with history, physical exam, and radiographic evaluation. The surgeon uses a piece of tendon to form a spacer that separates the surfaces of the cmc joint. These instructions are to compliment the information given by the nursing staff and therapists. Patient is fitted with edema glove andor elastic stockinette for edema control as needed fit with orthoplast static thumb spica splint forearm based. Thumb cmc arthroplasty lrti boston, ma hand surgical. Thumb spica orthotic with ip free and in mid position to be worn at all. Why do i need post operative post op head positioning. Thumb carpometacarpal arthroplasty the thumb carpometacarpal joint, or cmc joint, is a very common place for arthritis to occur, especially in women. Blood test was neg only detects ra and xrays looked good. The cmc arthroplasty procedure includes the removal of the bone that is rubbing on the base of. I am new to this board, and would appreciate hearing from others who have had cmc arthroplasty with tendon transfer. There are several options for the surgical treatment for arthritis of the thumb cmc joint. Im in my mid 40s and had pain in my left basal joint since 2004.
Cmc thumb surgery is called excision arthroplasty or fusion arthroplasty of the thumb. More information for postoperation care for a thumb cmc suspensionplasty procedure can be found here. When you leave the operating room, you will be placed in a dressing with a splint protecting your thumb. Please call 9403233400 to schedule an appointment with dr. Cmc tightrope suspensionplasty rehabilitation protocol kelly holtkamp, m.
The most common surgical technique involves complete resection of the trapezium. After surgery, your forearm and hand will be in a large bandage and plaster splint. Aug 07, 2007 in light of the success of the various arthroplasty techniques, arthrodesis has fallen out of favor and is generally reserved for post traumatic or rheumatoid arthritis limited only to the first cmc joint of the hand. The cmc arthroplasty procedure includes the removal of the bone that is rubbing on the base of the thumb creating a.
The wrist and thumb static splint is worn between exercise sessions and at night for protection of the surgery and for comfort. Physical therapy exercises for basal joint arthroplasty by jan millehan osteoarthritis in the basal joint at the wrist and base of the thumb can require a surgical procedure called arthroplasty. Rehabilitation protocol after suspension arthroplasty of thumb carpometacarpal joint osteoarthritis article in journal of hand therapy 254. Had basal joint arthroplasty on my left hand over two months ago. The complications of cmc thumb surgery healthy living. It is intended to alleviate pain in the thumb and improve function. Cmc arthroplasty suspensionplasty rehabilitation protocol. In light of the success of the various arthroplasty techniques, arthrodesis has fallen out of favor and is generally reserved for posttraumatic or rheumatoid arthritis limited only to the first cmc joint of the hand. Rehabilitation after trapeziometacarpal arthroplasty. The therapeutic protocol was adjusted to address the softtissue contracture and imbalance that existed because of the chronicity of the condition. It has been pretty brutal, but xrays show the surgery to be in good shape.
Wiki lrtithumb cmc joint arthorplasty medical billing. Hand basal joint arthroplasty and replacement postoperative care. Postsurgery thumb cmc july 20 uw orthopaedics and sports. Cmc arthroplasty rehabilitation protocol thumb carpometacarpal joint arthritis can cause significant pain and instability. Wrist 20 degrees extension, cmc joint midway between palmar. Carpometacarpal cmc arthroplasty reconstructs the thumb joint to address pain and inflammation, usually in a patient with arthritis. Berschback for your postop visit about 1014 days after surgery.
Dislocations may be treated by closed reduction under anesthesia. Please fax initial evaluation and progress notes to 815. At week 2, active and passive mcp and ip range of motion is started. Osteoarthritis, or degenerative joint disease, is a loss of the cartilage or cushion in a joint, and is the most. Contact hand surgical associates boston today at 78189023 or visit our office servicing boston, ma. The surgery may be done as an outpatient procedure or may require an overnight stay at the hospital. Cmc tightrope suspensionplasty 2017 ortho illinois. It is critical to emphasize scar mobilization as dense adhesions are common.
Occupational therapy services cmc arthroplasty protocol weeks post op thumb spica orthotic with ip free and in mid position to be worn at all times eval thumb ip and mp flexion extension arom exercise as follows 6 times a day for 10 repetitions each 1. Hand basal joint arthroplasty and replacement post operative care dr. After an arthoplasty, physical therapy can help you regain strength and mobility in her hand. Unlike a fusion surgery that simply binds the joint together, excision arthroplasty can help take away pain while allowing the thumb joint to retain some movement. To determine the incidence of revision surgery after thumb trapeziometacarpal joint arthroplasty and to present the expected results of future surgical treatment. Older adults typically need this surgery as the wear and tear on the joint over the course of their lives eventually limits mobility and causes pain. No resistive activities or exercises treatment strategies. The cmc joint gives the thumb a wide range of motion up, down, and across the palm, as well the ability to pinch. Postoperative positioning after vitrectomy surgery. At the end of the operation, a pad and shield will be placed over your eye. An artificial joint called a prosthesis may also be used. Xrays should be obtained to evaluate the reduction, and if it is correct, the tmc joint may splinted in flexion with the post op splint for three weeks.
Post op pain after cmc joint arthroplasty is this normal. I got to the point where i am able to take 10 milligrams. You need to position your head so the bubble presses against the hole or tear so it can seal. Trapeziometacarpal joint arthroplasty of the thumb without osseous tunnels and carpal tunnel release. Following suture removal, the patient is fitted with a removable wrist and thumb static splint with the ip. The procedure is performed in patients with advanced basilar thumb arthritis. Im two weeks out tomorrow slow going with the typing still. Position must be checked in the or with postop xray. Thumb cmc basal joint arthroplasty thumb joint reconstruction. It may take 6 months or more for full pain relief and recovery of strength. The pain at the base of your thumb is relieved by removing the arthritic joints.