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After surgery

After Thumb CMC Arthroplasty

Also called thumb CMC suspensionplasty or trapeziectomy with LRTI. Recovery is longer than most hand surgeries but the end result is reliable and durable.

What was done

The arthritic bone at the base of the thumb (the trapezium) was removed. In most cases the space is then stabilized using a small tendon graft — a strip of a nearby tendon is used to suspend the thumb and fill the gap where the bone used to be. This group of procedures goes by several names: ligament reconstruction and tendon interposition (LRTI), suspensionplasty, or simply thumb CMC arthroplasty. Your operative report has the exact technique.

You have an incision at the base of the thumb and the radial side of the wrist, and the thumb is in a plaster splint or cast.

The first 2 weeks

  • Keep the plaster splint on, clean, and dry. Do not remove it or get it wet.
  • Keep the hand elevated above the level of your heart as much as possible for the first 3 to 5 days.
  • Move the fingers often — fingers that are not in the cast should be moving all day long. Fingertip pumping and full finger extension prevent stiffness.
  • Do not lift anything with the operated hand. Fingers are for gentle, light motion only.
  • Ice over the splint (20 minutes on, 20 off) helps with swelling in the first few days.

2 weeks: suture removal and transition to a thumb spica cast or splint

  • Come in at 10 to 14 days for suture removal and a check of the wound.
  • You will be transitioned into a thumb spica cast or a custom thermoplastic thumb spica splint made by a hand therapist. The splint holds the thumb in a safe position while the reconstruction heals.
  • The splint is typically worn full time for another 2 to 4 weeks, coming off only for showering (once the incision is fully sealed) and for a few gentle exercises.

4 to 6 weeks: starting therapy

  • At around 4 to 6 weeks, a certified hand therapist will begin guided range-of-motion exercises for the thumb.
  • Therapy focuses first on thumb motion (opposition, flexion, extension) and then gradually progresses to strengthening.
  • The splint is weaned slowly — first worn only for heavier activities, then only for support as needed.

Pain and expected symptoms

  • Pain is worst in the first 3 to 5 days and improves steadily after that. Most patients are off prescription pain medicine within the first week and use only over-the-counter medication after that.
  • Swelling and bruising across the thumb and wrist are normal and can persist for weeks.
  • A mild numbness along the back of the thumb is common because small branches of the superficial radial nerve pass through the surgical area. This usually improves over weeks to months.
  • Weakness in pinch and grip for 3 to 6 months is expected. Strength continues to improve for up to a year.
  • The thumb will feel "different" for a long time — shorter, less stable to load, and tender to forceful pinching. This settles gradually.

Activity

  • Driving: when the cast comes off and you are in a removable splint (usually 4 to 6 weeks), and you are not on prescription pain medicine.
  • Typing / desk work: right away as tolerated, within the splint.
  • Return to light work: typically 4 to 6 weeks, in the splint.
  • Return to heavy manual work or forceful pinching: 12 to 16 weeks.
  • Forceful gripping, lifting, and opening jars: expect to be a slow builder. Full strength often takes 6 to 12 months.

Follow-up

Wound check and suture removal at 10 to 14 days. Cast check at 4 weeks. Transition to splint and beginning of therapy at 4 to 6 weeks. Final follow-up at 3 and 6 months.

The long view

Thumb CMC arthroplasty is one of the most satisfying operations in hand surgery for patients willing to invest in the recovery. Pain relief is durable and the thumb works well for most activities of daily living. Recovery takes longer than after a carpal tunnel or trigger finger release — plan for several months of incremental progress rather than a quick fix.

Call the office right away if
  • You have a fever over 101°F
  • Fingers coming out of the cast are blue, pale, or cold, or if you cannot move them because of pain
  • The cast becomes wet through, cracked, or feels too tight
  • Pain is worsening instead of improving after the first few days
  • You have new numbness, tingling, or severe weakness in the hand

Related

About thumb CMC arthritis · Cast & splint care · Home hand therapy

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