What to expect during surgery:

Operative treatment of thumb CMC arthritis is generally performed on an outpatient basis. Surgery for thumb arthritis is called thumb CMC arthroplasty. Dr. Holt will meet you on the day of surgery and review the plan. Anesthesia options include general or light sedation in combination with local anesthesia vs. a regional nerve block. You will be taken back to the operating room where your hand and wrist will be cleaned and draped. An incision approximately 1 - 2 inches in length will be made over the base of your thumb. There can be some variations to the surgery dependent nonunion specific symptoms but in general, surgery involves removing a small wrist bone at the base of your thumb (the trapezium). Usually a portion of one of your tendons in the same area and/ or a suture will be used to help support your thumb after removal of the trapezium. The incision will be closed with stitches, a wrist splint will be placed to protect the wrist during the early healing period.

Pain Control:

Start with simple, but effective pain relief strategies such as ice and elevation. Especially for the first 2 - 3 days, attempt to keep your hand above your heart as much as possible. This will significantly limit pain and swelling.  Next, try over the counter pain medications such as Tylenol and/or Ibuprofen/Naproxen. Most patients tolerate these medications well. Take them with food, and make sure to check your allergies and/or other medications and medical issues to ensure it is safe to take them. Some patients will use a short course of low dose narcotics for the first few days after surgery to help manage the initial pain.  Dr. Holt will likely provide a small prescription of narcotics and should discuss this on the day of surgery. Take them as directed and only as needed.

Dressing/Bandage:

Keep your dressing on until follow up. Use a plastic bag or cover to keep it dry during showers/hygiene.

Activity:

You may use your hands immediately for light activities of daily living such as feeding yourself, dressing, and using a phone and/or computer. Your thumb will be relatively immobile due to the splint and you should avoid lifting/pushing/pulling more than 1 pound and/or the use of power tools and highly repetitive activities.   However, you can use her fingers for very light activities such as phone/keyboard use. Work on the attached finger range of motion exercises multiple times per day. It is very important to elevate your hand consistently and begin moving your fingers right after surgery and keep them moving to avoid stiffness.

Additional Information:

After surgery, you should expect some pain, swelling, and stiffness. Dr. Holt will talk to you about when it is safe to return to work. Most patients can return to light work (computer/desk work) within a few days, but it will often take 8 – 12 weeks to return to more demanding work (labor, construction, etc.) or longer depending on your surgery.  Most patients will be transitioned to a removable brace at their two week follow up visit and begin therapy at 6 weeks for progressive strengthening.  Most patients ultimately obtain excellent pain relief though it may take 6 months or longer for maximal recovery.

Follow-Up:

Your follow up appointment is generally 10 – 14 days after your surgery and should be in your discharge packet on the day of surgery.