Basal thumb surgery, also known as carpometacarpal (CMC) arthroplasty, treats arthritis at the base of the thumb, alleviating pain and restoring function. This occurs when cartilage cushioning the joint between the thumb’s metacarpal and wrist’s trapezium bone wears away, causing inflammation, stiffness, and discomfort. The surgery reconstructs the joint, often by removing the damaged trapezium bone and creating a new cushion with a wrist tendon. Understanding the recovery process, which involves several stages of healing and rehabilitation, is important.
Your Initial Post-Surgery Period
Immediately following basal thumb surgery, managing pain and swelling is a primary focus. You will likely receive prescription pain medication to control discomfort. It is often recommended to start taking it before the regional nerve block, which numbs the arm, fully wears off. For the first two to three days, taking pain medication around the clock helps maintain control, after which it can be taken as needed. Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen may also be used after the initial few days, provided there are no contraindications.
Your hand will be protected by a bulky dressing or splint covering the thumb, wrist, and forearm. Keep it clean and dry until your first post-operative appointment, typically within 7 to 10 days. Elevating your hand above your heart, especially for the first 48 to 72 hours, significantly reduces swelling and throbbing. Rest your hand on pillows when lying down or keep it at shoulder level or higher when walking. While the thumb is immobilized, gently move your other fingers to promote circulation and reduce stiffness. Some bruising and mild to moderate swelling are expected.
Navigating Your Recovery
Longer-term recovery from basal thumb surgery typically spans several weeks to many months, with full recovery potentially taking up to a year for complete strength gains. After approximately four to six weeks, your initial splint or cast will be removed, and you will begin physical or occupational therapy. This therapy is a cornerstone of recovery, focusing on regaining range of motion, strength, and overall hand function.
Hand therapists will guide you through specific exercises, starting with gentle range-of-motion activities to restore thumb joint mobility. These might include making a loose or tight fist, finger stretches, and thumb stretches that involve touching the thumb to each finger. As your mobility improves, strengthening exercises will be introduced, such as squeezing a soft ball. Consistent adherence to these exercises, often performed several times a day, helps maintain grip strength, dexterity, and flexibility.
Gradual return to daily activities is advised. Light activities like eating, writing, and typing are often permissible soon after surgery, though the thumb should not be heavily used initially. Activity restrictions typically continue for about 6 to 12 weeks post-surgery. Heavy lifting, strong gripping, or pinching with the operative hand is generally discouraged during this period. Driving is usually not allowed while taking narcotic pain medication. A return to driving depends on feeling safe and in control of the vehicle. For sports and recreational activities, most patients can resume some level of participation within six to nine months, with 73% reporting a successful return with decreased pain.
Scar management is another important aspect of recovery once the incision has healed and sutures are removed, typically 8 to 14 days post-surgery. Scar massage, performed firmly in all directions (up and down, left and right, and in circular motions), helps reduce redness, swelling, and sensitivity, and prevents sticky areas from forming. Using an unperfumed moisturizer during massage keeps the skin soft and supple. This massage should be done at least twice daily for about two minutes each time, and can continue for three to six months as the scar matures and becomes less visible and tender.
Recognizing Potential Concerns
While recovery generally progresses smoothly, be aware of signs that may indicate a complication and warrant contacting your healthcare provider. Report increasing pain that worsens after initially improving, or severe pain uncontrolled by medication. This could be accompanied by swelling, warmth, and redness extending beyond the surgical site.
Signs of infection include increased redness, warmth, swelling, pus or cloudy drainage from the wound, a foul odor, or fever (greater than 101°F). While rare, superficial infections can occur within three to seven days post-surgery and may require antibiotics. Promptly report new or worsening numbness, tingling, or any significant loss of sensation or movement in the thumb or hand after the initial post-operative numbness from the nerve block has worn off. Attending all scheduled follow-up appointments is important to monitor your progress, address any concerns, and adjust your rehabilitation plan as needed.