Thumb carpometacarpal (CMC) arthroplasty is a surgical procedure designed to alleviate pain and improve function for individuals suffering from arthritis at the base of their thumb. This condition, often characterized by pain during gripping or pinching activities, can significantly impact daily life as the joint breaks down. The surgery reconstructs the joint, often by removing the arthritic trapezium bone and using the patient’s own tendon as a spacer.
Initial Recovery Phase
Immediately after CMC arthroplasty, patients can expect to experience some pain, swelling, and stiffness in the surgical hand. Pain medication may be prescribed, though over-the-counter options like acetaminophen or ibuprofen are often sufficient. Elevate the hand above heart level for the first few days, and apply ice packs for 20-30 minutes, several times daily, to reduce swelling and pain.
The hand will be placed in a bulky dressing or bandage with a plaster splint immediately following surgery, covering the thumb, wrist, and forearm. This splint should remain dry and undisturbed until the first follow-up, typically around two weeks post-operation. Patients are advised to cover the splint with a plastic bag during showering to keep it dry. While the thumb will be relatively immobile due to the splint, gentle movement of the fingers and elbow is encouraged to prevent stiffness in those joints.
Rehabilitation Process and Timeline
Around two weeks post-surgery, the initial dressing and sutures are removed, and a lighter, custom thermoplastic splint is applied. This splint is worn continuously for two to four weeks, removable for specific exercises and wound care. During this phase, early active range of motion exercises for the fingers and wrist are initiated, focusing on gentle movements to avoid stressing the healing thumb.
Formal physical or occupational therapy usually begins around four to six weeks post-surgery. The therapist will guide patients through specific exercises to regain thumb and wrist motion, address scar tissue, and manage any ongoing swelling. Initially, exercises may focus on movements like wrist flexion and extension, side-to-side wrist motion, and spreading the thumb away from the palm. Strengthening exercises, such as those using putty for grip and pinch, are introduced around 8 to 12 weeks after surgery, allowing sufficient joint healing. The custom splint may continue to be worn for vigorous hand activities until about 12 weeks from the surgery date.
Resuming Activities and Long-Term Outlook
As recovery progresses, patients gradually resume daily activities. Light activities like eating, dressing, using a phone, or typing may be possible within days or weeks, even with the initial splint. Activities requiring heavy gripping, pulling, or pinching are restricted for several months to protect healing tissues. Driving is permitted once a patient is off narcotic pain medication and can comfortably grip the steering wheel, often after the initial cast is removed.
Full recovery from CMC arthroplasty can take several months, with continued improvement for up to a year after surgery. Most individuals achieve significant pain reduction and improved thumb function, including better grip strength and range of motion. While full pinch strength may not always be completely restored, the surgery is highly effective at relieving pain and enhancing overall thumb mobility. Most patients (around 73%) successfully return to sports and recreational activities.
Recognizing and Addressing Concerns
Following CMC arthroplasty, some expected symptoms include swelling, stiffness, and mild discomfort that gradually improves over time. It is also normal to experience some pulling sensations in the wrist, forearm, and thumb during movement. However, patients should be aware of signs that warrant contacting their surgeon or medical team.
Signs of a potential infection include fever, chills, increasing redness spreading beyond the incision site, worsening pain or swelling, or any new drainage from the wound, especially if it is thick or foul-smelling. Persistent or worsening pain that is disproportionate to what is expected, or new numbness, tingling, or a significant loss of sensation, should also be reported. Patients should follow all post-operative instructions carefully and communicate any unusual or concerning symptoms to their medical team promptly.