After your surgery · Nicholas Genovese, M.D.

Thumb CMC arthroplasty — exercises around 10 weeks

Your surgical team’s instructions come first. If this page differs from the printed instructions you received, call (858) 560-0242 before changing wound care, splint use, exercises or activity.

Only use this program after your surgeon or hand therapist has cleared you for the 8–12 week phase. If they gave you different instructions, follow theirs. The rule at this stage is position first, strength second.

Before you strengthen: the stability check

Go ahead if the thumb is pain-free or only mildly sore afterward, rests out of the palm, keeps the knuckle gently bent during use, opens away from the palm well, and does not collapse after exercise.
Hold strengthening if the base of the thumb folds into the palm, the knuckle snaps backward when you pinch, the web space is getting tight, pain or swelling at the thumb base is increasing, or the thumb cannot hold a steady "C" shape.

Motion and position (5–10 slow repetitions, 3–5 times a day)

Thumb joint blocking: support just below the thumb joint you are working and bend and straighten only that joint. Do not let the thumb base collapse inward.
Thumb out and away: move the thumb out from the palm to open the web space, keeping the knuckle gently bent.
O to C: touch the thumb to the index fingertip to make a round "O", then open slightly into a steady "C" as if holding a small ball. Hold 3–5 seconds. Work mainly to the index and middle fingers; do not force reaching the ring and small fingers before about 12 weeks unless cleared.
Web-space release: gentle pressure into the web space between thumb and index finger with the other thumb or a soft ball, 20–30 seconds, 2–3 times, 1–2 times a day.

Strengthening — only after the stability check is passed (once a day)

Index finger side-slide: hand flat on a table, slide the straight index finger away from the middle finger; add a very light rubber band only if easy and pain-free. 8–10 times.
Thumb out and away against light resistance: only if the "C" shape stays steady. 5–10 times.
Light wrist strengthening: forearm supported, very light weight, slow lifts and lowers. 10 times each direction.
Gentle grip with the thumb relaxed: squeeze a soft sponge with the four fingers. 8–10 times.
No key-pinch, hard putty pinch, clips or repeated pinch loading at this stage. If any exercise changes the thumb position, stop and go back to the motion exercises.

Scar care — only after the incision is fully healed

Massage over and around the scar with small circles, side-to-side motion and strokes along the scar line for 3–5 minutes, 1–2 times a day.
Stop and call the office for skin breakdown, drainage, marked redness or increasing sensitivity.

A simple daily schedule

Morning: web-space release, thumb blocking, thumb out and away, O to C, wrist motion.
Midday: brief motion and O-to-C practice, plus normal light use.
Evening: repeat the motion exercises, light strengthening if the check is passed, scar massage.

Illustrated exercise guide

Photo guide demonstrating supported thumb joint blocking, thumb extension and palmar abduction, stable O-to-C posture, and gentle first web-space release. — Exercises 1–4: motion and positioning during the cleared 8–12 week functional phase.

Photo guide demonstrating first dorsal interosseous side-slide, thumb abduction and extension activation, light wrist strengthening, gentle grip with the thumb relaxed, and scar massage. — Exercises 5–9: begin light strengthening only after the stability check is passed and you are cleared; massage the scar only after the incision is fully healed.

About these instructions

These instructions are general guidelines for patients of Nicholas Genovese, M.D. Your surgeon may change your plan based on your surgery and how you are healing. If anything here differs from what your surgeon or therapist told you, follow their instructions, and call the office before changing any activity, splint use or therapy.

All after-surgery instructions