Thumb CMC arthroplasty (thumb base arthritis surgery)

The first three days

Keep your hand higher than your heart as much as you can. Rest it on pillows when you sit or sleep. This is the most important thing you can do for swelling and pain.

Put ice over the dressing or splint for 15–20 minutes at a time, several times a day. Never put ice directly on the skin, and do not let the dressing get wet.

Move the parts that are not in the dressing or splint: open and close your fingers, and gently move your elbow and shoulder every hour while awake.

Some swelling, bruising and soreness are normal. Bruising can travel down into the fingers.

Use the hand for light tasks only. Do not lift anything heavier than a coffee cup with the operated hand until your surgeon tells you that you can.

Dressing and bathing

Keep the splint and dressing clean, dry and in place until your first follow-up visit. Do not remove, trim or adjust the splint, and do not put anything inside it.

You may shower after 24 hours. Cover the whole splint with a waterproof bag or cast cover. If the splint gets wet, cracks, loosens or shifts, call the office.

If the splint feels too tight, or your fingers become very swollen, cold, blue or numb, you may unwrap and loosely rewrap the outer elastic (ACE) wrap. Do not remove the hard plaster underneath.

Do not soak the arm in a bath, hot tub, pool or the ocean until the stitches are out and the incision is fully closed.

Splint or sling

• You will go home in a thumb splint (thumb spica) with the tip of the thumb free.
• At your first visit the splint comes down and your hand therapist makes a custom thumb splint.
• Wear the custom splint most of the time until about 6 weeks, then wean out of it as directed.

If you had a nerve block

A nerve block keeps the arm numb for about 8–24 hours. Protect the arm while it is numb: keep it in the sling or on pillows, and keep it away from heat, cold and sharp edges.

Start your pain medicine before the block wears off, usually the evening of surgery or before bed, so the pain does not catch up with you.

Pain control

Follow the plan your surgeon gave you and the directions on your prescription labels. Unless you were told otherwise, the plan below works well for most patients.

Acetaminophen (Tylenol 8 HR Arthritis Pain, 650 mg): one tablet every 8 hours for the first 3 days, even if your pain is mild, then as needed. Do not take more than 3,000 mg of acetaminophen a day from all sources. Many prescription pain pills also contain acetaminophen, so count them too.

Naproxen 500 mg (or the anti-inflammatory your surgeon prescribed): twice a day with food for the first 3 days, then as needed. Only take it if anti-inflammatory medicine is safe for you. Do not take it if you have kidney disease, a stomach ulcer or stomach bleeding, take a blood thinner, are pregnant, or were told to avoid these medicines.

Stronger prescription medicine for breakthrough pain: take it only as written on the label, and only if you need it, usually at night. It can cause drowsiness and constipation. Drink 6–8 glasses of water a day and use a stool softener such as Colace while you take it. Do not drive, drink alcohol or make important decisions while taking it.

The worst pain is usually in the first 48 hours. Most patients need nothing stronger than acetaminophen and naproxen after 3–5 days.

Prescription refills and changes are handled during business hours only, not at night or on weekends.

Activity and lifting limit

• First 2 weeks: no use of the thumb; lift nothing with the operated hand.
• Weeks 2–6: light hand use in the splint; no pinching or gripping with the thumb.
• Weeks 6–8: light pinch exercises; avoid opening jars and tight lids.
• Weeks 8–12 and beyond: gradual return to most activities as strength returns.

Driving

Do not drive while you are taking prescription pain medicine, while your arm is numb from a block, or while a splint or dressing keeps you from controlling the wheel safely.

Exercises to start now

Your first post-op visit

Your first post-op visit is usually about 2 weeks after surgery. The date and office are on your appointment card. If you cannot make it, call (858) 560-0242.

Exercises by phase

Scar massage

Hand therapy

• Hand therapy is a key part of recovery and starts after the first visit.
• Weeks 0–4: custom splint with the knuckle free; finger motion and swelling control.
• Weeks 4–6: begin weaning the splint; gentle thumb motion; pain-free thumb muscle activation.
• After 6 weeks: progressive thumb strengthening, focused on a stable thumb position before pinch strength.
• Around 10 weeks: a functional home program may be added once your therapist clears you.

What not to do yet

• Weeks 6–8: light pinch exercises; avoid opening jars and tight lids.