Arthritis at the base of the thumb is a very common condition. When symptoms are not controlled by non-operative methods, one of several surgical procedures may be performed. All of these are designed to relieve pain and preserve function. The two most common procedures are as follows:
You will be shown a diagram of these procedures. This surgery can be done as an outpatient under a regional anesthesia. This means that only your arm needs to be put to sleep for the surgery. The surgery takes an hour to an hour and a half to complete.
When you go home after surgery you will want to keep your hand elevated for several days to control the swelling. You may want to put ice on the back of your hand. If your dressing is too tight or too loose, you may unwrap and rewrap the ace bandage that holds it in place. If you want to take a shower you should cover the bandage with a plastic bag. You are encouraged to move your fingers and use your hand for light activities and to move your elbow and shoulder.
You have been provided with a prescription for pain medicine which you should take as directed. You may also have been given a prescription for medicine to treat nausea and vomiting. Use these judiciously as necessary.
When your pain has subsided to the extent that you do not require much narcotic pain medication, you may resume driving. Start with short distances and gradually increase your driving.
Your first postoperative appointment is usually two weeks after your surgery. At this visit you will have your dressing changed, sutures removed, an x-ray taken, and a new dressing and cast or splint applied. If you had an interposition arthroplasty, you will have small pins between your thumb and index digits. If you had a fusion, you will have a small metal plate on the bones holding them together. These need to be protected for an additional three weeks until further healing has occurred.
Your second postoperative appointment occurs about five weeks after your surgery. At this appointment you will have your cast or splint removed and if you have pins they will be removed. You will then have an orthoplast splint constructed to protect your thumb until further healing has occurred.
During the first week after the orthoplast splint is made you should wear it all the time except to dress, bathe, and do your range of motion exercises. You will be shown how to do contrast baths and range of motion exercises.
During the second week after the orthoplast splint is made you should follow the same procedures as mentioned above but you will add therapy putty exercises.
During the third week after the orthoplast splint is made you will start to wean from the orthoplast splint and start to wear the black neoprene CMC joint splint. Start wearing the black neoprene splint one hour in the morning and one hour in the evening and then double the time you are wearing it every three or four days. Continue to wear the white orthoplast splint at night for the next month.
Your third postoperative appointment occurs eight or nine weeks after your surgery. You will have your incision checked, an x-ray taken, and your strength and function measured. If you are doing well this may be your last appointment. You may gradually resume your normal activities. If there are any concerns, an additional follow up appointment will be scheduled. If you are having trouble regaining strength and function you may want to work with our hand therapist.
Hopefully this information answers some of your questions and will allow you to have a comfortable post-operative experience. If you have additional questions or concerns don't hesitate to contact your physician or our nursing staff.