Carpal Meta-Carpal (CMC) Arthroplasty
What is it?
The carpometacarpal joint is where the metacarpal bone of the thumb attaches to the trapezium bone of the wrist. This joint has a very unique shape that permits the thumb to move in multiple directions. Arthritis at the CMC joint may cause changes in the shape of the joint and weakening of its ligamentous supports as well as the formation of bone spurs. Diagnosis is based on history, physical examination and X-Rays.
What are the treatment options?
Conservative treatment includes activity modification, splinting, nonsteroidal antiinflammatory medication administration, and steroid injection. If these measures prove inadequate, surgical intervention should be considered. One type of surgery is called a thumb carpometacarpal (CMC) joint arthroplasty. This surgery is done to relieve pain in your thumb and wrist and give you movement of the thumb. It is often done as an outpatient surgery.
The main goal of both conservative treatment and surgical intervention is to ease pain where the surfaces of the joint thumb are rubbing together while retaining thumb movement.
Risks of the Procedure
As with all surgical procedures there are complications that occur. For CMC arthroplasty complications include infection and nerve damage. Before surgery your doctor will review the possible risks and complications of surgery with you.
What to Expect
The day of the procedure, you will need to arrange for a ride to and from the procedure and arrange for help at home.
Wear comfortable clothing.
Do not take anything by mouth after midnight for arrivals before noon; this includes eating, drinking, gum, candy and smoking. Otherwise do not take anything by mouth seven hours prior to your arrival at the surgery center. Directions provided by Lawrence Surgery Center in regards to consumption prior to surgery may differ, follow directions provided to your personally.
You will be contacted by Lawrence Surgery Center to set up your patient account. They will inform you of your pre-operative instructions as well as tell you when to arrive for surgery.
When you get out of surgery your thumb and wrist will be in a splint that will keep it in a neutral position while it is healing. Your incision will be closed with stitches. Your stitches will be removed 7-10 days after your surgery.
You will have limited use of your operative hand the days following surgery as you will be in a splint from surgery until your post-op visit. You may want to have someone available to help you perform daily activities at home.
Swelling and bruising is normal and is okay. If there is a loss of a circulation, call your doctor immediately.
You will need to schedule a follow-up visit one week from your surgery. At this appointment, your splint will be removed and x-rays will be taken. Depending on x-rays and healing, at this time your sutures may be removed. If sutures are removed, you will then be sent over to occupational therapy where you will meet with them to have a custom removable splint made and receive a home exercise program.
- You may resume your regular diet. However, start slow with clear liquids and gradually work your way back to your normal diet. This will help prevent nausea and vomiting
Hand Care & Bathing
- Keep your dressing and splint in place until your first post-op visit
- It is essential that you keep the splint dry!
- Dressing will be changed at your first post-op appointment
- The splint should not be too tight, if it is, call the office and schedule to come in.
Elevation and Circulation
- Elevate the extremity on pillows with fingers point toward the ceiling as much as possible for the first 3-5 days.
- After these first few days, continue to elevate as needed in order to reduce swelling and pain.
- To encourage circulation and decrease swelling and pain, wiggle your fingers and massage them with the other hand.
- To help reduce pain and swelling, apply an ice pack to the surgical area for 20 to 25 minutes every one to two hours for the first 48 hours and then as needed to help control pain and swelling.
- To avoid frostbite, place a cloth barrier between the ice pack and your skin.
- It is not necessary to use ice while sleeping.
- Your physician will give you a written prescription for pain medicine as you leave the surgery center. Take your pain medication as prescribed. You may want to take it regularly for the first 48 hours after surgery as needed. Do not take any additional Tylenol as man pain medications already contain Tylenol.
- While you are asleep in the operating room, a long acting numbing medication may be injected into the surgical area to help relieve your immediate postoperative discomfort for up to 24 hours. When you first notice tingling or throbbing, begin taking your pain medicine so it will become effective before the local anesthesia wears off.
- No driving while taking any narcotic pain medication!
- The pain medication may cause some nausea so take it with food.
- The pain medication and general anesthesia may also cause constipation. Constipation can be treated as your normally would.
- Watch for temperature > 101.5°F, persistent numbness and tingling, persistent bleeding or drainage from the wound, foul odor, progressively worsening pain that is unresponsive to pain medication, chest pain or difficulty breathing. If you have any of these symptoms, call the office if during normal business hours or go to the nearest emergency room.
- Please make sure to follow instructions given to you by your physician, they may have specific instructions to your care.
- If you do not have a postoperative appointment set-up already, please call the office to schedule an appointment for 7-10 days after surgery at (785)843-9125.
Rehabilitation Plan - Exercises
Begin finger bending and straightening exercises right after surgery. Your thumb will be in splint or cast but you will be moving all your other fingers.
Do these exercises 3 to 5 minutes and repeat them 3 to 5 times each day.
Your goal by days 7-10 is to make a full fist and to fully open your fingers.
Use your hand to do daily activities. Avoid pinching or direct pressure on your thumb. Avoid lifting, pulling or pushing items that weigh more than 1 pound for about 6 weeks. For reference, a gallon of milk weighs about 8 pounds.
Avoid activities that cause hand pain. Let pain be your guide.
A referral to a hand therapist will be needed to have a splint made after surgery at your first post-op visit. Make sure to follow splint instructions provided by the occupational therapist. See splint care for additional instructions. At this time you will also receive a home exercise program.
Additional therapy may or may not be needed and will be determined at future follow-up visits.