What to Expect After Basal Thumb Surgery

Basal thumb surgery, often called carpometacarpal (CMC) joint arthroplasty, is a procedure designed to relieve pain caused by arthritis at the base of the thumb. This surgery typically involves removing the trapezium, a small wrist bone, and reconstructing the joint with a tendon to create a cushion or spacer. The recovery process is sequential, moving from a protected healing period to an active phase of regaining motion and strength. Understanding this recovery pathway provides a clear guide for what to anticipate in the months following the operation.

Managing the Initial Post-Operative Phase

The immediate period after basal thumb surgery is focused on controlling pain and swelling while the surgical site begins to heal. Post-operative pain often peaks in the first two to three days, and managing this discomfort is typically achieved through a combination of prescribed narcotic medications and over-the-counter anti-inflammatories. Elevating the hand above the level of the heart for the first 48 to 72 hours minimizes swelling and throbbing pain.

The hand and wrist will be secured in a bulky dressing or a plaster splint to protect the reconstruction and maintain the thumb’s position. This splint must be kept clean and completely dry to prevent infection, often requiring the use of a plastic bag cover during showering. Although the thumb is immobilized, patients are usually encouraged to gently move their other fingers frequently to prevent stiffness and promote healthy circulation.

During this initial phase, all heavy use of the hand is prohibited, including lifting, gripping, or driving, as these actions could compromise the surgical repair. Patients should remain vigilant for signs that require immediate medical attention, such as excessive swelling that causes a loss of sensation in the fingers, a foul odor emanating from the dressing, or pain that is uncontrollable despite medication.

The Active Phase of Rehabilitation

The transition to active rehabilitation usually begins around two to six weeks following surgery, marked by the removal of the initial cast or splint. At this point, the patient is fitted with a custom-made, removable thermoplastic splint that provides support but allows for controlled movement. This marks the beginning of formal hand therapy.

Physical therapy sessions initially focus on restoring basic range of motion to the thumb and wrist joints. Early exercises involve gentle, active range-of-motion drills, such as thumb opposition (touching the thumb tip to the tips of the other fingers) and tendon gliding, which helps prevent scar tissue from restricting movement. This early active recovery is generally encouraged.

The therapist guides the patient through a home exercise program. While range of motion is the focus early on, strengthening exercises, often involving therapeutic putty or resistance bands, are typically introduced around six to eight weeks post-operation. These exercises are crucial for rebuilding the pinch and grip strength. The goal of this active phase is to manage residual stiffness, decrease swelling, and systematically build the strength necessary for functional use.

Milestones for Full Functional Recovery

Returning to daily activities extends well beyond the initial weeks of immobilization. Light daily activities, such as typing, dressing, or holding a light cup, may be cautiously resumed between three to six weeks post-surgery. Driving is generally considered safe to resume when a patient is no longer wearing the protective splint and can operate the vehicle’s controls with full reaction time and comfort, often around four to six weeks.

Returning to more demanding activities, like heavy gripping, lifting substantial objects, or engaging in contact sports, typically requires a longer timeline, usually three to six months. The joint needs time for the reconstructed soft tissues to mature and gain sufficient stability before it can withstand significant force. Patients may experience some residual stiffness for several months, particularly in the morning, which usually lessens with consistent use and therapy.

The most significant gains in pain relief are often seen within the first three months, but the return of maximum strength is a much slower process. Although patients often feel good after regaining full motion, it can take six months to a full year for the thumb to achieve its final level of strength and comfort.