CMC arthroplasty, also known as thumb basal joint replacement, is a common surgical procedure designed to treat advanced arthritis at the base of the thumb. This condition, which often develops at the carpometacarpal (CMC) joint, causes pain, stiffness, and weakness when gripping or pinching objects. The surgery typically involves removing a small, damaged wrist bone called the trapezium and reconstructing the joint using a tendon or artificial spacer to create a cushion. The procedure aims to eliminate bone-on-bone friction and restore functional movement to the thumb. This article provides a comprehensive roadmap for the recovery process, detailing what to expect from the first post-operative hours through to long-term strength outcomes.
The Initial Post-Operative Phase
Following CMC arthroplasty, your hand and forearm will be secured in a bulky dressing and a plaster splint to protect the surgical site and immobilize the thumb joint. This splint must remain clean and dry until your first follow-up appointment. To control swelling and pain, it is important to keep the hand elevated above heart level as much as possible, using pillows for support while sitting or sleeping.
Mild to moderate post-operative pain is expected, and a short course of prescription narcotic medication is often provided to manage discomfort for the first two to three days. After this initial period, many patients can transition to over-the-counter anti-inflammatory drugs and acetaminophen. Gently move your fingers, excluding the thumb, within the splint to prevent stiffness and reduce swelling.
At the first follow-up visit, the surgeon will remove the sutures and the initial bulky dressing and transition the hand into a custom-made, removable thumb spica splint. This change marks the end of the strict immobilization period and the beginning of gentle motion exercises. The removable splint is worn full-time, except during prescribed exercises or hygiene, protecting the newly reconstructed joint as healing progresses.
Structured Rehabilitation and Functional Milestones
Formal physical rehabilitation typically begins around two weeks post-surgery, focusing on a phased approach to restore motion and strength. The initial phase concentrates on protecting the surgical repair while introducing light, passive range of motion exercises for the thumb. A therapist will guide you through exercises that gently stretch the thumb to prevent scar tissue from limiting flexibility without stressing the reconstruction.
The next stage, generally beginning between four and six weeks, shifts toward improving flexibility through active range of motion exercises. You will work on regaining the ability to move the thumb, focusing on motions like opposition (touching fingertips) and abduction (moving the thumb away from the palm). Functional milestones during this phase include being permitted to drive once you are no longer taking narcotic medication and can comfortably grip the steering wheel.
The final phase, starting around 8 to 12 weeks, involves initiating strengthening exercises. This includes using therapeutic putty or small hand weights to rebuild strength for gripping and pinching. Light activities of daily living, such as typing or eating, are allowed early on, but return to work that involves repetitive hand use or heavy lifting is typically restricted until after the 12-week mark.
Long-Term Strength and Activity Expectations
Beyond three months, the focus is maximizing functional strength, though final results may take 9 to 12 months to fully materialize. Most patients experience significant pain relief and improved overall function of the thumb, which is the primary measure of success for the procedure. While mobility generally improves, patients should have realistic expectations regarding the complete return of strength.
It is common not to fully regain pre-injury strength; pinch strength may remain somewhat less than the non-surgical hand. However, the strength gained is usually sufficient for nearly all daily activities without pain. Patients may use a soft, supportive splint during activities requiring heavy or sustained use, even after formal rehabilitation.
Long-term activity modifications are sometimes necessary, especially for individuals whose work or hobbies involve heavy lifting, forceful gripping, or repetitive pinch tasks. Your surgeon may recommend avoiding activities that place excessive, prolonged stress on the reconstructed joint to ensure the longevity of the surgical result. While the surgery provides lasting pain relief and significantly improves function, it does not restore the joint to its original, healthy state.
Recognizing Potential Post-Surgical Concerns
While most CMC arthroplasty recoveries are straightforward, be aware of signs indicating a complication requiring immediate medical attention. Symptoms of a possible infection include a persistent fever, excessive redness extending beyond the incision site, or thick, colored drainage from the wound. Clear or light pink drainage is normal initially, but any foul-smelling or purulent discharge needs prompt evaluation.
Monitor for signs of nerve irritation or damage, such as persistent numbness or tingling extending outside the surgical area. An inability to move the thumb or fingers after the initial immobilization period is a serious concern and should be reported immediately.
A rare but serious concern is Complex Regional Pain Syndrome (CRPS), characterized by pain disproportionate to expected recovery. Signs of CRPS include:
- Extreme sensitivity to touch.
- Noticeable changes in skin temperature.
- Significant changes in skin color or texture.
Early diagnosis and treatment of any of these concerns are important for a successful outcome.