Basal Thumb Arthritis / Trapeziectomy / Pyrocarbon disc
Basal thumb arthritis is extremely common in the population secondary to osteoarthritis (OA) at the carpal-metacarpal joint (CMC). Traditionally procedures such as trapeziectomy with or without a ligament suspension have been performed. Nowadays joint replacement and arthroscopic debridement with interposition grafts are possible.
The therapy protocol here applies to:
- Excision Arthroplasty
- Trapeziectomy with sling procedure ( flexor carpi radialis )
- Trapeziectomy with implant (pyrocarbon )
- Trapeziectomy with implant (pyrocarbon ) and sling procedure ( flexor carpi radialis)
- Trapeziectomy with k-wire fixation
Over night admissions are seen by the therapist on the first postoperative day or if a day case procedure, within a few days of surgery.
Immediate Post Op from theatre
Bulky bandage & volar POP supporting wrist and thumb
Elevation of limb over night on ward or at home if Day Case
1st post-op day ( or day 1,2 or 3if day case procedure)
Reduction of postoperative dressing and removal of POP
Application of light dressing
Application of thumb spica splint / cast providing rigid immobilisation of wrist (neutral alignment) and thumb (neutral alignment i.e. thumb in line with radial border of the radius, no flexion, extension or abd/adduction, thumb nail at 90 degrees to palm plane)
Advice on mobilisation of digits and all other uninvolved joints
Provision of collar & cuff for out door use if necessary
Named therapist and contact number should difficulties arise
If concerns over swelling/ pain/ mobilisation of digits request they remain as inpatient for longer or arrange an appointment for review by senior therapist before the 2 week outpatient appointment.
2 weeks post-op
Outpatient Department (OPD) attendance for removal of sutures / k-wire inspection
Reapplication of thumb spica in therapy department
Check range of movement in digits and other joints
6 -12 weeks post-op
Patient attends from clinic or by therapy appointment to commence mobilisation of CMC joint, thumb MCP & IP joints & wrist.
Light weight, removable thumb spica provided for functional activity.
Scar care commenced
Home Exercise Programme (HEP) initiated.