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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
Wound inspection
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

Elevation advice

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.



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