Basal Joint Arthroplasty Rehabilitation Protocol

2-6 Weeks Post-Op

  • Active and self passive ROM exercises are Initiated to the thumb and wrist 6 – 8 times a day for 10 minute sessions. Exercises should emphasize:
    • palmar & radial abduction
    • thumb circumduction
    • flexion/ extension
    • wrist flexion/extension
  • The CMC joint should be supported during self passive exercises.
  • The wrist and thumb static splint is worn between exercise sessions and at night for protection of the surgery and for comfort.
  • Scar management is initiated at 3 weeks.  It is critical to emphasize scar mobilization as dense adhesions are common.
  • Initiate manual desensitization techniques as the area is often hypersensitive along the surgical site, as well as due to superficial sensory branch of radial nerve neuritis.

6 Week Post-Op

  • Unrestricted PROM exercises may be Initiated. Continue to support the CMC joint
  • Continue with the wrist and thumb static splint between exercise sessions and at night
  • Persistent and dense scars may benefit from ultrasound. The ultrasound can enhance the vasoelasticity of the soft tissues, thus increasing mobility.

8 Weeks Post-Op

  • Gentle strengthening may be initiated between 6 and 8 weeks postop. If edema and/or pain are persisting, delay strengthening until 8 weeks.
  • The wrist and thumb static may be discontinued. Patients who require use of their hand in repetitious, heavy lifting or pinching activities may be more comfortable in a short opponens splint. The splint will provide external support. Depending on the level of need, either a thermoplastic or neoprene splint can be used

10-12 Weeks Post-Op

  • The patient may resume normal use of their hand in daily activity. Patient education is Important. The basic guidelines outlined in conservative management of CMC arthritis should be reviewed once again. Simple suggestions such as using non-skid pads to remove jar lids, etc. should be reinforced.

Considerations

  • The Inability to flatten the palm after the procedure is typical. Often this is a concern to the patient. Activities such as cleaning the windows, wiping down a countertop, etc. can be frustrating. Patients need to understand this is to be expected to a degree because this positioning Is maintaining stability at the CMC joint.
  • The patient should be encouraged to practice functional activities and prehension of small, lightweight objects to regain dexterity and minimize frustration. To begin this when the patient begins AROM exercises is encouraged.
  • Patients will typically indicate their thumb and hand have restored functional use within 6 months.