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 abductionthumb circumductionflexion/ extensionwrist flexion/extension
  • The wrist and thumb static splint is worn between exercise sessions and at night for comfort. If the patient is comfortable without the brace, this is fine and the patient may have unrestricted motion.
  • 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.

6-8 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.
  • If the splint is still occasionally being used, it should be discontinued completely
  • 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
  • Performing previously painful maneuvers (such as opening jar lids) should still be performed with caution and with assistive devices if necessary (using non-skid pads to remove jar lids, etc.)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.