LSUHSC

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LSUHSC Occupational Therapy CMC Arthroplasty
Treatment Protocol
Carla Saulsbery LOTR, CHT Dr. A. Hollister, MD
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The trapeziometacarpal joint and the
articulations of the trapezium with the
scaphoid, trapezoid and second metacarpal make up
the basal joint complex. Basal joint
arthroplasty is indicated when there is
significant arthritis of the
trapeziometacarpal joint, which results in
disabling pain and loss of hand function in
ADLs. Occurs more frequently in women and is
thought to be related to hormonal changes,
ligamentous laxity. Surgery is designed to
decrease pain. Secondary gains are the improved
positioning of the thumb, stability, and
increased functional use of the hand. Surgery
consists of the trapezium either being trimmed or
excised. A soft tissue spacer is constructed
from part of the abductor pollicis longus and is
inserted in the trapezial space. Fixation
with K-wire for 4 weeks. Patient education is
important pre and post op to instruct in no use
of the hand in ADLs for 6 weeks.
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Post operative Surgeon places patient in plaster
half cast in the OR. Week 1 post op Patient is
seen in Orthopaedic clinic for initial post op
visit Patient is referred to Occupational
Therapy for fabrication of a radial based
dorsal blocking splint. The splint will prohibit
radial abduction, palmar abduction and
adduction motions. Splint will be worn 6
weeks No strapping around the thumb
itself Bubble splint in the area of the k-wire
to prevent pressure Instruct patient in active
flexion ROM of the thumb within the splint.
Patient to actively extend thumb back to
splint. AROM of composite fisting all
remaining digits. Instruct patient in one-handed
ADL techniques Instruct patient in no use of the
hand for grasping, pinching for 6 weeks
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Radial based dorsal blocking splint
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Weeks 2-4 post op Continue to adjust splint for
proper fit as edema decreases Monitor for
irritation of the pin site area from the
splint AROM of the thumb in flexion and
opposition to each digit. Gradually work
towards complete flexion of the thumb to the
small finger base. Avoid undue stress on the
reconstructed ligament. Scar massage and
desensitization as indicated ?Continue to remind
patient of no pinching with thumb Week 4 -6 post
op ?At week 4 K-wire fixation is usually
removed ?Continue with protective splint.
Continue with AROM as noted ?Continue to remind
patient of no use of the thumb ?Begin scar
massage as indicated Weeks 6-8 post op At 6
weeks patients may resume use of the hand in
light ADLs with the splint on. Pain-free
sponge gripping Joint protection
techniques Adaptive equipment assessment Surgeon
may request a neoprene splint
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Week 8 post op Splint can be discontinued if the
joint is stable and the patient is
asymptomatic Begin gentle radial/palmar
abduction and adduction ROM exercises Gentle
strengthening including grip and pinch
strengthening can be started with
theraputty Fine motor manipulation tasks Wrist
and upper arm strengthening Weeks 10-12 post
op Normal use of the hand may resume