CMC Joint Arthroplasty with Flexor Tendon Interposition

Thumb carpometacarpal (CMC) arthritis is a disorder where the cartilage of the thumb CMC joint erodes, causing pain, inflammation, stiffness, and swelling of the joint.  The thumb CMC is located at the base of thumb where it meets the wrist.  All movement of the thumb revolves around this joint, and this wide variety of movement lends this joint to more instability than the CMC joints of the other fingers.  After the cartilage protecting the thumb CMC joint erodes, you are left with the bone of the thumb rubbing and grinding on the bone of the wrist.  Due to the importance of this joint and its involvement in thumb movement, thumb CMC joint arthritis can be severely debilitating. Symptoms usually start with pain in the base of the thumb, but can also include swelling or weakness of the joint. You may notice difficulty manipulating small objects when using your thumb.  

One surgery for thumb CMC joint arthritis is called CMC arthroplasty with flexor tendon interposition. In this surgery, two incisions will be made in the forearm and a section of a flexor tendon (usually the flexor carpi radialis) is harvested.  Then part of that tendon will be placed into the thumb CMC joint space to cushion the joint, replacing the eroded cartilage, and the other part of the tendon is used to secure the cushion in place.  

This surgery is performed on an outpatient basis, meaning you will be able to go home on the same day of the procedure.  You will be discharged with a temporary splint that must be kept clean and dry until you are seen for follow up with your surgeon, typically the next day.  At the follow up appointment the day after surgery, we will write you a prescription for a splint called a thumb spica splint that must be worn at all times (except when showering). You are able to shower 48 hours after surgery; however, it is important that you do not submerge your surgical incision in water (i.e. no bath tubs, swimming pools, etc.). After showering, pat incision dry and replace splint. Elevating the affected arm with a couple of pillows can alleviate pain and swelling.

Sutures will be removed 10-14 days after surgery. After suture removal, keep wearing the splint at all times and return to the office for follow up appointments, typically every 2 weeks.  At the appointment 6 weeks after surgery, we may proceed to starting occupational/physical therapy, beginning with gentle range of motion exercises.

You may resume your regular diet after surgery; however, you should start slow. It is a good idea to start with things like toast, Jell-O, crackers, and soup to see how your stomach tolerates food after anesthesia. Drink plenty of fluids such as water or Gatorade and limit your intake of sodas, coffee and other caffeinated beverages.  

We will send you home with a prescription for an antibiotic and a pain medication. It is important to take your antibiotic and pain medication with food to prevent nausea (unless you are instructed otherwise). Do not take your pain medication and antibiotic at the same time as this may upset your stomach; separate them by an hour or two. You cannot drive while taking pain medication.

Should you develop any of the following signs and or symptoms of possible infection, call our office immediately:

  1. Fever over 100.3
  2. Chills or night sweats
  3. Unusual swelling, redness, or warmth to your incision site
  4. Purulent drainage from incision site.

Please do not hesitate to call our office with any concerns or questions you may have.

Please remember the above instructions are only a guide.  Always listen to the instructions given by your healthcare provider and follow those if in conflict with any listed above.

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