Postoperative Rehabilitation Protocol CMC Suspensionplasty

Adam Barnard, PA-C

acbarn215@gmail.com

Owensboro Health Orthopedics

And Sports Medicine

270-417-7940

 

 

The purpose of this protocol is to assist the Physical Therapist with guidance on the post-operative rehabilitation course of a patient who has undergone Carpometacarpal (CMC) suspensionplasty for basilar thumb joint arthritis.  It is by no means intended to replace or substitute the clinical decision-making process of the therapist assisting the post-operative patient in their recovery.  A patient’s individual needs are based on many factors including physical exam findings, rate of progression, presence of post-operative complications, personal goals/aspirations/expectations, and potentially confounding medical diagnoses/conditions. If the therapist/clinician has concerns, recommends urgent evaluation, or patient specific alterations to the protocol, they should contact myself(acbarn215@gmail.com) or our office staff directly(270-417-7940).  

 

Phase I- Early Post-Operative Phase (Post-op Day 0-7)

The goal of physical therapy intervention during the early post-operative phase is to protect the repair, reduce swelling and edema, and monitor wound healing. 

Goals: 

  1. Implement use of nonpharmacologic modalities to control pain and swelling such as icing, manual massage, elevation of the extremity, etc
  2. Facilitate healing and protect repair by wearing splint all times post-op 
  3. Establish therapy plan for patient and counsel on timeframe of healing, expectations, importance of avoiding nicotine and monitoring blood sugar levels if diabetic 

Assessment by Therapist:

  1. Not necessary to begin formal physical therapy during 1st week after surgery 
  2. Elbow/Shoulder ROM and scapular/rotator cuff mechanics
  3. Assess for signs of wound infections, DVT/PE, Nerve palsy/dysfunction/CRPS Type II  

 Therapeutic Exercises:

  1. OK to begin AAROM/AROM elbow and shoulder immediately post-op

Precautions:

  1. Wrist splint on all times  
  2. Sling for comfort, not mandatory 
  3. No lifting/grasping/pinching/use of hand 

Phase II (Post-op Week 1-6)

Goals:

  1. Implement home exercise plan 5X/day, approx 10-15 minute sessions 
  2. Reduce pain and swelling
  3. Protect repair with orthotic
  4. Improve IP joint and wrist ROM 

Assessment by Therapist:

  1. Assess frequency of narcotic and non-narcotic analgesic use 
  2. Assess pre-treatment and post-treatment ROM 
  3. Monitor scar tissue formation.  Begin massage/mobilization at 3 weeks if incision healed 

Therapeutic Exercises:

  1. Begin active and self-passive ROM of thumb and wrist 
    1. Palmar and radial abduction 
    2. Thumb Circumduction
    3. Thumb Flexion/Extension
    4. Wrist Flexion/Extension 
    5. Wrist Radial/Ulnar deviation 

Precautions:

  1. Wrist orthotic on all times unless bathing, attending physical therapy, or doing home exercises 
  2. No weighted or resisted movements 
  3. CMC joint should be supported during self-passive exercises 

 

Phase III (Post-op Week 6-12)

Goals:

  1. Initiation of grip/strengthening after 2nd post-op visit @ 6 weeks 
  2. Discontinue wrist orthotic 
  3. Improve ROM 
  4. Prepare for return to work 

Therapeutic Exercises:

  1. Thumb opposition exercises 
  2. Grip strengthening with putty, bands, springs 

Precautions:

  1. Delay strengthening exercises until 8 weeks if pain/swelling, limited ROM, excessive scar tissue
  2. Consider short opponens splint if necessary to support CMC joint with activity 

Phase IV (Post-op Week 12-16)

Goals:

  1.  Advance strengthening as tolerated 
  2. Continue Phase I, II and III exercises
  3. Improve ROM, counsel patient it is common not to achieve fully flattened palm after procedure 

Therapeutic Exercises:

  1. ADL and work specific exercises/movements 
  2. No restrictions in use beyond 16 weeks if no pain and strength acceptable 

Precautions:

  1. Must have clearance before return to work 
  2. Consider extending formal therapy and re-evaluation in office if delayed recovery 

 

Precautions: 

Do not advance strengthening exercises if patient experiencing painful response.  Goal is maximize endurance of movements before increasing loads