CMC Arthroplasty with Speed Spiral Protocol

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Surgical Procedure

This procedure is recommended for advanced stages of thumb CMC joint arthritis and/or instability of the thumb CMC joint. The procedure is performed by first removing the trapezium. A reconstruction of the CMC joint is then performed by utilizing a tendon as the soft tissue interpositional arthroplasty. This is often referred to as ligament reconstruction and tendon interposition (LRTI). This technique creates a space between the trapezium and thumb metacarpal, reducing pain caused by arthritis. Typically, dissolvable sutures are used to close the skin and will not need to be removed post-operatively.

When you go home from surgery, you will be placed in post-operative dressings and a short arm thumb spica splint. All dressings should be left alone until your first post-op appointment. Dressings will be removed at your first post-op appointment and the wound will be cleaned. Once post-op dressings have been removed, you will either be placed in a short arm thumb spica cast or sent to a therapist to have a custom, removable splint made.

3-7 Days Post-Op (Initial Visit after Surgery):

• Dressing:
  • The bulky post op dressing is removed, and a light compressive dressing is applied.
• Orthosis:
  • Fabrication of a forearm-based thumb spica orthosis with the thumb positioned mid-way between palmar and radial abduction, MP in slight flexion and IP free. Wear full-time w/removal for 4x/day for exercise and wound care as indicated.
• Exercise:
  • Full Active/Passive Range of Motion of digits 2-5, thumb IP and MCP, forearm, elbow, and shoulder.
  • Gentle AROM thumb MCP joint in the line of the radius unless otherwise specified by the surgical team.

10-14 Days Post-Op:

• The therapist is authorized to remove sutures if still in place/if applicable.
• Once the incision is completely healed, scar management techniques may be initiated.
  • Scar massage
  • Use of silicone gel sheeting
  • Scar desensitization
• Continue full-time orthosis wear with removal for MCP AROM 4x/day.
• Lifting limited to <2lbs (weight of a coffee cup)with the orthosis on.

4 Weeks Post-op:

• Orthosis:
  • Transition to a hand-based thumb spica orthosis, fabricated by a hand therapist.
  • Continue wearing orthosis between exercise sessions and at night for the protection of surgical procedure and for comfort.
• Exercise:
  • Orthosis is removed for active range of motion, initiated to the thumb CMCJ and wrist and continued for the thumb MCP and IP joints 4-6x/day.

6 Weeks Post-Op:

• Orthosis:
  • Continue orthosis wear between exercise sessions and at night for the protection of surgical repair and for comfort.
• Exercise:
  • Passive Range of Motion exercises may be initiated to MCP and CMC as indicated.

8 Weeks Post-Op:

• Splint:
  • Discontinue daily use of splint with continued use only during heavy lifting and/or sports activities for protection until 12 weeks post-op.
• Exercise:
  • Begin gentle progressive strengthening if pain-free.

12 Weeks Post-Op:

• Splint:
  • May discontinue splint completely.
• The patient progressively return to full activity

FAQs

How quickly may I return to activities such as skiing/snowboarding, etc.?

8-10 weeks

How quickly may I be able to complete administrative duties such as typing and filing?

Following your first post-op appointment, approximately 7-10 days after surgery. This time period is patient-dependent based on pain tolerance. No lifting more than 2lbs.

Can I get my incision wet?

No, the incision should be kept covered and dry until your first post-op appointment, approximately 7-10 days following surgery.

Will I need pain medication?

The thumb CMC arthroplasty surgery is often painful. Pain is always worse at night and elevating the surgical extremity is the most important factor when working to improve pain. If tolerated, we use extra strength Tylenol and Ibuprofen/Naproxen as a first line medication. You will be offered a nerve block to numb the extremity for a period of time. There are two versions of the nerve block that we utilize; a single shot block that will last roughly 14 hours and a 3 day catheter that constantly infuses numbing medication. You typically lose motor and sensory function during the effective timeframe of the desired block, we put you in a sling to protect your arm after surgery. In addition to the nerve block, you are provided with narcotic medication to help with the breakthrough pain and to help you sleep at night.  We will have a discussion on the day of surgery to best determine the medication and anesthetic regimen for you surgery. Most patients are done taking narcotic pain medication within 5-7 days post-op.

What anesthesia will I have?

We perform our thumb CMC arthroplasty surgeries under general anesthetic with a single day or three day nerve block for the arm.

What is the Speed Spiral implant?

The SpeedSpiral™ CMC Implant is a shaped allograft intended to be used for supplemental support and reinforcement of the flexor carpi radialis tendon and other structures of the capsuloligamentous complex; and as such, functions as a dense, strong and flexible connective tissue layer.

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