ALYSSA'S THUMB REPLACEMENT REHAB
In January 2023, I underwent a right thumb carpometacarpal (CMC) arthroplasty, or thumb joint replacement. This thumb joint is the most common joint to develop arthritis in the hand, and it can be successfully "replaced" using your own tissue.
Osteoarthritis can be brought on at an advanced rate in the CMC joint depending on various factors including:
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Genetics - did you know that your hand genetics are almost entirely from your mother? My mother had one of her thumb joints replaced in her 50's
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Injury - I have sprained this joint in the past
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Occupational demands - due to the physical requirements of my job as a physical therapist both inpatient therapy, which requires heavy lifting of patients, and outpatient therapy, which involves significant use of my hands and thumbs for manual therapy, my thumb has taken significant wear and tear which contributed to advancement of the arthritis
The procedure I underwent is called a CMC Arthroplasty, otherwise known as a Ligament Reconstruction Tendon Interposition (LRTI), or the Anchovy Procedure (watch video). The surgery involves removing the trapezium bone from the wrist, which connects with the thumb bone and forms the CMC joint, as this is the bone that has the arthritic surface. A tendon is then cut from one of your forearm muscles (flexor carpi radialis, which is one of your wrist flexors). The tendon is fed through a hole drilled in the bone and then coiled into the joint space where the trapezium bone was, to form a new joint. A screw is then placed to secure the tendon. I was then placed in a soft cast and immobilized for 10 days.
This is the first surgery I have ever had, despite being on the other end countless times as a physical therapist, helping my patients, family and friends recover. Below is my own personal rehab journey through this process.
Phase 1: Surgery & Day 1-9 Post-Op Recovery
IV's, nerve blocks, propofol sedation and recovery room post-op. Arm and fingers waking up from nerve block. Elevate elevate elevate! Instructed to move it but don't use it!
Phase 2: Post-Op Day 10
Cast off; stitches out, new splint made. Instructed to wear splint 24/7 except for hygiene and while doing exercises. Given initial range of motion exercises for wrist and thumb by Occupational Therapist.
Phase 3: Weeks 2-4
Able to start wrist and thumb active range of motion (AROM) --> Progress!!!.
Phase 4: Weeks 6-8
Strengthening! Putty and clothes pins for hand and thumb strengthening; weights and isometrics for wrist strengthening!
Phase 5: Months 2-3
I am able to start fully weight bearing through my right hand, though I’m still stiff at end ranges of motion and not able to even think about doing a push-up yet!
Weight Bearing Progression:
Warm Up 1: Weight shifting on hands and knees - side to side & front to back
Warm Up 2: Full weight bearing in extended plank
Exercise 1: Extended plank on BOSU with knee lifts - bilateral arm weight bearing
Exercise 2: Extended plank with alternating rows - bilateral to single arm weight bearing