RECOMMENDED HAND SURGEON THERAPY ORDERS
Early edema control, elevation, and icing to exposed fingers as needed
Early AROM for shoulder and elbow to prevent stiffness
Patient education on prevention and wound management
AROM exercises for fingers to encourage edema control and finger AROM
AROM for thumb and wrist at week 3-4 (thumb IP AROM can be initiated immediately)
Splinting introduced after cast removal (to be removed for exercises and cleaning at the sink)
Strengthening at 8 weeks may begin
REVIEW OF THERAPIST INTERVENTIONS FOR OSTEOARTHRITIS
Therapy for non-operative patient to include:
Night splint in long thumb spica splint
Daytime short thumb spica splint and/or CMC ring splint (see images)
Gentle AROM exercises, tendon glides, encourage taking breaks, heat or ice x 10 minutes intermittently throughout the day for comfort and pain reduction
Review isolated thumb IP AROM within long spica splint
Gentle strengthening of intrinsic muscles while using CMC ring splint
Heat or paraffin intermittently for comfort and self management of pain
Look out for patient complaints of CTS symptoms in more advanced cases
STATUS POST CMC RECONSTRUCTION
Early hand therapist assistance and intervention:
Edema control – encourage elevation, encourage early gentle finger ROM, watch for RSD/CRPS signs
Very light compressive sleeves for fingers, thumb and/or hand
Patient education –splinting to protect the surgical site, encourage smoke free recovery, early AROM avoid excessive exercise to minimize scarring
REVIEW OF POS-TOPERATIVE CMC ARTHRITIS
Early hand therapist assistance and intervention (fourth week post-op):
At week 4 post-op, edema control – encourage elevation, review AROM for fingers, wrist, and elbow watch for RSD/CRPS signs.
Continue scar management and introduce a scar conformer such as silicone based products, (see image below)
Very light compressive sleeves for thumb and/or hand. Be aware of the tourniquet effect causing distal edema accumulation and restricted blood flow to the surgical site.
Patient education – functional task precautions, encourage a smoke free recovery, avoid excessive exercise to minimize scarring. Heavy scarring is possible at the thumb due to its multiple axes of mobility. Remind patient not to carry anything with their hand or arm.
Initiate AROM for thumb glides in flexion, extension, palmar and radial abduction.
Initiate isolated blocking exercises for IP and MCP AROM of the thumb.
Initiate AROM for wrist; and elbow & shoulder AROM if needed to prevent stiffness.
Encourage finger food tasks, in hand manipulation and coin stacking to optimize AROM and function.
Scar management, scar massage with vitamin E oil/thick vitamin E cream in light circular motions with moderate pressure 3-4 minutes twice daily. Heavy scarring is possible at the thumb due to its multiple axes of motion. (donor tendon harvest scars can become adherent)
At week 5 post-op, continue AROM thumb glides in flexion and extension and initiate thumb AROM in palmar & radial deviation, and gently introduce circumduction clockwise and counterclockwise.
At week 6, allow full light thumb and hand use reintegration for all activities of daily living.
Allow opposition of thumb to fingertips of index, long, and ring; gradually progressing to the little fingertip by week 6.
Initiate PROM for thumb and wrist in all planes within a pain free range (flexion/extension and UD/RD). Provide CMC support with PROM for thumb MCP and IP.
At week 8 initiate strengthening for thumb, fingers and wrist.
At week 8-10, progress strengthening and work hardening/work simulation as needed.
Progress PRE’s (Progressive Resistive Exercises) with theraputty, thumb plunger, pen clicks, paper ball rip and roll, grippers, clips, dumbbells, and work simulator if necessary.
Education on reintegration into functional life without reinjury. Prevention education.
