CMC suspension arthroplasty (Use of APL slip)
In this procedure where the trapezium is removed and a slip of the APL is removed from the base of the thumb metacarpal. It is passed dorsally deep to the EPB and brought to the base of the 2nd metacarpal. Drill holes are passed in the base of the 2nd metacarpal from the radial to ulna side. Once the tendon is passed through it is then tensioned to appropriate length and the tendon is attached to the base of the 2nd metacarpal with a screw. The FCR stays intact with this procedure.
0-2 weeks post op-The patient is in post op dressing.
2 weeks post op-Patient is placed in a short arm thumb spica splint. The patient is allowed to remove for showering but needs to wear it the rest of the day and night.
6 weeks post op-Start to wean from splint and therapy is initiated. They are not allowed to lift anything. They can do ADL’s and drive.
- -Scar and retrograde massage
- -A/PROM of the thumb, finger and wrist as needed
- -Functional thumb mechanics (abduction without MP hyperextension, making an “O” when tip pinching to the index).
8-10 weeks post op-If motion is good then light strengthening can begin. You want to avoid strengthening the thumb adductor. Focus for the thumb should be the 1st dorsal interossei, APB and APL (without hyperextension of the MP joint).
12 weeks post op--unrestricted use of hand as tolerated.