Postoperative precautions are released and patients may perform more intensive. Fashion a removable shortarm thumb spica splint holding the wrist in 30 degrees of extension, thumb cmc joint in full radial abduction and extension, mcp joint in neutral, and ip joint in neutral to slight hyperextension. After an arthroplasty, your doctor can suggest physical therapy exercises to help regain strength and mobility in your thumb. In 2000 a joint care programme was implemented at the university hospital maastricht. Physical therapist will instruct patient and work with patient 2x day. Has sections for neuro, orthopedics, pediatrics, miscellaneous includes info on diabetes, amputations, burns, iontophoresis, ra, weight management, hydrotherapy and information on wheelchair and ambulation aids. Postsurgical rehabilitation guidelines for the orthopedic. The most common surgical technique involves complete resection of the trapezium. This is a clinical pathway in which the activities of physicians, nurses, physical therapists and other staff inside as well as outside the hospital are coordinated to provide the best. Johns hopkins shoulder surgery arthroscopic acromioplasty. The thumb can move up and down, in and out, and rotate slightly to touch the fingers. Wear splint at all times except washing and excercises. Charles giangarra, md and robert manske, pt continue the commitment to excellence established. Cmc arthroplasty suspensionplasty rehabilitation protocol.
Carpometacarpal cmc joint of the thumb is a saddle joint located at the very base of the thumb, and is subject to large physical stresses throughout life. Thumb cmc joint replacement university orthopedics. The thumb also acts as a stabilizer to allow the fingers to manipulate items. The cmc joint gives the thumb a wide range of motion up, down, and across the palm, as well the ability to pinch. Thumb cmc arthroplasty lrti boston, ma hand surgical. Treatment and rehabilitation protocols are presented in a stepbystep, algorithmic format. The primary objective of this study is to compare outcomes between formal clinic based physical therapy pt rehabilitation and surgeon directed home therapy ht after reverse total shoulder arthroplasty rsa as measured by pain, range of motion, single assessment numerical evaluation sane, and american shoulder and elbow surgery ases scores at 6 weeks, 3, 6, 12, and 24 months.
Thumb cmc joint arthroplasty surgery home program phase. Joint protection and home hand exercises improve hand function in patients. Total hip replacement rehabilitation protocol outpatient physical therapy phase i weeks 1 6 postop patient is evaluated weekly in outpatient pt unless deemed otherwise, or in inpatient setting evaluate and document. Splinting is available to help position your hand and thumb in a resting position to allow for healing throughout the day andor night. The purpose of this book is to provide the orthopedic sur geon and hand surgeon as well as the physical, occupational, and hand therapist with an. Rehabilitation guidelines after surgery, sports medicine. Physical therapy after a resection arthroplasty without reimplantation or a twostaged reimplantation is dependent on the extent of joint or bone destruction caused by the infection and the removal of the prosthetic components and cement and debridement of soft tissue.
My doctor recommended this book and the exercises are very easy to follow. Arom thumb ip and mcp with the cmc supported in abduction 2. In this surgery, the surgeon takes out a small bone at the base of the thumb and fills in the space with. Doing a 10 minute warm water soak or hot pack beforehand will help you do the exercises with. Exercises should be done with your splint off, just 3 times per day.
A curvilinear incision is made along the base of the thumb. Begin active finger, wrist and elbow range of motion limit if deltoid was involved 2. Pilates training for use in rehabilitation after total hip. Ligament of the thumb metacarpophalangeal joint gamekeepers thumb. Thumb cmc joint arthroplasty surgery home program phase 2. Presenting over 100 rehabilitation protocols for the hand and upper extremity in an easytouse, stepbystep format, this practical reference provides surgeons and therapists alike with a goto source for the therapy technique or strategy appropriate for their patients. Postoperative rehabilitation following thumb base surgery. Uw health s sports medicine sports rehabilitation physical therapists and athletic trainers in madison, wisconsin, help injured athletes return to. They are key to decreasing unwarranted variations in practice, decreasing the knowledge translation gap, and optimizing movement. Patient should elevate the arm above the level of the heart as much as possible, and do digit flexion and extension exercises and fds glides hourly, to help reduce swelling see phase 1 exercises. Beyond 6 months patients are near full strength and have maximized their range of motion for their respective joint arthroplasty. Home exercise vs pt for reverse total shoulder arthroplasty. Thumb arthritis may be surgically treated with a procedure called excision arthroplasty.
At week 2, active and passive mcp and ip range of motion is started. Thumb cmc joint arthroplasty surgery home program phase 2 exercises. At week 6, gentle strengthening is begun with discontinuation of the splint. If full recovery is not complete then a more targeted protocol or formal physical therapy can be initiated during this time period. Cuong pho dpt, joe godges dpt loma linda u dpt program kpsocal ortho pt residency 1 1st cmc arthroplasty joint rehabilitation surgical indications and considerations anatomical considerations. Prior to surgery, the patient is prepped with sedation medication and a peripheral nerve block5 to numb the arm. Listed below are physical therapy pt protocols categorized by physician. Thumb exercises following cmc joint repair fitzmaurice. Complete consult for inpatient and outpatient physical therapy p.
University orthopedics is a regional center for sports medicine and rehabilitation with specialty areas in arthroscopy, physical therapy including occupational therapists certified hand therapists, athletic trainers for rehabilitation. Kathy explains the processes of performing thumb exercises, used for therapy following cmc joint repair at the fitzmaurice hand institute, in phoenix arizona. Physical therapy exercises for basal joint arthroplasty. It can provide effective relief of the pain of thumb arthritis for many people. Lrti is a serious surgery with a lengthy recovery time. This section includes hand therapy protocols, sorted out by diagnosis and procedure, based on a joint project with kathy detemple. The term gamekeepers thumb originated back in the 1950s in the united kingdom and scotland when the injury was first seen in gamekeepers, especially rabbit hunters.
Treating a gamekeepers thumb with physical therapy gamekeepers thumb refers to an injury of the ulnar collateral ligament ucl, which is found in the thumb. A light compressive dressing is applied to the hand and forearm prior to fabricating the splint note. Acl reconstruction rehab protocol arthrosurface joint replacement protocol. The thumb joint at the base of the thumb is the most mobile in the hand. No resistive activities or exercises treatment strategies. A dvd accompanies the book, featuring over 60 minutes of video of patients demonstrating various therapeutic exercises spanning the different phases of postsurgical rehabilitation. Klika cmc arthroplasty when conservative treatment of thumb osteoarthritis fails to control pain surgical treatment may be indicated. This subsection of our website contains rehabilitation programs or protocols designed for patients recovering from wrist or hand surgery. Gait c orrect any abnormal gait patterns noted hip rom s tay within the precaution limits hip strength.
Increase thumb opposition, thumb abd palmar and radial, flexion and extension, and. The thumb must not be positioned in radial abduction. Efficiency of immediate postoperative inpatient physical. If you are an hss physician, alumnus, or rehab network member, and need. Excision arthroplasty an overview sciencedirect topics. The thumb is positioned midway between palmar and radial abduction. Treat your own hand and thumb osteoarthritis paperback october 4, 2012. Clinical practice guidelines cpgs enable pts and ptas to understand the state of the evidence as it stands. In this surgery, the surgeon takes out a small bone at the base of the thumb and fills in the space with a rolled up section of tendon. Each protocol has evaluation form, objectives, treatment suggestions with goals, and discharge plan. Initiate codman exercises to be done 3 to 4 times per day followed by ice.
Ligament reconstruction with tendon interposition arthroplasty, journal of hand surgery, 11a, pp. A joint is comprised of two bones, each covered with cartilage. Examples include hand therapy procedures, working with postsurgical patients with cerebral palsy, sports patient injuries, and pediatric procedures for disorders. To stabilize the thumb base and address the trapezial void, a ligament reconstruction and tendon interposition lrti, also called. The effectiveness of a manual therapy and exercise. Patients are commonly off work for 1 week, and then on light duty. Physical therapy tips thumb arthritis michael curtis pt. Thumb cmc joint arthroplasty therapist protocol david gesensway, md week 1. Ligament reconstruction tendon interposition department of orthopaedic surgery. A study of ulnar collateral ligament of the thumb metacarpophalangeal joint. Thumb cmc arthroplasty is a treatment option for thumb arthritis, a type of osteoarthritis found at the carpometacarpal cmc joint located at the base of the thumb. However, the risk of ongoing complications can be as high as. Microfracture treatment of articular cartilage defects tibiofemoral patellar tendon repair. Physical therapy treatment pt plays an important role in this strategy.
University orthopedics is a regional center for sports medicine and rehabilitation with specialty areas in arthroscopy, physical therapy including occupational. Physical therapy after hip or knee resection arthroplasty. Each variable should be considered when formulating a postoperative therapy plan. Click on your rehabilitation protocol to download a pdf file containing specific exercises and instructions for each phase of your recovery. University orthopedics in rhode island also specializes in total knee and hip replacement, orthopedic spine surgery for traumatic and degenerative conditions. Therapy protocols provided by university orthopedics. Postsurgical rehabilitation guidelines for orthopedists. Postoperative rehabilitation following trapeziectomy and. Doing a 10 minute warm water soak or hot pack beforehand will help you do the exercises with less discomfort, and will help improve your motion. Conservative and operative rehabilitation from the physical therapy library of. Thumb carpometacarpal joint arthroplasty page 2 of 3 restore stable arom of thumb cmc and mp joints and wrist within tolerance precautions. Aptas ptnow clinician portal provides a collection of cpgs that are applicable to the physical therapy.
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