Thumb basal joint replacement is removing a part of the joint at the base of the thumb and inserting a cartilage spacer with a small tendon graft. The following are postoperative care instructions. Please refer to this reference sheet, which should probably answer most of the questions you might have. If you have further questions that need immediate answering, contact us at our office at.
A sling will be provided for elevation when up and walking around. It is only for assistance and better elevation can be achieved with elevation on a pillow or chest when reclining.
You have a bulky dressing with a light cast over this that will allow for swelling. Although it is very unlikely, you may notice some bloody spotting coming through the cast. It is important for you to watch this area, and contact us if it continues to spread. Otherwise, any small area of spotting will dry and can be ignored until we remove the cast. You may shower with the waterproof cast bag. You must keep the dressing dry and can use the bath with the arm hung out of the tub or sponge bath. If you use the shower you will need to apply a plastic bag around the foot and tape it at the top. There are excellent cast protector products available locally at pharmacies or online from Amazon (Duro-Med). However, it is hard to keep the dressing absolutely dry and some leakage may occur. If the dressing gets a little wet allow it to dry.
Some swelling, bruising and warmth is expected after surgery. If you develop increased redness, drainage, or a fever, CALL THE OFFICE. Bruising around the upper arm area is not uncommon. This may even extend down the elbow and forearm area and will resolve in over 3-4 weeks. The sutures utilized in closing your wounds will need to be removed in about 2 weeks unless the wound is not ready.
You will be provided with a prescription for a pain medication when you are ready to leave the hospital. Usually, we will prescribe hydrocodone, hydromorphone, or oxycodone. These are generic names for three different narcotic pain relievers. If you are aware of a certain pain medication that you have previously had problems with or one that you normally respond favorably to, please inform us so that we can give you the appropriate prescription. You may have the prescription prior to surgery to avoid filling it the day of surgery.
Normally we will avoid using anti-inflammatory medication (i.e. ibuprofen, Advil, Aleve, etc.) as this may interfere with bone or tendon healing. If you are intolerant to most pain medications the short term use of anti-inflammatory medication is OK. In this case you might be given a prescription for an anti-inflammatory medication Toradol (ketorolac) that will help lessen pain and swelling. If not, you are welcome to use an over-the-counter anti-inflammatory such as Ibuprofen (Advil, Nuprin, etc.). These come in 200-mg tablets. The usual maximum adult prescription dosage is 400-600 mg 3-4 times per day, usually taken with food. This would amount to taking 9-12 store tabs per day. The anti-inflammatory medicine can be taken on a regular basis along with the prescription pain medication, which is utilized on an as needed basis. You will find that the combination will lessen your need for the prescription pain pill. If you have a history of ulcers or of stomach irritation with aspirin or anti-inflammatory drugs, then you should avoid taking these medications. If you have high blood pressure you should check your blood pressure to be sure these medications do not cause an elevation in your pressure. If you have kidney problems you should avoid these medications.
Plain Tylenol is OK if you have no liver disease. Remember, the short acting pain pills often have acetaminophen (Tylenol) in them. The maximum daily dose of Tylenol if you have a normal liver is 3500-4000 mg. If your narcotic pain medicine is not lasting long enough you can use a little more or use if less often as long as you do not overuse the maximum daily acetaminophen dose.
If you have a history of nausea with surgery we can prescribe an anti-nausea medication (Phenergan or Zofran). Try to take this medication regularly at first and prior to taking the narcotic pain pills to allow it to be most effective.
Please try to anticipate the need for any refills on your pain medication, and contact our office early in the day the day before running out completely. I cannot provide prescription refills after business hours or on weekends.
Ice and elevation will help minimize the pain and swelling after surgery, especially during the first few days. Elevation, to be effective, involves keeping hand above the level of your heart. You can keep ice packs on the cast continually during the first few days without risk of frostbite injury to the underlying skin as long as the original dressings are in place. The initial cast involves multiple layers of cotton gauze and padding, therefore insulating the skin surface reasonably well. When we remove the original cast and apply only a lighter more form fitting cast the swelling will probably be resolved enough to discontinue icing. Otherwise, we would recommend ice applications to the involved area for 20 minutes at a time, multiple times each day.
We will prescribe the exercises in our office or with a hand or physical therapist at about 4-6 weeks after surgery when we remove the cast and apply a neoprene support.
Office follow up
Please call our office within a few days following surgery to schedule your first follow-up visit. A suggested day for follow-up will be noted in your discharge directions. It is usually about 10-14 days after surgery. If the cast is becoming uncomfortable or ill-fitting we should move up the visit to replace the cast.
Most thumb surgery is safe and performed as an outpatient, so complications are fortunately quite rare. The worse early problem is excessive swelling. If you are having increasing pain unrelieved by the pain medications, pressure or the feeling the cast is too tight, or numbness and tingling, the cast may be too tight. If this is unrelieved by elevation you should seek immediate consultation either in the emergency room or our office. The incidence of an infection deep is one out of thousands. The onset of symptoms would be approximately 5-7 days following surgery, and would consist of a significant increase in pain, swelling, warmth, and redness of the foot or ankle, fever, chills or night sweats. More common, but still quite rare, would be a small superficial infection or irritation at one of the skin incisions. There can also be a very small incidence of a blood clot developing deep within your leg or arm veins. This would be characterized by a sudden onset of new pain (usually different from your surgical pain) or tightness in the back of your calf or knee. This usually begins about 5-7 days from the day of surgery. The presence or absence of a clot can usually be determined by a simple non-invasive ultrasound test at the hospital.
If you then still have any questions or concerns please notify me, my nurse, or physician assistant.
Bryan Bomberg, MD