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Carpometacarpal Ligament Repair

AMBULATORY CARE:

What you need to know about carpometacarpal (CMC) ligament repair:

CMC ligament repair is used to treat arthritis at the carpometacarpal joint. This is the area at the base of your thumb where your thumb bones meet your wrist bones. This surgery is also called ligament reconstruction and tendon interposition (LRTI).

How to prepare for surgery:

Your healthcare provider will talk to you about how to prepare for surgery. He may tell you not to eat or drink anything after midnight on the day of your surgery. He will tell you what medicines to take or not take on the day of surgery. Arrange for someone to drive you home.

What will happen during surgery:

  • You may be given general anesthesia to keep you asleep and free from pain during surgery. You may instead be given local anesthesia to numb the surgery area. With local anesthesia, you may still feel pressure or pushing during surgery, but you should not feel any pain. Your surgeon will make an incision near the base of your thumb.
  • All or part of the trapezium, the small bone at the base of your thumb, may be removed. Your surgeon will drill a hole in a thumb bone near the space where the trapezium was removed. A tendon (cord of tissue) will be taken from your wrist and passed through the hole. The tendon will be rolled up and placed into the space where the trapezium used to be. This provides a cushion for the remaining bones. A pin may be used to hold the joint in place. The incision will be closed with stitches and covered with a bandage.

What will happen after surgery:

You may have a splint on your hand and arm. This splint is used for 2 weeks or until the stitches are removed. At that time, a cast is placed on your hand and arm for 4 to 6 weeks. If you have a pin in your wrist, it will be removed when the cast comes off after 4 to 6 weeks.

Risks of surgery:

You may bleed more than expected or get an infection. You may develop scar tenderness. You may have long-term discomfort in your hand. Your sense of touch may feel different than it used to. You may develop numbness from nerve damage during surgery. Your symptoms may not go away completely. You may not have the same strength of pinch or grasp as you did before surgery.

Seek care immediately if:

  • Blood soaks through your bandage.
  • Your incision comes apart.
  • You have severe pain.

Contact your healthcare provider if:

  • You have a fever or chills.
  • Your wound is red, swollen, or draining pus.
  • You have questions or concerns about your condition or care.

Medicines:

You may need any of the following:

  • NSAIDs , such as ibuprofen, help decrease swelling, pain, and fever. NSAIDs can cause stomach bleeding or kidney problems in certain people. If you take blood thinner medicine, always ask your healthcare provider if NSAIDs are safe for you. Always read the medicine label and follow directions.
  • Prescription pain medicine may be given. Ask your healthcare provider how to take this medicine safely. Some prescription pain medicines contain acetaminophen. Do not take other medicines that contain acetaminophen without talking to your healthcare provider. Too much acetaminophen may cause liver damage. Prescription pain medicine may cause constipation. Ask your healthcare provider how to prevent or treat constipation.
  • Take your medicine as directed. Contact your healthcare provider if you think your medicine is not helping or if you have side effects. Tell him or her if you are allergic to any medicine. Keep a list of the medicines, vitamins, and herbs you take. Include the amounts, and when and why you take them. Bring the list or the pill bottles to follow-up visits. Carry your medicine list with you in case of an emergency.

Wound care:

Care for your wound as directed. When you are allowed to bathe, carefully wash the wound with soap and water. Dry the area and put on new, clean bandages as directed. If you have a cast, cover it when you bathe to keep it clean and dry. Ask your healthcare provider for more information about cast care.

Self-care:

  • Ice helps decrease swelling and pain. Ice may also help prevent tissue damage. Use an ice pack, or put crushed ice in a plastic bag. Cover it with a towel and place it on your thumb for 15 to 20 minutes 5 to 6 times a day or as directed.
  • Elevate your thumb above the level of your heart as often as you can. This will help decrease swelling and pain. Prop your thumb on pillows or blankets to keep it elevated comfortably.
  • Wear your cast or splint as directed. You usually have a splint and then a cast for a total of 6 weeks. Wiggle your fingers often to prevent stiffness.
  • Go to hand or physical therapy as directed. This usually starts at 6 weeks when the cast is removed. Therapists can teach you exercises to help improve movement and strength.

Follow up with your healthcare provider as directed:

You will need to return to have your stitches removed and a cast placed. Write down your questions so you remember to ask them during your visits.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.