CMC (carpometacarpal) joint surgery: What outcomes can I expect?

@chooch25 Ah, CMC surgery - I am a gardener, painter & fiber artist - when my hands quit working, I was in a panic! CMC tightrope surgery to the rescue!
I knew the first one was old - I just happened to find the x-rays today - it was in 2008 and is still working just fine, the other hand was in 2020 and is fully functioning.

Recovery...I won't lie, the first few weeks were Uncomfortable and clumsy - I got through with ice, elevation, and lots of tylenol/ibuprofen. At 5 weeks, I was using the hand for quite a few tasks, even using some sewing tools. I was at full function (but not full strength) at 3 months - full recovery was around six months, with additional strength coming until a year.

PT is the key! Doing the exercises 2-3 times a day every day - boring but necessary. My friend who didn't do them never regained full function.

We have a friend who is a drummer and had a stroke some years ago - when he didn't have enough strength to hold his stick his wife helped him stick it into his hand brace for stability so he could drum - that's determination!

72 days ago I had my whole wrist replaced - every day I am getting closer to full function and full strength - without the pain. The daily therapy is a drag, but I have so much to do yet!

@sueinmn Thank you so much for the quick response! Sounds like it’s working out great for you!
I just got back into touring work about two years ago.
But now back to no drumming for a while!
I’m hoping for a quick recovery!!
Thank you again!!

@chooch25 Good luck. Be sure to find a specialized hand therapist to work with in the beginning. They know the best exercises and when something "just isn't right."

Hello,
I was told that I have Thumb arthritus in both my hands which would require re-constructive surgey. My left (dominent) thumb is not functioning like it did. Example: Not being able to bend my thumb properly to send text messages. My thumb clicks like a broken cabinet hinge to straighten it out. They explained the LRTI procedure which just seems pretty radical to replace a bone with some cartilage to regain stability and reduce pain. I am concered that if I go through with this procedure, I may not be able to use my thumb again for things like: playing guitar to grip the neck. golfing, bowling, labor intensinve work and general gripping.

1. Can someone please tell my their experience and whether this surgery will allow for me to continue doing the things I love?
Will I be at 100% functionality again?

2. Also by removing some of the tendon from your arm, do you lose strength and mobility from your arm?

3. Also how long can I expect to be disabled (i.e., recovery process before resuming normal tasks with my hand and thumb?)

Sorry for asking so many questions, but just concerned is all.

Thank you!!

I had CMC surgery on my dominant thumb. My surgeon had me do two months (OT) occupational therapy to build strength prior to surgery. He said most of his patients did not require any therapy post op. It is a longer recovery time than I anticipated. I ended up in therapy post op because my nerves were in hyper state and I required desensitization and strength as I had already had a reverse total shoulder and required more OT than the average person. So for me it was a year recovery process. Having said that my thumb works just like a normal thumb would.
Everyone has a different experience but I am in no pain and thumb works great! Best of luck

@jokish Unlike @dmk, my hand surgeon was insistent on therapy by a qualified hand therapist (this is a specialty for either a physical, or more usually occupational, therapist.)
Before surgery, you may want to check into the exact procedure - there are several types of CMC surgery. In my case, I had what is known as CMC suspension arthroplasty without tendon transfer (sometimes call the tightrope procedure.) This was done on both hands, one nearly 20 years ago, the other 6 years ago. Both are still functioning perfectly and without pain.

The trapezium bone (cause of your pain) is removed. A small "cable" between the metacarpal bones of the thumb and first finger is inserted to support the joint as it heals. Scar tissue forms naturally where the bone was removed. There is no second surgery site or tendon stripping, and no waiting for the tendon to heal in. This cuts down on the immobility time for 6 weeks to 3-4 before you begin strengthening therapy and moderate hand use. Total recovery time is individual, usually 3-5 months, with longer to regain full strength.

Outcome for me - no pain since the post-surgical pain. Able to do everything I could before including lifting, carrying, holding and using tools, gardening. I have some moderate loss of pinch strength, but am average for a 75yo female. I have good grip strength - now that they have also replaced my arthritic wrist I can even open tight jar lids. Range of motion is better than before surgery.

Like may other orthopedic procedures, this recovery is not "automatic" - you will need to do mobility and strengthening exercises daily for three months or more, but they can be done at the kitchen table while you have your coffee.

PS A couple friends who play guitar have had this done, and were told playing is good therapy.

Thank you Sue for your feedback!! I was presented with 3 surgical options. with one being the CMC suspension arthroplasty as well as LRTI procedure. I will eventually will have to have one of these procedures done. I'll have to weigh the pros and cons to both. My only dilema is that I'll have to miss work for quite a long time since I do labor intensive work. It is however re-assuring to know that you can continue doing normal activities after the surgery.

@dmk. Thanks for the feedback. I was just curious as to which procedure you had. The CMC suspension arthroplasty or the CMC LRTI?

Thanks again!

I had the CMC LRTI , using part of my forearm tendon to put in space where the metacarpal bone was taken out

Opps mercantile in place trapezium bone