BASAL THUMB CMC Joint ARTHROPLASTY SURGERY DAVID GESENSWAY, MD
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1 BASAL THUMB CMC Jint ARTHROPLASTY SURGERY DAVID GESENSWAY, MD THE DAY OF SURGERY: Welcme! We will try t make yur experience as easy as pssible. Please leave valuables at hme, but the surgery centers d require pht ID. Remve all rings and jewelry. Wear cmfrtable clthes. The surgery centers ften dn t knw their final schedule until 1-2 days prir, s yur arrival time and surgery time may change. Please cnfirm yur arrival time with yur surgery facility the day befre yur surgery, if yu haven t heard frm them (please see page 7 fr the phne numbers). We mst cmmnly use ne f tw types f anesthesia, and the instructins fr befre surgery are different depending n which type f anesthesia yu selected: If Arm Blck Anesthesia (als knwn as a reginal blck, axillary blck, r supraclavicular blck): With Arm Blck Anesthesia, yu will get an IV and IV sedatin, as described abve, and then the anesthesilgist will make yur entire upper limb numb by blcking the nerves near yur arm pit r cllar bne. The anesthesilgist will discuss all aspects f yur anesthesia with yu in cnsultatin, in the pre-p rm befre surgery. After the blck is placed, yu will be given mre medicatin in the perating rm by the anesthesia team t make yu sleepy. Generally they d nt put yu cmpletely asleep, but rather yu will drift ff t sleep and can be cmpletely unaware f the surgery, if yu want. Yu can discuss hw sleepy r unaware yu want t be with yur anesthesia team in the pre-p area befre surgery. If the blck is nt making yur arm fully numb then yu might g t sleep as well, with a general anesthetic. Yu may start t wake up when we are finishing with the surgery and putting n the bandages, and the sedatin medicine usually wears ff quite quickly. Yu will generally have n pain, and the numbing medicatin usually lasts abut 8 r mre hurs, s yu will leave the surgery center with n pain. Hw lng the blck lasts is very variable, but the anesthesia team will give yu an estimate. Occasinally there might still be sme residual numbing r tingling effect even the next day. Yu need a sling t prtect yur arm until the blck wears ff. If General Anesthesia (als knwn as Cnscius Sedatin r Twilight Anesthesia):
2 With General Anesthesia, yu will get an IV and then given medicatin s that yu will be cmpletely asleep during the surgery. Once yu are asleep, I will cmpletely numb the surgery site with the lcal anesthetic, s yu will generally wake up with n pain. The numbing medicatin usually lasts abut 4-6 hurs, s yu will leave the surgery center with n pain. Occasinally there might still be sme residual numbing r tingling effect even the next day. With Arm Blck Anesthesia OR General Anesthesia, yu will need t: Have nthing t eat r drink fr at least 8 hurs prir t yur surgery. Yu can and shuld take yur usual imprtant medicatins with a sip f water n the day f yur surgery. If there is ANY chance that yu are pregnant please d a pregnancy test the day befre surgery and ntify the surgery center. If yu have Type 1 insulin dependent diabetes, please let me knw and cnsult pre-peratively with yur endcrinlgist r family dctr. The plan generally includes taking all r half f yur lantus r lng-acting insulin the night befre surgery, r cntinuing yur nrmal basal rate n yur pump vernight. Then depending n yur mrning bld sugar levels, either cntinue r lessen yur basal rate s yu dn t get lw. Yu may need t check yur glucse mre ften than nrmal. Even withut eating befre surgery yur bld sugar can rise due t the nrmal stress f surgery. Yu can cntinue wearing yur pump during the prcedure. Bring yur meter, etc t the surgery center. If yu d get lw, f curse take smething, preferably glucse tabs r hard candy, r juice/cke if needed. Yu will need a driver t take yu hme, and a respnsible adult t g ver the pst-p instructins with yu at the surgery center, and stay with yu that day after surgery. Yu shuld nt return t wrk r the ffice r attend meetings n the same day f yur surgery. DURING BASAL THUMB CMC JOINT ARTHROPLASTY SURGERY - WHAT IS DONE: The pain at the base f yur thumb is relieved by remving the arthritic jints. We d this by remving a small wrist (carpal) bne called the trapezium, and the bne spurs. We then stabilize the jint by making a new ligament frm ne f yur wrist flexr tendns, t supprt and give strength back t the thumb fr pinch and grasp. Finally, in the hle where the trapezium used t sit, we place a sft spacer made up f a rlled up ball f yur wn tendn. This prcedure is frmally knwn as a trapezium excisinal arthrplasty with ligament recnstructin and tendn interpsitinal arthrplasty.
3 1 2 3 AFTER BASAL THUMB CMC JOINT ARTHROPLASTY SURGERY: Bandage/splint/surgical dressing care Please keep yur hand elevated as much and as ften as pssible fr 3-4 days after surgery. This helps reduce swelling, and yur hand may thrb and feel wrse if it is hanging dwn. This is very imprtant! In bed at night yu can easily keep yur hand cmfrtably elevated by wrapping a thin pillw arund yur frearm, and secure it with tape r an ace wrap r a safety pin, then place yur elbw n anther pillw. The wrapped pillw will hld yur arm upright fr yu, with yur elbw bent at a right angle. Please keep yur surgical bandage n and clean and dry until yur pst-perative appintment. Yu may shwer/bath, but keep the bandage dry. Yu can use a plastic bag taped up at the end, saran wrap r press-n-seal. If yu had a full arm blck, yu need a sling t prtect yur arm until the blck wears ff, but still try t elevate it as much as pssible. Hand Therapy Exercises I want yu t mve any and all unsplinted digits and jints as much and as ften as yu are able. Speed desn t help, but try t get the full excursin (range f mtin), mving them slwly and as far as they can g. Yu can use yur ther hand t help them. Als, please mve yur shulder thrugh its full range f mtin, ften. We dn t want anything t get stiff. Hand Use
4 Ice Yu will nt be able t use the hand much at all initially after surgery. It is OK t use yur fingers fully as much as yu are able. Typing, writing, eating, dressing are Ok t d. Yu will nt be able t d any strng gripping r grasping, pulling r pushing, r perating f pwer tls. It will hurt if yu veruse it, s just g by hw yur hand feels. If yu have ne f the ice units in place under yur bandage, please plug it in and use it as much as yu like, full-time, day and night, fr cmfrt and t reduce swelling. It is easily discnnected frm the ice cler fr walking arund. It wrks best if the cler is placed near arm height n a bedside table. Als, 2 bttles f water that have been frzen int blcks wrk well t cl the water in the cler, instead f ging thrugh lts f ice. It will be remved with the bandage at yur first pst-p visit. If yu dn t have the cler ice unit, yu can try icing n the utside f the bandage and abve the bandage n the frearm. Pain Management Expectatins Yur thumb will be likely be pain free when yu leave the surgery center, and the numbing effect f the arm blck will likely last 8-20 hurs but is variable. Occasinally there might still be sme numbing/tingling effect frm the blck even the next day. I recmmend starting the pain medicine befre the blck wears ff. Additinally, if yu were given a medicatin called gabapentin befre yur surgery yu may have a prescriptin t cntinue it three times a day fr 2 weeks after surgery. Pain Medicatins There are three types f pain pills. All three types can be taken tgether, and at the same time. Their pain-relieving effects are additive. Tylenl (acetaminphen) Nn-narctic, safe Inexpensive, cmes in generic Regular strength is 325mg Extra-strength is 500mg The dse is 1000mg 3-4 times per day. Many ver the cunter pain and cld preparatins cntain acetaminphen. It is als a fever reducer. Nn-steridal Anti-inflammatry drugs (NSAIDs) Ibuprfen (Advil) Sld ver the cunter as 200mg pills Inexpensive, cmes in generics Can take 1-3 pills every 6 hurs r up t fur times per day (lasts 6 hurs) D nt take if yu are already taking a prescriptin NSAID (there are many) as there is just extra risk and n extra pain relief. D nt take bth ibuprfen and naprxen at the same time Naprxen (Aleve) Sld ver the cunter as 220mg pills Inexpensive, cmes in generics
5 Can take 1-2 pills twice a day (lasts 12 hurs) D nt take if yu are already taking a prescriptin NSAID (there are many) as there is just extra risk and n extra pain relief. Narctics Require a dctr s written prescriptin and generally cannt be refilled ver a weekend r hliday. Fairly safe fr shrt-term use. All types can becme habit frming and addicting. Yu can build up a tlerance t narctics ver time, meaning if yu cntinue t take them lng-term it takes a higher dse t prduce the same effect (like alchl). They affect different peple differently (like alchl) All are cnstipating. Best t take a stl sftener (clace) and a bulk agent (metamucil, fiber, prunes) if yu are susceptible t cnstipatin r are taking these medicatins beynd a week. All can cause sme itching. All can cause sme nausea. All are sedatives that cause varying degrees f sleepiness that can interfere with driving and decisin making, and can cause unsteadiness and lightheadedness. Best nt cmbine narctics with alchl r ther narctics Are ften sld in a cmbinatin pill with acetaminphen (Tylenl). Cmmnly used narctic medicatins are: Tramadl (Ultram) 1 pill every 6 hurs as needed Generally the lightest and best tlerated with the least unpleasant side-effects Hydrcdne with acetaminphen (Vicdin, Nrc, Lrtab) 1-2 pills every 4-6 hurs as needed This medicatin requires the actual written prescriptin fr any refill and cannt be called in. Oxycdne with acetaminphen (Perccet, rxicet) 1-2 pills every 4-6 hurs as needed This medicatin requires the actual written prescriptin fr any refill and cannt be called in. Exercise (fitness) It is OK and beneficial t remain active after yur surgery. Walking is gd, and yu can elevate yur hand while walking. Driving Fr the next three mnths, it is OK t cntinue any kind f aerbic fitness rutine, but yu will nt be able t d any strenuus activities with yur thumb. It is generally OK t d any exercise if yu are able t d it cmfrtably, letting pain be yur guide, while wearing yur cast r brace. Recvery f maximal strength f thumb pinch can take 1.5 years after this surgery.
6 Wrk It is OK t drive a car if yu can d it safely with yur ther hand and yu are nt n narctic medicatin. Mst peple are able t drive a manual transmissin. Yu cannt drive a mtrcycle r snwmbile fr 3 mnths. Mst peple are ff wrk fr 1-2 weeks, and then n light, restricted-duty wrk restrictins fr the perated arm fr abut 12 weeks pst-p. Peple are different, and their jb demands are different, s yur exact return t wrk plan will be individualized fr yu, and shuld be discussed ahead f time. Almst everyne can get back t ding their usual jb eventually, withut restrictins. Permanent restrictins are very unusual. Diet/fd/eating Yu can resume yur usual diet, and there is n need fr anything special r fr any supplements. Smking, r the use f any nictine-cntaining prduct, can slw and delay wund and ligament healing. Prblems Please call us if yu have: Fever ver fr mre than a day Ful smelling drainage frm the dressing r wund Excessive bleeding Uncntrlled pain Please seek ER evaluatin r treatment if yu have: Persistent vmiting Inability t vid (urinate) fr mre than 8-10 hurs after surgery Shrtness f breath r chest pain Severe allergic reactin YOUR FIRST POST- OPERATIVE VISIT: Yur first visit back after surgery will be with the Hand Therapist r me, usually 5-8 days after surgery. The bandage will be remved, sutures ften remved, the ice pad remved, and yu will be placed in a cast that includes the base f yur thumb. Yu will then wrk n getting back all f yur finger and thumb tip mtin. It is OK t use yur hand lightly as yu are able, but yu will nt be using the thumb fr any significant pinch r grasp. At 3-4 weeks after surgery, the cast will be remved and the hand therapist will make yu a remvable, light-weight plastic prtective thumb splint, and yu will be able t get it wet then. Updated wrk slips will be issued at each and every clinic visit with me, as needed. Charges fr all pst-p dctr visits within 90 days f surgery are generally included with the surgery glbal fee. Charges fr X-rays, splints, casts, supplies, medicatins and Hand Therapy visits are ften nt included in the surgery glbal fee. Fr questins abut yur bill frm Twin Cities Orthpedics, please cntact ur Custmer Service Department at
7 QUESTIONS?: Fr questins abut yur medical cnditin r surgery please cntact me r Julie (my Hand Therapist) thrugh ur Care Crdinatr Sarah at Fr questins abut scheduling, insurance, paperwrk, r wrk slips please call Sarah, ur Care Crdinatr, at Fr prescriptin refills please call Sarah at Fr questins abut surgery arrival time r ther day-f-surgery questins please cntact yur Surgery Center lcatin directly. Crsstwn Surgery Center: WestHealth Surgery Center: Abbtt Nrthwestern Hspital: Fr after-hurs medical urgent questins please reach the n-call Orthpedic Surgen at Our Walk-In Access Clinic, TCO Orthpedic Urgent Care, is pen every day at the Edina lcatin frm 8:00 am 8:00 pm, fr urgent prblems with yur cast r ther urgent pst-p prblems. It is als pen frm 8am 8pm n Saturday and Sunday. Fr any f the many ther metr lcatins and hurs fr ur Urgent Care centers, please visit ur website Fr billing questins, please call TCO Custmer Service at Fr questins abut yur surgery center bill, c-pays r ut-f-pcket csts please call yur specific surgery center directly (abve). Fr questins abut yur anesthesia bill, please call yur anesthesia prvided directly. THANK YOU!
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