Thumb CMC Arthroplasty

What to expect with Thumb CMC Arthroplasty Surgery

Pre-operative instructions

1. Night before surgery: Wash your hands well including under the fingernails with a cuticle cleaner or Qtip. This is even more important if you have artificial nails.

2. Arrange for a friend or family member to drive you to and from the hospital or surgery center, where surgery is to be performed. If you need directions to CJW Hospital (Johnston-Willis Campus), OrthoVirginia Operatories (St. Mary’s or Boulders) please consult

3. You should not be home alone the night after surgery


Post-operative Instructions

1. Swelling control: My staff will instruct you in the best method for postoperative swelling control. This may include holding your hand in the Statue of Liberty position, propping it in a foam block that we provide, or using a sling. In each case, the hand should be held above the heart level for the first 24-48 hours or until it no longer throbs if held down. Call us if swelling and pain are severe, particularly if the bandage feels “too tight” the next day.

2. Postoperative pain medications will be prescribed after surgery. If you would like to have it ePrescribed, please ask Dr. Rawles or his nurse at the facility and we will gladly arrange for the medication to be waiting for pickup at your pharmacy. You will most likely need to take the first pain med just as local anesthesia is wearing off (when your fingers begin to feel and move more). Just like a leg waking up when it is asleep, the first tingles and pains are the most uncomfortable.

3. Clean and dry: Keep your bandage clean and dry. This can be accomplished in several ways. When taking a shower, the easiest method is to wrap the bandage and hand with GLAD Press’nSeal Wrap (found at grocery stores), which will almost stick to your skin and seal well. It can be removed easily. A longer term option is to purchase a cast protector at a pharmacy or medical supply center. If the bandage gets soaking wet you need to call my office for further instructions.


Specific Postop Thumb CMC Artroplasty Instructions

          Surgery Day: your hand and arm will be numb from local anesthetic for 6-10 hours. Then as it wears off you will have a variable degree of pain from the surgery and sutures. Follow instructions above.

First Week: The first bandage and cast will remain for 8-10 days to protect your hand from accidental injury. Pain should subside gradually after 2-4 days.

First Postoperative Visit: You will be given an appointment time and place, where my staff will remove the bandage, sutures, then reapply a smaller, more comfortable bandage and splint; then give instructions in further swelling control and limited finger exercises. Pain medication can be refilled at that time.

3 Weeks:  You will be seen by my hand therapy staff for removal of the splint-cast and conversion to a lighter removable plastic splint. You will be given instructions for gradual rehabilitation of your hand to regain range of motion and later strength. You will be seen at therapy 4-6 times.

5 weeks: Dr. Rawles will see you to evaluate your recovery and to perform X-rays of your thumb. He will advise you and the therapy team on progression of your therapy program, based on your individual recovery to date.

          8 weeks: Dr. Rawles will see you to evaluate your recovery and to decide whether you need additional therapy and when you can function without the splint. This may take until 3 or sometimes 4 months following the surgery date.


Please call Dr. Rawles or his staff (804-379-8088) if you experience major deviation from the expected recovery or have additional questions.