Thumb Joint Reconstruction Recovery
Thumb CMC Arthroplasty (LRTI / Suspensionplasty)
What the operation does
The joint at the base of the thumb sits between a small wrist bone called the trapezium and the thumb metacarpal. When it wears out, the trapezium is removed entirely, and the space it leaves is managed — commonly by using a strip of nearby tendon both to sling the thumb and to fill the gap. That is what the letters LRTI describe: ligament reconstruction and tendon interposition.
Why the base of the thumb wears out
Because it is a saddle joint doing an enormous amount of work. Every pinch puts many times that force through the joint, and it is one of the commonest sites of arthritis in the hand — particularly in women from around fifty onwards. The pain is felt at the very base of the thumb, in the web of the hand, and comes on with pinching, turning keys and opening jars.
Removing a bone sounds drastic and works well
The reassurance worth giving early. The thumb does not collapse into the space left behind. It is held by the surrounding soft tissue, by the tendon sling where one is used, and by scar tissue that fills the gap over the following months. The thumb ends up slightly shorter and, in most people, comfortable and functional.
Pain goes reliably; strength comes back slowly
Two different timetables, and confusing them is why people worry unnecessarily. Pain relief is among the more dependable results in hand surgery — the great majority get substantial, lasting relief and satisfaction is high. Strength is the slow half: pinch is commonly weaker than before for the first three to six months and continues improving for a year or more. Opening jars, turning a stiff key and using scissors are the practical milestones, and they arrive late. Judging this operation at three months measures the wrong thing.
The thumb will be slightly shorter
Removing a bone shortens the thumb column a little. Most people never notice it functionally, and the small loss of length is part of why pinch takes time to rebuild. It is not a sign anything has settled or failed.
The cast and the early weeks
A cast or firm splint holding the thumb for around four weeks is usual, sometimes longer. The fingers and wrist must keep moving during that time — a stiff hand is the avoidable complication, and it is caused by the cast rather than the operation.
The nerve on the back of the thumb
A branch of the radial nerve crosses the operating area on its way to the skin of the back of the thumb, and it is easily bruised. Numbness or an oversensitive patch there afterwards is fairly common, usually improves over months, and occasionally leaves a small permanent area. Firm desensitisation work settles it faster.
Where the tendon came from
Usually a strip of a wrist tendon, taken through a second small incision on the forearm. Losing that strip causes no meaningful weakness because other tendons do the same job. Some surgeons use different techniques — a suture button suspension, or simply removing the bone with nothing added — and results between them are broadly similar. If you are unsure which you had, it is worth asking.
Working with a hand therapist
Most people are referred, and it matters here. The therapist makes the splint, progresses the thumb through motion into pinch, and picks up stiffness while it is still easy to treat. Their instructions come before anything general.
When to start pinching
Later than instinct suggests. Pinch loading is deliberately held back until the tissues filling the gap have matured, commonly around two to three months, which is why the strengthening phase is named for it and starts then rather than earlier. Pinching early is the commonest way to end up with a sore thumb at six months.
If the pain does not settle
Where pain persists past six months, the usual explanations are irritation of that skin nerve, arthritis in the neighbouring joint that was always there, or tendon irritation at the wrist. All are identifiable and most are treatable, and going back is more useful than waiting.
The other hand
Basal thumb arthritis is frequently bilateral. Many people eventually have the second side done, usually separated by at least several months so one hand is always working. If your other thumb aches, mentioning it early makes the planning easier.
Driving and work
Driving generally waits until you are out of the cast and can grip and turn the wheel confidently — commonly around six to eight weeks. Desk-based work is often possible within two to three weeks. Work involving repeated pinching, gripping or tools commonly waits three to four months.
How the first year usually unfolds
Four weeks in a cast with fingers and wrist kept moving. Four to eight weeks brings thumb movement back and scar work. Two to four months brings pinch strengthening, which is where the real work is. Four to eight months brings most everyday tasks back comfortably. Pinch strength continues improving to eighteen months, and gains in the second year are normal.
Staying in touch with your care team
How worn the joint was, which technique was used, and whether the neighbouring joints are also arthritic all shape this recovery. Your surgeon knows those details. If something about your recovery is worrying you or does not match what is described here, contact your care team — they would far rather hear from you.
Exercises for Thumb Joint Reconstruction
An illustrated, phase-by-phase exercise program for this procedure. View the Thumb Joint Reconstruction exercise program.
Recovery education · Condition guides · Exercise programs
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This guide is general education and doesn't replace evaluation by a licensed provider. Recovery and treatment vary by person — follow the guidance of your own surgeon or care team.