MCP ARTHROPLASTY
THERAPY GUIDE

· Replacement of MCPJ's with silastic spacers, normally for RA patients to help decrease pain and increase function and improve deformity
· In hospital for 4 days
· Forearm based POP holding affected digits in extension
· Elevation ++ for 2/52
· OPA for next Hand Clinic
· Rehab begins after R/O POP @ 2-3/52
· Volar based forearm splint keeping IPJ's free and MP's in natural cascade position.  Wear full time for 6/52

EXERCISES (2-4 Weeks)

In splint

· flex fingers over edge of splint (x 20 every hour)

Out of splint

· MP flexion with PIP's extended (shelf position)
· In shelf position, active/assisted flexion of PIP's & IP's into palm
· Radial walk fingers

4 weeks 

• Late fibroplastic stage
• Co-ordination and light strengthening starts

5 weeks 

• Light ADL's & functional activity
• Do not carry any bags by hand
  Avoid static postures

6 weeks 

• Implant is encapsulated.
• Stop splint during day but continue at night for next 2/52
• Return to light work

8 weeks 

• Scar maturation well underway
• Increase strength

Outcome - Aim for an arc of movt. Of about 70 degrees i.e., 0-70°

Look out for:

· Lack of extension at MP's.  If so, use a  full extension splint at night and increase wear of day splint for another 6/52
· Ulnar drift.  May need outrigger or functional ulnar deviation splint