CMC Cable Fix
Anatomy: The carpometacarpal (CMC) joint is located at the base of the thumb
and is the articulation between the 1st metacarpal and the trapezium. The CMC
joint is a saddle joint, which means it can allow the thumb to move in almost any
direction (including the motions of flexion, extension, adduction, abduction, and
circumduction). These motions are what enable humans to grasp objects ranging
from a car key to a basketball with their hand. The CMC joint is surrounded by the
following ligaments: 1.) Anterior oblique ligament- runs from the palmar surface of
the 1st metacarpal base to the palmar aspect of the trapezium. 2.) Posterior
oblique ligament- runs from the dorsal ulnar tubercle of the trapezium to the ulnar
tubercle of the 1st metacarpal base. 3.) Dorsal radial ligament- runs from dorsal
radial aspect of the 1st metacarpal to the dorsal radial aspect of the trapezium and
is reinforced by the Abductor Pollicis Longus tendon. 4.) intermetacarpal ligament
– runs from the radial aspect of the 2nd metacarpal to the ulnar aspect of the 1st
metacarpal. 5.) Ulnar collateral ligament- runs from the flexor retinaculum to the
palmar ulnar tubercle of the 1st metacarpal. The tendon of Abductor pollicis longus
passes over the CMC joint and attaches to the radial side of the base of the 1st
metacarpal. The tendons of Extensor pollicis brevis and Extensor pollicis longus
also pass over the CMC joint, but do not attach to the 1st metacarpal.
Mechanism of Injury: The CMC joint can develop osteoarthritis, which leads to
debilitating hand pain, decreased strength, decreased range of motion and makes
it difficult for an individual to perform household activities like opening cans or
unlocking doors with a key. Although the specific cause of CMC osteoarthritis is
unknown, factors such as being overweight, the aging process, heredity, and
repetitive use of the joint in occupations like assembly line work are thought to be
contributing factors. With repetitive stress to the CMC joint, the cartilage that normally covers the articulation
between the 1st metacarpal and trapezium wears down and allows the two bones to rub together causing
friction and joint damage. As the body tries to repair this damage, new bone growth can occur and form “bone
spurs” which can produce noticeable lumps around the CMC joint. Treatment options for CMC osteoarthritis
include the use of a splint to limit movement of the thumb and wrist, NSAIDS, corticosteroid injections, physical
therapy, and in some cases surgery.
CMC Cable Fix Surgery: One of the surgical options for CMC osteoarthritis is the
procedure known as Cable Fix Surgery. This involves removing the arthritic trapezium
bone and attaching the 1st metacarpal to the 2nd metacarpal via a guide wire for a cable
lock. This enables the thumb to move through its original range of motion but without
its former painful articulation with the trapezium. The operative hand is placed in a
splint immediately after surgery. At 1 week to 10 days post op the dressing, splint, and
sutures are removed. At this time a thumb spica splint is fabricated and placed upon
the patient, holding the thumb in a slightly abducted position. The spica splint is
typically discontinued at 4 weeks and the patient is able to begin controlled thumb
motion and gentle strengthening exercises.
CMC Cable Fix
Treatment: Physical therapy can be initiated after surgery to help the patient regain/
maintain range of motion, improve strength/flexibility, and assist with pain control. On the initial visit to physical
therapy, the therapist will assess the patient’s range of motion of the thumb, wrist, and any other joints of the
upper extremity that lack normal range of motion. The physical therapist will also assess the patient’s pain
Norman
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Newcastle
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level, take circumferential measurements of the wrist to identify edema, measure strength of
applicable muscles, and perform any other necessary tests to determine the patient’s current level
of function and factors which may effect healing. The physical therapist will then create a plan of
care to include the following:
1. Modalities: to decrease pain, decrease inflammation, decrease tissue tightness, promote
muscle re-education
Including: Transcutaneous Electrical Nerve Stimulation (TENS), Neuromuscular
Electrical Stimulation (NMES), Interferential Current (IFC), Ultrasound, Phonophoresis,
Thermotherapy, Cryotherapy
Spica Splint
2. Manual Therapy: to improve range of motion, decrease tissue tightness, decrease pain
Including: soft tissue massage, joint mobilization, myofascial release, manual stretches,
tendon glides, and passive range of motion.
3. Therapeutic Exercises: to improve range of motion, decrease tissue tightness,
maintain/improve muscular strength and muscular endurance.
Including: active range of motion, active assistive range of motion, progressive resistance
exercises, stretches, and a home exercise program (HEP) to help the patient play a crucial role
in their own recovery. The following pages show examples of active range of motion,
stretches, isometric strengthening, and progressive resistance exercises.
4. Contraindications: No electrical stimulation if the patient has history of cancer or a pacemaker. Ultrasound
treatment is contraindicated for patients who have significantly diminished pain or heat sensitivity. Avoid
Exercise Program For:
Date: 2/9/2012
heavy resisted pinching exercises.
CMC HEP
Page: 1
Iso thumb abd
Iso thumb add
Iso thumb CMC ext
Perform 1 set of 10 Repetitions, once a day.
Perform 1 set of 10 Repetitions, once a day.
Perform 1 set of 10 Repetitions, once a day.
Hold exercise for 10 Seconds.
Hold exercise for 10 Seconds.
Hold exercise for 10 Seconds.
Iso thumb CMC flx
Iso thumb DIP flx
Iso thumb/finger opposition
Perform 1 set of 10 Repetitions, once a day.
Perform 1 set of 10 Repetitions, once a day.
Perform 1 set of 10 Repetitions, once a day.
Hold exercise for 10 Seconds.
Hold exercise for 10 Seconds.
Hold exercise for 10 Seconds.
CMC Cable Fix!
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