Phase I: Early Recovery and Motion (0–2 Weeks)

Immobilisation:

• Soft dressing or thumb spica splint for comfort

• Removed regularly for exercises as tolerated

Precautions:

• Avoid forceful gripping or repetitive thumb use

• Avoid heavy lifting

• Protect wound and soft tissues

Therapy:

• Early active range of motion of fingers, thumb, and wrist as tolerated

• Edema control and wound care

• Gentle tendon gliding exercises

• Maintain shoulder and elbow mobility

Criteria to Progress:

• Healing wound

• Controlled pain and swelling

• Improving range of motion

Phase II: Progressive Motion and Function (2–6 Weeks)

Precautions:

• Avoid repetitive or forceful thumb loading

• Avoid heavy gripping

Therapy:

• Full active range of motion exercises

• Gradual return to functional hand use

• Light strengthening exercises

• Desensitisation techniques if required

Criteria to Progress:

• Minimal pain

• Functional range of motion

• Improved hand use

Phase III: Strengthening and Functional Recovery (6–12 Weeks)

Precautions:

• Avoid sudden increases in activity

Therapy:

• Progressive strengthening (grip and pinch)

• Functional and task-specific exercises

• Gradual return to work and recreational activities

Criteria to Progress:

• Good strength and control

• No significant pain or swelling

Phase IV: Return to Function (3–6 Months)

Precautions:

• Gradual return to higher-demand activities

Therapy:

• Return to full functional and recreational activities as tolerated

• Criteria for Return to Activity

• Full range of motion

• Good strength and function

General Recommendations

Work:

• Desk-based work may resume within 1–2 weeks.

• Manual or repetitive hand work typically from 4–6 weeks as tolerated.

Driving:

• It is important that you are medically fit to return to driving and you feel safe to control the vehicle and take evasive action if needed.

Sports and Leisure:

• Lower-limb activities may resume as comfort allows.

• Light hand and wrist activities may resume as tolerated within the first 1–2 weeks.

• Progressive return to functional and light gym activities from 2–4 weeks.

• Repetitive thumb use and heavier gripping from approximately 4–6 weeks as comfort allows.

Disclaimer: This protocol is intended as a general rehabilitation guide only. Rehabilitation progression should always be individualised and may be modified by A/Prof Ernstbrunner and the treating rehabilitation team based on the patient’s clinical progress, surgical findings, and individual circumstances.