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

Immobilisation:

• Thumb spica cast or splint with wrist and thumb positioned to protect the reconstruction

• Elevation encouraged to reduce oedema

Precautions:

• Avoid active thumb flexion against resistance

• Avoid forceful thumb extension

• Avoid gripping, lifting, and weight-bearing through the hand

• Protect reconstruction and tendon glide

Therapy:

• Finger range of motion exercises

• Passive thumb flexion exercises within splint limits

• Gentle protected tendon gliding exercises as directed

• Elbow and shoulder mobilisation

• Oedema control and wound care

• Maintain mobility of uninvolved joints

Criteria to Progress:

• Healing wound

• Controlled pain and oedema

• Good digital mobility

• Smooth tendon excursion

Phase II: Protected Motion and Tendon Glide (2–6 Weeks)

Immobilisation:

• Continue with dorsal blocking splint

• Wean splint gradually towards the end of this phase as directed

Precautions:

• Avoid resisted thumb flexion

• Avoid passive overstretching

• Avoid forceful pinch and gripping

• Avoid loading through the thumb

Therapy:

• Progress passive and active-assisted thumb flexion exercises

• Initiate gentle active thumb flexion and extension

• Continue tendon gliding exercises

• Wrist and finger mobilisation

• Functional hand use for light activities only

Criteria to Progress:

• Smooth tendon glide

• Improving thumb motion

• Minimal pain and swelling

Phase III: Progressive Motion and Early Strengthening (6–12 Weeks)

Immobilisation:

• Discontinue splint as control improves

Precautions:

• Avoid forceful pinch and heavy gripping early in this phase

• Avoid repetitive high-load activities

Therapy:

• Progress active thumb range of motion

• Commence gentle strengthening of thumb flexion

• Grip and pinch strengthening as tolerated

• Functional and task-specific rehabilitation

• Scar management and desensitisation as required

Criteria to Progress:

• Functional thumb flexion

• Good tendon excursion

• Improving strength

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

Precautions:

• Gradual return to repetitive loading

• Avoid sudden increases in activity

Therapy:

• Progressive strengthening and endurance training

• Functional rehabilitation

• Return to occupational and recreational activities

• Criteria for Return to Activity

• Functional range of motion

• Good thumb strength and endurance

• No significant pain

General Recommendations

Work:

• Desk-based work may resume after 1–2 weeks depending on comfort.

• Manual work is typically deferred until 8–12 weeks or longer depending on recovery and job demands.

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 use may commence from approximately 4–6 weeks.

• Progressive return to functional and gym activities from approximately 8–12 weeks.

• Higher-demand gripping, racquet sports, or impact activities typically from 3–6 months or longer with full recovery and surgeon clearance.

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.