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

Immobilisation:

• Forearm-based thumb spica cast or splint maintaining thumb opposition and palmar abduction

• Elevation encouraged to reduce oedema

Precautions:

• Avoid active opposition against resistance

• Avoid forceful thumb adduction

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

• Protect tendon transfer tension and soft tissues

Therapy:

• Finger range of motion exercises

• Gentle tendon excursion 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

Phase II: Protected Motion and Motor Re-education (2–6 Weeks)

Immobilisation:

• Transition to removable thumb spica splint at approximately 2 weeks

Precautions:

• Avoid resisted thumb opposition

• Avoid forceful pinch and gripping

• Avoid stretching the transfer

• Protect webspace and tendon tension

Therapy:

• Commence gentle active opposition exercises

• Initiate motor retraining of the tendon transfer pattern

• Thumb palmar abduction and opposition retraining

• Continue wrist and finger mobilisation

• Functional hand use for light activities only

Criteria to Progress:

• Improving opposition pattern

• Good motor recruitment

• Minimal pain and swelling

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

Immobilisation:

• Wean splint progressively as control improves

Precautions:

• Avoid forceful pinch and repetitive loading early in this phase

• Avoid heavy gripping

Therapy:

• Progress active opposition and thumb mobility

• Continue tendon retraining exercises

• Commence gentle grip and pinch strengthening

• Functional and task-specific rehabilitation

• Scar management and desensitisation as required

Criteria to Progress:

• Functional opposition

• Good thumb control

• Improving strength

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

Precautions:

• Gradual return to repetitive loading

• Avoid sudden increases in demand

Therapy:

• Progressive strengthening and endurance training

• Functional rehabilitation

• Return to occupational and recreational activities

• Criteria for Return to Activity

• Functional opposition

• Good pinch and grip strength

• 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.