Phase I: Protection (0–2 Weeks)

Immobilisation:

• Below-elbow cast or bulky bandage.

Precautions:

• Protect reconstruction.

• No wrist motion, no forearm rotation.

• Avoid lifting, gripping, or weight bearing through the hand.

Therapy:

• Finger and thumb range of motion exercises.

• Elbow and shoulder range of motion exercises.

• Oedema control and elevation.

Criteria to Progress:

• Wound healing satisfactory.

• Pain and swelling controlled.

Phase II: Continued Protection (2–6 Weeks)

Immobilisation:

• Below-elbow splint or Muenster cast in slight extension.

Precautions:

• No wrist loading.

• Avoid gripping and lifting activities.

Therapy:

• Gentle dart thrower’s motion

• Continue finger, thumb, elbow, and shoulder exercises.

• Maintain mobility of uninvolved joints.

Criteria to Progress:

• Stable postoperative course.

• Cleared to commence wrist motion.

Phase III: Controlled Motion Phase (6–12 Weeks)

Immobilisation:

• Removable splint used between exercises.

Precautions:

• Avoid forceful gripping and resisted wrist movements.

• Avoid weight bearing through the wrist.

Therapy:

• Begin gentle wrist range of motion exercises.

• Gradual progression of flexion, extension, and deviation within comfort.

• Muscle re-education of FCR, ECRL/ECRB, and APL with forearm in neutral

• Initiate light functional use of the hand.

Criteria to Progress:

• Improving wrist range of motion.

• Minimal pain with light activities.

Phase IV: Strengthening and Functional Return (3–6 Months)

Immobilisation:

• Discontinue splint as tolerated.

Precautions:

• Gradual return to loading; avoid heavy lifting early in this phase.

Therapy:

• Progressive strengthening of wrist and grip.

• Functional and task-specific rehabilitation.

• Gradual return to manual activities.

Criteria to Discharge:

• Functional, pain-free wrist motion.

• Strength appropriate for daily and occupational demands.

• No clinical instability.

• Clearance by the treating surgeon.

General Recommendations

Work:

• Office/desk work may resume after 2–4 weeks if pain is well controlled

• Manual labour should be deferred until 3–6 months depending on 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 begin from approximately 6–8 weeks.

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

• Gripping, strengthening, and gym-based activities from approximately 3–4 months.

• Higher-demand wrist loading, racquet sports, or impact activities typically from 4–6 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.