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

Immobilisation:

• Long forearm cast or splint

• Immobilisation maintained at all times

Precautions:

• Avoid forearm rotation (pronation/supination)

• Avoid wrist loading or gripping

• Protect repair at all times

Therapy:

• Finger, elbow, and shoulder range of motion exercises

• Edema control and wound care

• Maintain mobility of uninvolved joints

Criteria to Progress:

• Healing wound

• Controlled pain and swelling

Phase II: Protected Motion (2–6 Weeks)

Immobilisation:

• Transition to Muenster splint

Precautions:

• Avoid forceful forearm rotation

• Avoid wrist loading and gripping

• Avoid weight-bearing through the wrist

Therapy:

• Initiate gentle wrist range of motion

• Gradual introduction of forearm rotation within limits

• Continue edema control and mobility exercises

Criteria to Progress:

• Improving range of motion

• Minimal pain

• Stable repair clinically

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

Precautions:

• Avoid heavy lifting or forceful rotation early in this phase

Therapy:

• Progress to full wrist and forearm range of motion

• Initiate gentle strengthening exercises (grip, wrist, forearm)

• Functional and task-specific exercises

• DRUJ stabilising exercises

Criteria to Progress:

• Functional range of motion

• Improved strength

• Minimal pain or swelling

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

Precautions:

• Gradual return to higher-demand activities

Therapy:

• Progressive strengthening and endurance training

• Return to functional and recreational activities

• Sport-specific rehabilitation as required

• Criteria for Return to Activity

• Full range of motion

• Good strength and control

• No pain or instability

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.