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

Immobilisation:

• Thumb spica cast or splint

• Elevation encouraged to reduce oedema

Precautions:

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

• Avoid valgus stress across the thumb MCP joint

• Protect repair / reconstruction and soft tissues

Therapy:

• Finger range of motion exercises

• Maintain interphalangeal thumb motion

• Elbow and shoulder mobilisation

• Oedema control and wound care

• Tendon gliding exercises

Criteria to Progress:

• Healing wound

• Controlled pain and oedema

• Good finger mobility

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

Immobilisation:

• Transition to removable short thumb spica splint at approximately 2 weeks

Precautions:

• Avoid forceful pinch and gripping

• Avoid valgus loading across the MCP joint

• Avoid lifting and repetitive thumb loading

Therapy:

• Commence gentle thumb active range of motion exercises

• Restore thumb opposition and webspace mobility

• Continue wrist and finger mobility exercises

• Functional hand use for light activities only

Criteria to Progress:

• Improving thumb motion

• Minimal swelling

• Good pain control

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

Immobilisation:

• Wean splint progressively as comfort and control improve

Precautions:

• Avoid forceful pinch and heavy gripping early in this phase

• Avoid contact loading

Therapy:

• Progress thumb and wrist range of motion

• Commence gentle pinch and grip strengthening

• Functional and task-specific rehabilitation

• Scar management and desensitisation as required

Criteria to Progress:

• Functional range of motion

• Improving strength

• Minimal symptoms

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

Precautions:

• Gradual return to higher-demand activities

• Avoid excessive pinch loading until strength restored

Therapy:

• Progressive strengthening and endurance training

• Functional rehabilitation

• Return to recreational and occupational activities

• Criteria for Return to Activity

• Functional range of motion

• Good pinch and grip strength

• No pain or instability

General Recommendations

Work:

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

• Manual work typically from 6–10 weeks 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.

• Pinch loading, racquet sports, contact, or higher-demand activities typically from 3–4 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.