Postoperative dressing.
3 - 5 days:
The postoperative dressing is removed.
A light dressing and edema control are applied as needed.
A full Dorsal Blocking splint is fitted to the wrist and digits for controlling wear in the following position:
Wrist: 20 degrees of flexion
Basal joint: Palmar adduction, radial abduction
MCP/IP: full extension
Controlled passive mobilization is initiated 2 x day (Modified Duran program) with the splint on as follows:
8 repetitions of passive flexion and active extension of the MCP joint.
8 repetitions of passive flexion and active extension to the IP joint.
Optional: Controlled active mobilization is initiated 2 x day with the splint on as follows:
8 repetitions of active unresisted composite flexion and extension of the MCP and IP joints with the wrist supported in flexion.
4 weeks:
The Dorsal Blocking splint is removed every 2 hours for the following exercises:
10 repetitions of active flexion and extension to the wrist.
10 repetitions of active flexion and extension to the digits.
Passive exercises are continued as needed.
The Dorsal Blocking splint is re-applied.
Electrical stimulation of the muscle may be used with the splint on, to increase tendon excursion.
5 weeks:
The Dorsal Blocking splint is discontinued.
Active exercises are done hourly as follows:
12 repetitions of MCP blocking.
12 repetitions of IP blocking.
12 repetitions of active composite flexion and extension.
Continue passive flexion as needed.
6 weeks:
Passive extension exercises are initiated to the wrist and digits.
Dynamic extension splinting may be applied as indicated.
8 weeks:
Gentle strengthening is initiated beginning with foam, then putty and hand helper. Light grasping is allowed.
No lifting or heavy use of the hand is allowed.
10 - 12 weeks:
May return to work with full use of hand, including sports.
NOTE: Generally the greatest achievement in total motion is seen by this period.
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