Extensor Tendon Repair — Thumb (EPL/APL/EPB) Zones II–V Early Active

UW Health · UW Health Orthopedic Surgery; UnityPoint Health - Meriter Rehabilitation

Weight-Bearing

NWB surgical UE

Key Restrictions

No lifting/pushing/pulling >2 lbs through 8 weeks; no functional use of thumb/wrist through 5 weeks; IPJ extensor lag = halt progression at every phase; no discontinuing night orthosis until 12 weeks; no restrictions at 12 weeks

Timeline & Phases

Phase I (0-10 days): forearm-based thumb spica orthosis (IPJ hyperextension, MP 0°, thumb radial abduction/extension, wrist 20-30° ext), synergistic wrist flex/ext with thumb protected, IPJ blocked flexion 25% then full extension; Phase II (3 weeks): opposition to IF/MF/RF with full extension after each, IPJ blocking to 50-75% if stiff; Phase III (4 weeks): full composite thumb flexion, full opposition to small finger base, full IPJ flexion blocking; Phase IV (5 weeks): wean orthosis 30-60 min 3-4x/day for light activities, light therapeutic pinch/grasp, isometric thumb extension; Phase V (6 weeks): wean for light/moderate activities, transition to oval-8 IPJ extension splint daytime, PROM and dynamic splinting if scar/stiffness present; Phase VI (8 weeks): D/C orthosis except heavy activities and night, grip/pinch strengthening; Phase VII (12 weeks): no restrictions

Notes

UW Health / UnityPoint Health - Meriter Rehabilitation; OT-based; covers EPL (extensor pollicis longus), APL (abductor pollicis longus), EPB (extensor pollicis brevis) zones 2-5; Zone 1 thumb extensor injury uses Mallet protocol instead; IPJ extensor lag is the progression gate at every phase; forearm-based thumb spica with volar gutter piece positions IPJ in hyperextension; thumb/hand swelling normal for 6-12 months post-repair; OT appointments begin 3-5 days post-op; published April 15, 2022

Surgeon / Author

UW Health Orthopedic Surgery; UnityPoint Health - Meriter Rehabilitation

Published

2022-04-15