Flexor Tendon Repair — Flexor Pollicis Longus (FPL) Repair — Early Active Place and Hold

University of Virginia Orthopaedic Surgery

Weight-Bearing

NWB surgical arm

Key Restrictions

Do not initiate if significant edema/stiffness present; no end-range thumb extension; no resistance strengthening until 8-10 weeks; WHFO dorsal block (wrist neutral to 20° flexion, thumb MCP 15° flexion, IP 30° flexion) full time including sleep; exercises every 1-2 waking hours

Timeline & Phases

Phase 1 (0-3-5 days): thumb spica IP in extension; Phase 2 (3-9 days to 4 wks): WHFO dorsal block, PROM warmup then place-and-hold exercises; Phase 3 (4-6 wks): active tenodesis (wrist flex/thumb ext ↔ wrist ext/thumb flex), gentle thumb extension; Phase 4 (6-12 wks): discontinue orthosis, progressive resistance from week 9

Notes

4 phases; PROM always performed slowly as warmup before active exercises; place-and-hold: passively flex thumb/extend wrist, actively hold and extend wrist; active MCP motion limited to 30-40°; passive thumb extension not beyond orthosis limit

Published

09/2024