Flexor Tendon Repair — Flexor Pollicis Longus (FPL) Repair — Early Active Motion

UW Health · UW Health Orthopedic Surgery; UnityPoint Health - Meriter Rehabilitation (Dr…

Weight-Bearing

NWB surgical UE

Key Restrictions

No lifting/pushing/pulling >2 lbs through Phase III (8 weeks); no functional use of thumb; no weightbearing; WHFO dorsal blocking orthosis full time; no resistive or torque activity through Phase III; no restrictions at 10 weeks; elevate and immobilize 3-5 days before starting motion

Timeline & Phases

Phase I (3-5 days to 4 weeks): WHFO dorsal blocking (wrist 30° extension, thumb neutral abduction); passive composite IP/MP flexion + active extension to orthosis; early active opposition by week: week 1 — IF and MF; week 2 — RF; week 3 — SF; week 4 — base of SF; tenodesis: active wrist flexion and extension with synergistic thumb motion; Phase II (4-6 weeks): progress each visit — active MP/IP flexion in varying wrist positions, IPJ blocking, light therapeutic activities for IPJ flexion; cut down to hand-based at 6 weeks, begin light activities; Phase III (6-8 weeks): passive stretching into extension if needed; wean orthosis per pain; 5 lbs limit; no resistive/torque; Phase IV (8-12 weeks): progressive strengthening; no restrictions at 10 weeks

Notes

UW Health / UnityPoint Health - Meriter Rehabilitation; OT-based; one PDF shared with FPL Modified Duran protocol; Early Active Motion = default UW Health FPL protocol; surgeons: Dr. Tofte, Dr. Kruse, Dr. Mizerik; WHFO wrist 30° extension (less ulnar deviation than Modified Duran); incremental opposition progression week by week (IF/MF → RF → SF → base SF); light coban compression for edematous thumb — remove before active motion; Linburg-Comstock anomaly: if surgeon cannot divide, include IF in WHFO; criterion-based — "if progressing slowly, progress exercises; use clinical judgement"

Surgeon / Author

UW Health Orthopedic Surgery; UnityPoint Health - Meriter Rehabilitation (Dr. Tofte, Dr. Kruse, Dr. Mizerik)