Flexor Tendon Repair — Flexor Pollicis Longus (FPL) Repair — Modified Duran

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; WHFO dorsal blocking orthosis full time; no resistive or torque activity through Phase III; no restrictions at 12 weeks; elevate and immobilize 3-5 days before starting motion to reduce work of flexion

Timeline & Phases

Phase I (3-5 days to 4 weeks): WHFO dorsal blocking (wrist 10° ext/10° ulnar deviation to minimize FPL tension at distal carpal canal, CMC 30° palmar abduction/10° flex, MP slight flex, IP neutral); passive IP flexion + active IP extension with MP stabilized neutral; passive composite MP/IP flexion + active extension to orthosis; tenodesis: active wrist flex/ext with synergistic thumb; Phase II (4-6 weeks): pain-free AROM thumb, IPJ blocking, wrist AROM; orthosis all time except bathing/exercises; at 6 weeks cut down to hand-based and begin light activities; Phase III (6-8 weeks): passive stretching into extension if needed; wean orthosis per pain tolerance; no resistive/torque; 5 lbs lifting limit; Phase IV (8-12 weeks): progressive strengthening; no restrictions at 12 weeks

Notes

UW Health / UnityPoint Health - Meriter Rehabilitation; OT-based; one PDF shared with FPL Early Active Motion protocol; Modified Duran = passive protocol — surgeons: Dr. Gander, Dr. Michelotti, Dr. Salyapongse, Dr. Zachary; active protocol is UW Health default unless Modified Duran ordered; WHFO wrist 10°ext/10°ulnar deviation minimizes FPL tension at distal carpal canal; Linburg-Comstock anomaly (present ~1/3 population): intertendinous FPL-FDP connection — if surgeon unable to divide, include IF in 25° MP flex and IPs in extension in WHFO; edematous thumb: light coban compression, remove before active motion

Surgeon / Author

UW Health Orthopedic Surgery; UnityPoint Health - Meriter Rehabilitation (Dr. Gander, Dr. Michelotti, Dr. Salyapongse, Dr. Zachary)