MP Arthroplasty — MCP Arthroplasty with Extensor Tendon Repositioning/Reconstruction

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

Weight-Bearing

NWB surgical UE

Key Restrictions

Orthosis 24/7 except hygiene and exercises — alternate Splint #1 (wrist 30° ext, MPJ full flex to 70°, IPJ full ext) and Splint #2 (wrist 30° ext, full MPJ/IPJ ext) every 24 hours; avoid ulnar deviation and finger abduction/adduction throughout; avoid lateral pinch — pad-to-pad pinch only; no functional use Phase I; splints worn at night/rest/outside home in later phases; continue avoiding activities with ulnar deviation after D/C

Timeline & Phases

Phase I: alternating Splint #1/Splint #2 every 24 hours; exercises in orthosis hourly 10 reps — AROM shoulder/elbow/forearm/thumb, active MPJ flex/ext with IPJ in ext, gentle IP ROM; 3x/day — radial finger walking, active wrist flex/ext; Phase II: add passive MPJ ext with place and hold, active MPJ ext individually and composite off table; adjust orthosis as flex/ext improve; Phase III: add gentle passive MPJ flex 3x/day, scar management; Phase IV: composite finger flex leading with DIP, soft theraputty, pad-to-pad pinch focus; splints at night/rest/outside home only; Phase V: progressive putty strengthening, pad-to-pad pinch, revise/discontinue night splint when optimal ROM achieved

Notes

UW Health / UnityPoint Health - Meriter Rehabilitation; OT-based; indications: RA with MPJ ulnar drift and palmar subluxation, OA, trauma subluxation, EDC rupture at MPJ, radial sagittal band injury; distinctive two-splint alternating approach — Splint #1 maintains MPJ flexion (prevents extensor shortening), Splint #2 maintains full extension (prevents flexion contracture); radial finger walking to counteract ulnar drift; avoid lateral pinch throughout (stresses reconstructed extensor mechanism); non-adherent superficial scar essential for tendon excursion; joint protection post-D/C: avoid ulnar deviating activities; adaptive equipment PRN; published July 20, 2022

Surgeon / Author

UW Health Orthopedic Surgery; UnityPoint Health - Meriter Rehabilitation

Published

2022-07-20