Opponesplasty — Conservative

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

Weight-Bearing

NWB surgical UE

Key Restrictions

Dorsal thumb spica orthosis (wrist 10-20° flex, thumb max palmar abduction/rotation) full time 3-5 weeks; avoid simultaneous wrist/thumb/finger extension; avoid thumb adduction until 3 weeks post-op; no lifting >2 lbs; short exercise sessions to prevent transferred muscle fatigue; autologous or allograft used: default to conservative protocol

Timeline & Phases

Phase I (7-10 days to 3 weeks): digit/forearm/elbow/shoulder ROM, dorsal thumb spica orthosis (wrist 10-20° flex, thumb max palmar abduction/rotation) full time 3-5 weeks; E-stim or biofeedback to increase AROM; mirror visual feedback/whirlpool/vibration to facilitate muscle activation; Phase II (4-7 weeks): AROM/AAROM thumb and wrist + place and hold; gentle PROM wrist and thumb; perform ROM with non-involved hand assisting; short sessions to prevent fatigue (10 reps then rest); aquatherapy/gravity-eliminated plane option; wean orthosis as AROM improves, continue night and heavy activities; Phase III (8-10 weeks): progressive strengthening; progressive weightbearing; no restrictions; return to heavy work/leisure at 12 weeks

Notes

UW Health / UnityPoint Health - Meriter Rehabilitation; OT-based; one PDF shared with Opponesplasty Early Active protocol; indicated for low median nerve palsy or congenital thumb deficiency; three surgical techniques: Huber (abductor digiti minimi transfer), Camitz (palmaris longus with palmar aponeurosis), Ring finger FDS; donor muscle activation technique critical — FDS: block ring MPJ while flexing PIP + opposing thumb; palmaris longus: flex wrist while opposing; EDM: extend small finger MPJ while opposing; autologous or allograft bridge: use conservative protocol; published April 15, 2022

Surgeon / Author

UW Health Orthopedic Surgery; UnityPoint Health - Meriter Rehabilitation

Published

2022-04-15