Tendon Transfer — Thumb EPL Tendon Transfer — Early Active Motion

UW Health Orthopedic Surgery; UnityPoint Health - Meriter Rehabilitation

Weight-Bearing

NWB surgical UE

Key Restrictions

No AROM/functional use of thumb early; no lifting >2 lbs; orthosis full time; IPJ extensor lag = halt progression; avoid passive thumb stretching early

Timeline & Phases

Phase I (3–4 days): short arc wrist flex/ext with IPJ/MCP in ext; AROM IPJ with wrist/thumb in ext; orthosis full time except bathing/exercises | Phase II (2 wks): AROM thumb opposition with emphasis on ext, wrist in extension | Phase II/III (3 wks): progress opposition; plastic cup grasp/release; EIP: active IF extension isolated | Phase III/IV (4 wks): full AROM; EIP: active IF ext; PL: wrist flex + thumb ext; combined finger/thumb motion; isometric strengthening | Phase V (5 wks): light functional therapeutic activities for grasp/release and pinch; wean orthosis, night + heavy activities | Phase IV/VI (6 wks): PROM wrist/thumb; AA/PROM if needed; isometric; continue wean | Phase VII (7 wks): resistive strengthening; D/C orthosis (oval-8 night support optional) | Phase V/VIII (8 wks): progressive WB; continue strengthening | Phase VI/IX (10–12 wks): no restrictions at 10 wks

Notes

Donor tendon: PL or EIP; EIP: active IF ext to fire transfer; PL: wrist flex to fire transfer; avoid passive stretching early (risk overstretching transfer); NMES at 4 wks; IPJ extensor lag = halt progression; shared URL with Conservative protocol; developed collaboratively by UW Health and UnityPoint Health - Meriter Rehabilitation

Published

2022-04-15