Tendon Transfer — Thumb EPL Tendon Transfer — Conservative

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 (10–14 days): ROM uninvolved joints only; no thumb AROM; orthosis full time | Phase II/III (3 wks): short arc wrist flex/ext with thumb/wrist in ext for proximal gliding; AROM IPJ flex/ext with emphasis on ext; thumb opposition to IF and MF | Phase III/IV (4 wks): full AROM thumb; PL: wrist flex + thumb ext; combined finger/thumb motion to decrease extrinsic tightness; isometric thumb/wrist strengthening; orthosis except bathing/exercises | Phase IV/VI (6 wks): PROM wrist and thumb independently then combined; AAROM; isometric; wean orthosis, night orthosis; light activities | Phase V/VIII (8 wks): PROM combined wrist/thumb; resistive strengthening; wean orthosis, night only | Phase VI/IX (10–12 wks): heavy work/leisure strengthening; no restrictions at 12 wks

Notes

Donor tendon: palmaris longus (PL) or EIP; indications: significant EPL laceration, delayed repair, or nutritional deficiency rupture (post-distal radius fracture, synovitis, RA); IPJ extensor lag = halt progression; avoid passive stretching early (risk overstretching transfer); NMES at 4 wks; shared URL with Early Active Motion protocol; developed collaboratively by UW Health and UnityPoint Health - Meriter Rehabilitation

Published

2022-04-15