4 Corner Fusion

Wrist & hand
Written By

Download this rehabilitation protocol (PDF)

For patients and physiotherapists.

Week 0-2

Aims:

  • Pain control
  • Protect fixation
  • Allow the wounds to heal
  • Maintain overall mobility including fingers

Suggested treatment:

  • Arm in sling and plaster
  • Pain relief
  • Finger ROM

Week 2-6

Aims:

  • Wean out of sling
  • Transition to moulded thermoplastic long opponens splint

Suggested treatment:

  • Gradual increase wrist range
    • Commence with passive ROM
    • Graduate to AROM around 4/52
  • Ongoing finger and elbow mobility exercises

Restrictions:

  • No heavy lifting/weight bearing on repaired side
  • Lifting lighter objects (eg phone/cup) permitted

Week 6-12

Aims:

  • Minimal pain
  • Increased active ROM
  • Wean out of sling and thermoplastic splint completely
  • Return to most normal activities

Suggested treatment:

  • Progression in AROM
  • Strengthening exercises
  • Graded functional exercises and increase to ADLs

Restrictions:

  • No heavy lifting

Week 12 and beyond

Aims:

  • Protect fixation
  • Improve endurance/power
  • Return to higher demand activities

Suggested treatment:

  • Commence isometric exercises
  • Strengthening
  • No lifting restriction

Some General Questions

What to expect after surgery:

  • Most patients will stay a night post operatively
  • After you wake up, you might notice some numbness to fingers of the operated hand. This may be secondary to local anaesthetic and will wear off over 48-72 hours.
  • The next morning, you will be seen by the medical team and physiotherapist or hand therapist prior to your discharge
  • You will be sent home with medications or a script to help with pain relief

Time in Sling:

  • Generally your sling should be on most of the time in the first 2 weeks
  • From 2-6 weeks, you can wean out of the sling gradually using it less and less each day. You do not need to use your sling at night/sleeping
  • From 6 weeks, you should not need to use your sling at all

Return to Activity

  • Work: Depends what you do. Desk based work can be done from 2 weeks post operatively, if you can do these tasks single handedly. Otherwise generally 6 weeks before you can use both hands freely whilst seated.
    For manual work, it depends on what kind of lifting/pushing you do, but generally not before 3 months
  • Drive: In Australia, you can’t drive unless you are in full control of both your arms. Therefore, whilst you’re in a sling, you cannot drive. Generally 6 weeks post operatively.
  • Sports/Hobbies:
    • Gentle swimming: after 6 weeks
    • Gardening (light tasks only): 8-12 weeks
    • Bowls: after 3 months
    • Golf, tennis, badminton, squash: after 4-6 months
    • Weights: commence after 3 months

Concerns or questions?

If you have any concerns post operatively, or you would like further information, please contact Mr Lau through the VBJS on 03 5752 5020 or via email at admin@vbjs.com.au

If you need urgent medical help, call 000 or go to your nearest emergency department.

Patient information

These notes have been prepared by Mr Simon Lau. They are general overviews and information aimed for use by his patients. They reflect Mr Lau’s views, opinions and recommendations. They do not constitute medical advice. The contents are provided for information and education purposes only. Please seek Mr Lau’s specific advice with any questions regarding medical conditions and treatment.

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Carpal Tunnel Release