EI to EPL Transfer
Download this rehabilitation protocol (PDF)
For patients and physiotherapists.
Day 5-7
Suggested treatment:
- Wound review and oedema management
- Change to TPS – forearm based
- Wrist 30 deg extension
- Thumb IPJ/MCPJ in extension
- Thumb – midway between radial and palmar abduction
- Commence controlled active mobilisation
- Wrist in extension and 1st CMCJ held still – thumb opposition to index fingertip, leading with IPJ flexion to form a ‘circle’ then extend thumb
- Hand flat on table – passive thumb abduction à active thumb abduction
- Function: light ADLs in splint ok
Restrictions:
- Wear splint at all times, except when completing HEP
- No driving
Day 14-21
Suggested treatment:
- Continue with splint, unchanged
- Progress to thumb opposition to index and middle fingertips leading with IPJ flexion; then thumb extension
- Continue passive thumb abduction/active thumb adduction
Week 3-5
Suggested treatment:
- Continue splint unchanged
- Continue opposition to index and middle fingertips
- Progress opposition towards volar PIPJ of index and (if able) middle finger
- Passive thumb abduction: hold 5 seconds then active thumb adduction
- Scar massage ongoing
Restrictions:
- No heavy lifting or resistance
Week 5-6
Suggested treatment:
- Continue splint unchanged
- Commence tenodesis style exercises – wrist extension with finger/thumb flexion, moving to finger/thumb extension with wrist in neutral
- Progress thumb opposition to index, middle and ring fingertips
- Progress opposition towards volar PIPJ of index, middle and ring fingers
Week 6-8
Suggested treatment:
- wear splint for sleep and heavy ADLs; otherwise wean and can cease splint by week 8
- Continue tenodesis exercises
- Progress to graded strengthening
Restrictions:
- Can return to driving once splint weaned between 6-8 weeks
- Continue to use splint for sleep and heavy ADLs initially
Week 9-12
Suggested treatment:
- No splint
- Progress strengthening program and use of ADLs
- Return to manual work between wk 10-12
Some General Questions
What to expect after surgery:
- Most patients will have day surgery only (or at most one overnight stay)
- After your operation, 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.
- You will have arrangements made for hand therapy prior to discharge. It is important to be seen within 3-4 days of surgery as early hand therapy is vital to your rehabilitation
- You will be sent home with medications or a script to help with pain relief
Time in Sling:
- Generally your sling is for comfort only
- You will have a plaster splint on discharge but this will be converted to a thermoplastic splint within the first few days by your hand therapist.
- From 6-8 weeks, you should not need to use your splint at all
Return to Activity
- Work: Depends what you do. Desk based work can be done from 1-2 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 or have a splint on, 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.
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.