FPL REPAIR
THERAPY GUIDE

• Forearm based POP – wrist neutral/MCP flexed to 30° with IP @ 40° flexion
• To wear splint full time for 6/52
• Elevation 2/52 (longer if needed)
• Patient not to be discharged until seen by hand physiotherapist or if Bank Holiday then referred to Hand Physio next working day with daytime telephone number
• OPA next Hand Clinic
• 48 hours        POP and wound check
• Splint.  Wrist neutral / MCP 30° flexion,  IP in 40° flexion.  No velcro  across thumb

EXERCISES – every hour in splint
Weeks 1-3

• Passive flexion of thumb into palm x10
• Passive full flexion of thumb then Isomentric hold for 5 seconds.  Active extension to splint level
• Active flexion/extension of other digits x 10
• Stitches out 10 days
• Scar massage (once wound healed) – 10 minutes every hour using hand cream
• Shoulder and elbow exercises.  Scapulothoracic exercises

Look out for:

• Infection – if concerned, send to GP/SHO for AB’s ASAP
• Rupture – always test tendon each session to ensure still intact.  Weakest time around 10 days
• If IPJ is developing FFD then stretch with wrist and MP in full flexion

Weeks 3 – 6

• Continue all exercises
• Commence active flexion of thumb into palm x5 every hour (once hand warmed up following other exercises)
   

Weeks 6 – 8

• Splint is straightened
• Wean off splint but continue to wear at night for another 2 weeks and ‘at risk’ times
• Begin to stretch wrist backwards
• Commence light strengthening

Avoid

• Pushing hard against objects e.g., pushing doors open, getting out of the bath, pushing out of a chair
• No lifting anything heavier than a bag of sugar
• Do not drive yet

Weeks 8 – 12

• Can start light duties for short periods e.g., writing, light housework, using a keyboard
• Can drive at 10 weeks.  It is up to the patient to make sure he/she is safe to do so.  If it is his left hand, make sure that his thumb is strong enough to manage the button on the handbrake.
• Upper limb strengthening

Avoid

• Contact sports
• Lifting anything heavier than 6 lbs
• Static flexed postures for long periods e.g., writing, driving

Weeks 12 +
If FFD still a problem then use dynamic extension splint (armchair/Capener)
Return to heavy work and contact sports.  Be careful if patient does extreme sports such as climbing – may need longer rehab/strengthening