DAY 7 TO 14

Depending on when vascular status has stabilized and anticoagulant therapy has been discontinued, begin passive range of motion to wrist, fingers, and thumb.

DAY 14 TO 21

Begin active assisted and passive range of motion to shoulder, avoiding stress to any open wounds or repair sites. All shoulder motion should be approved by the physician.

3 WEEKS

Begin active range of motion to wrist, fingers, and thumb. Begin passive and active elbow motion if joint is free from fixation. All motion must be cleared by the physician. Gains should be gradual and may be restricted to 5 degrees per session to prevent stress on repairs that cross this joint. Edema reduction is often the primary goal at this stage; begin Coban wrap and retrograde massage to fingers and hand. Provide sling or fabricate arm support to prevent dependent position during ambulation.

4 WEEKS

Begin splinting to prevent flexion or extension deformities. Begin dynamic splinting to improve passive range of motion of hand as needed.

5 TO 6 WEEKS

Ultrasound to sensate areas if adhesions or joint restrictions are present. Begin functional activities.

6 TO 8 WEEKS

Discontinue use of protective splint. Initiate elastomero to form scar pads. As nerve regeneration occurs, therapist can initiate functional electrical stimulation to strengthen weak muscles. Begin progressive resistive exercise to weak muscles.

8 WEEKS

Goal from 8 weeks on is to maintain range of motion and maintain and improve strength of existing musculature as nerve regeneration occurs.

PROTOCOL V: GREAT TOE-TO-THUMB TRANSFER

Immediately postoperatively, elevate the upper and lower extremities. Use a heating pad to keep the upper extremity warm.

DAY 4 TO 10

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