Microsurgery: Transplantation and Replantation by Harry J. Buncke, MD, et al.
  Table of Contents / Chapter 42:
Hand Therapy
 
  Active and passive range of motion of uninvolved digits can be started.

FIG. 42-13. Dorsal protective splint for digital replantation. Dorsal view.


FIG. 42-14. Dorsal protective splint for digital replantation. Palmar view.


DAY 10 TO 14

Continue EPM I. Begin passive early protective motion II (EPM III. Motion is initiated to IP joints that are free of fixation as follows:

I. Claw position (intrinsic minus position)
   A. Wrist in neutral
   B. MP joints extended to neutral
   C. IP joints flexed up to 60 at the PIP joint.


To prevent attenuation of the extensor mechanism, PIP joint flexion is limited to 60 degrees and DIP motion is minimal.

II. Table top (intrinsic plus position).
   A. Wrist in neutral
   B. MP joints are flexed
   C. IP joints are extended


Begin gentle active holds in intrinsic plus position.

DAY 14 T0 21

Begin active EPM II within the guidelines outlined for passive EPM II.

 

3 TO 4 WEEKS

Continue EPM I and EPM II through 5 weeks. Begin scar massage. In cases of extreme edema, light Coban wrap and/or retrograde massage may be initiated.

4 TO 5 WEEKS

Gradual active and passive wrist extension past neutral is started and continued as tolerated. May begin functional electrical stimulation (FES). May begin light Coban wrap and/or retrograde massage.

5 TO 6 WEEKS

Begin composite wrist and finger flexion and extension, passive and active. Begin dynamic splinting as indicated if fractures are stable. Begin blocking exercises to isolate joint motion. Begin differential tendon gliding exercises. Begin static volar extension pan splinting at night when indicated. Begin supervised light functional activities (sponges, pegs). Begin pulsed ultrasound to sensate areas if adhesions are present.

6 TO 8 WEEKS

Discontinue use of protective splint. Continue light functional activities.

8 WEEKS

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