KEMBLE WANG - Upper Limb & Trauma Surgeon
MBBS (Hons), FRACS, FAOrthA
Thumb EI to EPL tendon transfer
You have ruptured the long extensor tendon to your thumb (Extensor Pollicis Longus). You have had an operation to move one of the extensor tendons from your index finger to the remains of the thumb tendon. The transferred tendon has been strongly repaired but it will take at least 6 weeks for your tendons to heal together and at least 12 weeks until the repair is strong enough for you to return to unlimited activities. Progress from this injury varies from person to person and you must be guided by your therapist. This page provides a guide for an average rehabilitation regime. You will have a removable splint made to fit you by your hand therapist when you first see them in clinic. This replaces the plaster splint applied in theatre. This splint protects the healing tendon of your finger. Pay close attention to how the splint is applied, attention to detail makes all the difference to the final results.
Your tendon repair requires splinting ALL the time for the first 4 weeks after your surgery. Every two hours during the day you should practice these exercises:
1. Keep your hand in the splint and remove the thumb and hand straps only. Lift the thumb off the splint with your other hand, as shown. Keep the thumb of the injured hand straight at all times. Hold the thumb up for 20 seconds and then place it back on the splint. Repeat 10 times
2. Now lift the thumb off the splint by itself, as shown. Keep the thumb straight at all times. Hold the thumb up for 5 seconds and then relax it back onto the splint. Repeat 10 times
3. Keep your wrist lifted up and support around the middle of the thumb with your other hand. Bend and straighten the end joint of the thumb. Repeat 10 times
4. Keep your wrist lifted up and support around the base of the thumb with your other hand. Bend and straighten the end two joints of the thumb, as shown. Repeat 10 times
Other General Advice for the first 4 weeks:
keep your arm/hand elevated to minimise swelling, for at least the first 2 weeks after your surgery. Elevate your hand using a pillow at night and for periods during the day instead of wearing a sling for too long, as this will cause shoulder and neck stiffness.
Wear your splints as prescribed.
Follow the therapist recommendations.
Keep all your uninjured joints moving, including your shoulder, elbow and the fingers of your injured hand.
Massage your scar (once healed) with moisturiser as demonstrated by your therapist
Contact your therapist if your splint or straps break for it to be mended
Don’t leave your hand out of the splints.
Don’t try to push hard against the splints when completing exercises.
Don’t try to make a full fist
Don’t use your injured hand to grip objects
Don’t drive until you have discussed this with your therapist
Your repair is healing and becoming stronger but still requires protection to avoid the weak healing tissue stretching. You may now begin to remove your splint for periods of exercise and light activities during the day. Light activities include turning pages, eating, folding light laundry, tying a shoe, buttoning and typing. Ask your Hand Therapist when you may begin specific activities if you are in doubt to avoid over doing it and undoing all your hard work. Continue to wear the splint at night. The following exercises should be done 10 times a day, every 2 hours. The effort you put into your rehabilitation is significantly related to the end result obtained from your repaired tendon
Place the back of your hand on the table, straighten your thumb away from the side of your index finger, back keeping it on the table. Now bring your thumb up so that it is pointing towards the ceiling, repeat this 10 times
Now put your elbow on the table and lift up your hand to do the next set of exercises. Touch the tip of the injured thumb to the tip of each finger in turn and then straighten out the thumb. Repeat this 10 times.
Move the thumb to the base of the little finger and then straighten it out. Do not force this movement with your other hand. Repeat this 10 times.
Bend and straighten your wrist. Do not force this movement with your other hand. Repeat this 10 times.
If you have managed all the previous stages you may now discard the splint.
Start to increase the use of your hand to performing moderate activities e.g. opening doors, holding a glass and washing-up.
If you are able to make a full fist at this stage, you are able to start driving. If you are unsure then check first with your physiotherapist.
You should now gradually progress your activities, working on increasing your strength and function towards full activities at 12 weeks.