Flexor Pollicis Longus Tendon Repair Rehabilitation
Date issued: November 2024
For review: November 2026
Ref: C-585/AH/Occupational Therapy/Flexor Pollicis Longus Tendon Repair Rehabilitation v2
PDF: Flexor Pollicis Longus Tendon Repair Rehabilitation[pdf] 552KB
Introduction
You have had the tendon that bends your thumb repaired. This will need to be protected in a splint. It will take several months to regain your movement and strength.
Post operative wound care:
Routinely the wound is closed with sutures (stitches) these need to be in place for 14 days. It is important to keep the wound clean and dry until your sutures are removed. This helps to reduce the risk of infection.
Swelling management:
Reducing the swelling allows for better movement and improves post operative outcomes. Following your operation you will be given a sling to wear. It is important to wear the sling during the day until your first appointment. If the sling becomes uncomfortable to wear you can place your hand against your chest, so it is higher than your heart. At rest or at night it can be elevated on pillows. Please remove the sling at least every 2 hours and move your shoulder and elbow. This will prevent you developing any stiffness in these joints.
Hand Hygiene:
When advised by your clinician
- To wash your arm/hand, place your forearm on the draining board/table, remove the splint keeping the wrist in a relaxed position and remember not to straighten your thumb.
- Using unperfumed soap or unperfumed wipes, wash the arm down (still with it supported on the draining board) from the elbow towards the fingers.
- Do not wash across any unhealed wounds unless advised by your therapist. Use wipes to clean between the fingers.
- Ensure the arm is dry before reapplying the splint.
- Do not extend the wrist.
- Shower wearing the splint (covered by a plastic bag/limbo) 6 weeks+
Scar Massage
Once your wound is healed you should spend at least 5 minutes 3-4 times a day performing scar massage while wearing your splint.
Use an unperfumed moisturiser to massage into the skin, rub firmly using circular movements up/down the scar. This will flatten the scars appearance, prevent sticking/adhesions and avoid any tightness.
Splinting:
Your therapist will make a splint for you to wear out of thermoplastic material. You will need to wear the splint 24 hours a day for the first 6 weeks. You will be able to remove the splint only for hygiene purposes. The tendon repair can be delicate in the first 6 weeks following the operation. The splint is designed to protect your tendon repair but also allow for guided movement and exercise. If your splint becomes uncomfortable or irritates the skin, please contact your therapist so it can be re-moulded or altered.
Within the first 6 weeks of having your operation remember ‘You can move the hand but not use it’
Exercises weeks 1-4
1. It is important to practise passively flexing the thumb fully. You can use the other hand to help bend your thumb as far as it’ll go. Repeat this 10 times every hour.
2. You can also start active flexion of the thumb as shown in the picture below. It’s important to initiate the movement from the tip of your thumb. Repeat this 10 times every hour.
Exercises from 4-6 weeks
The below exercises are specific exercises which promote the motion of tendons in the surrounding soft tissues. These exercises also help to reduce swelling in your hand.
Your therapist will advise you which specific exercises to do that are safe for your condition/injury and when to start them.
The following exercises are to be performed:…..….times a day.
Each movement is to be performed for:……repetitions.
Holding each position for:………..…seconds.
Exercise 1
Top joint of your thumb
1. Use your other hand to hold your thumb just below the top joint.
2. Bend down the top joint of your thumb.
3. Straighten your thumb.
Exercise 2
Knuckle joint of your thumb
Exercise 2
Bottom joint of thumb
1. Use your other hand to hold just below the knuckle joint of your thumb.
2. Bend down the knuckle joint of your thumb.
3. Straighten your thumb.
Exercise 3
Basal joint of your thumb
1. Rest the back of your hand on a table.
2. Raise your thumb above your index finger.
3. Move your thumb across the palm.
4. Move your thumb back to the starting position.
Exercise 4
Thumb extension
1. Rest the back of your hand on the table or place your palm on the table.
2. Move your thumb next to your index finger.
3. Straighten your thumb.
Exercise 5
Thumb opposition exercises
1. Move your thumb to touch the tip of your index finger, aiming to make a good “O” shape with the tip of your thumb and finger.
2. Repeat the same movement with your thumb and other fingers.
3. Proceed to touching the little finger if pain free.
Exercise 6
Flexion exercise
1. Move the thumb across the palm to touch the tip of ring or little finger if possible.
2. Gradually slide and bend your thumb down the finger to the palm.
Exercise 7
Thumb circumduction
1. Gently move your thumb in circular motion, both clockwise and anti-clockwise.
From 6 weeks:
You will have now discarded your splint during the day, and you can start to use your hand for light functional activities. We have outlined activities you may be able to resume post operatively below:
After 6-8 weeks: You may be able to resume using the operated hand for light functional activities for example using a keyboard, writing, washing and dressing.
After 8-10 weeks: You may be able to start doing heavier household tasks and driving.
After 10-12 weeks: You may be able to start some gym/sporting activities, heavier lifting and loading and manual work.
Exercises from 8 weeks:
You can now start to work on some gentle strengthening exercises. You could use a soft ball or putty and practise bending the thumb against the resistance of the ball. Repeat this 20-30 times 3 times daily.
