When associated with flexor tendon repairs, follow the protocol for flexor tendon repairs. This Protocol is for major nerve injury not associated with flexor tendon repairs.
3 weeks:
The postoperative dressing is removed.
Edema control is applied as needed.
A neutral wrist splint is constructed with the following splint components:
Median: thumb spica to maintain first web space.
Ulnar: anti-claw index through small fingers.
6 weeks:
Active and Passive Range of Motion wrist exercises are initiated to the digits each hour within the splint.
The patient is instructed in precautions for anesthetic digits. These precautions are repeated numerous times over the course of their care, especially if they are smokers or alcohol abusers.
Active and Passive Range of Motion wrist exercises are initiated.
Strength maintenance exercises of antagonist muscles are initiated.
Gentle strengthening is initiated.
NOTE:
When paresthesias to percussion are noted in the distal sensory distribution, begin desensitization in those areas. When this progresses out to the fingertips, begin sensory reeducation.
Hand splint components are maintained until normal motion returns or tendon transfers are performed.