Nasser Hyder - Orthopaedic Hand, Wrist and Trauma Surgeon Your Practice Online
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After Care and Therapy

EIP to EPL Transfer

This is an operation which is done if the extensor tendon of the thumb is torn or ruptured. The tendon ends are usually far apart and direct repair is difficult and leads to tightening of the tendon. It is therefore best that an adjacent tendon of the index finger (a spare) which is easily available is redirected to function as the extensor tendon of the thumb.  It does not affect the movements of the index finger. As with many hand surgery the after care and therapy are essential part of the treatment to achieve the desired results.

The operation is usually done as a day case procedure under general anaesthesia or a nerve block where only the arm is frozen. On discharge your hand and wrist will be in a plaster cast. You will be asked to keep the arm elevated in a sling to minimise swelling. You are likely to require some pain killers for a few days.

0 – 3 Weeks

You will be seen in the OT (Occupational Therapy) department within a week of discharge. The plaster cast will be removed and a splint will be made for your wrist. This splint will be a volar splint extending from below the elbow to the MCPJ of fingers and IPJ of the thumb. This will be designed to keep your wrist at 30 degrees of extension and the thumb abducted (away from palm) to 30 degrees and IP joint fully extended. Active extension and flexion and some passive stretching of the thumb will commence within the splint. You will be seen in the clinic at 2 weeks for wound check and removal of stitches.

The splint must be worn at all times.

3 – 6 Weeks

From 3 weeks on wards splint can be taken off during therapy sessions to allow some wrist exercises. Active exercise and passive stretching of the thumb will continue as before. It may be necessary to massage scar with E45 or even use silicone gel if scar is sensitive and tender.

6 – 12 Weeks

At 6 weeks the splint is discarded and active and resisted exercises are commenced. With continued use and exercise, the range of thumb movement will continue to improve for 12 months.

 

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Hand & Wrist Elbow After Care and Therapy