The postoperative cast remains on for 1 month. When the cast is removed, the patient is referred to the hand therapist, who provides a customized, thermoplastic, long opponens splint. The splint is worn for protection and removed for exercise. The patient works on active and active-assisted range of motion of the wrist and thumb CMC, MP, and interphalangeal (IP) joints. Palmar abduction of the thumb is begun first, followed by radial abduction. The patient is instructed to move from a position of palmar abduction to radial abduction

Fig. 6. One half of the FCR tendon is divided proxi-mally and the 0-prolene suture is used to split the tendon longitudinally by pulling it firmly from proximal to distal.
Fig. 8. The FCR tendon slip is drawn through the hole in the thumb metacarpal base from volar to dorsal using the previously placed wire. The tension is set on the reconstruction and the FCR is sutured to the adjacent periosteum with a 3-0 braided synthetic suture.
Fig. 9. The FCR tendon slip is passed deep to the APL tendon to which it is sutured.

and then relax. Opposition of the thumb to the index and long fingers is encouraged during the first 2 weeks out of plaster, avoiding opposition to the ring and small fingers so as to not stress the reconstructed ligament. Patients massage the scar several times per day. Gentle tip-to-tip pinch is begun to work on dexterity.

Opposition to the ring and small fingers is begun 2 weeks after cast removal. At this point, thumb flexion is increased by flexing from the tip to the base of the index and long fingers, followed by flexion along the ring and small fingers to the base during the next 2 weeks. During this same period, 2 weeks after cast removal, the patient exercises to maximize abduction.

Strengthening is initiated 1 month after cast removal. Tip-to-tip, key pinch, and grip strengthening are begun with minimal resistance putty and progressively increased. Patients are allowed essentially unrestricted activity 3 months postoperatively.

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