Postoperative dressing.
3 - 7 days:
The postoperative dressing is removed.
(3 days for single procedure-MCP arthroplasties only)
(6-8 days for multiple procedures)
The wound is inspected for edema and drainage.
A light dressing and edema control measures are applied as needed.
The patient is fitted for a CPM splint.
The hand is positioned as follows:
Wrist:15 degrees of dorsiflexion
DIP and PIP are fitted with gutter splints in full extension.
Parameters for the CPM range are set to maintain:
70 degrees of flexion and 0 degrees of extension.
CPM is worn continuously for 7 hours each day.
Gutter splints are applied to any fusions for continual wear.
A Resting Pan splint is fabricated to be worn at night as follows:
The digits are placed in full extension.
The MCP joints are held in neutral to slight radial deviation.
A Supinator is applied to the index finger.
NOTE:
Prior to discharge from the hospital, Joint Protection principles are reviewed. The need for adaptive equipment may also be assessed at this time.
2 weeks:
CPM is discontinued.
Day:
A Rheumatoid splint is fabricated for continual wear.
The hand is positioned as follows:
Wrist: 15 degrees of dorsiflexion
MCP: 0 degrees of extension and neutral alignment using MCP slings.
The slings are set up to approximately 60 degrees of radial pull from the outrigger. A Supinator Outrigger splint is worn on the index finger between exercises to protect the RCL repair.
Gutter splints are applied to any fusions for continual wear.
Active Range of Motion exercises are initiated 15 min/hr. with the MCP slings on.
Passive Range of Motion exercises are performed 2 x/day as outlined by the therapist.
Night:
1) IF Ring/small passive MCP flexion is equal to or is greater than 75 degrees:
A Resting Pan splint is fabricated to be worn at night as follows:
The digits are placed in full extension. The MCP joints are held in neutral to slight radial deviation. A Supinator is applied to the index finger.
2) IF Ring/small passive MCP flexion is less than 75 degrees: Dynamic MCP Flexion splint
4 weeks:
Light prehension activities are permitted outside of the R. A. splint.
No writing
6 weeks:
If MCP Extensor lag is less than 30 degrees and there is no ulnar drift:
The R. A. splint may be discontinued.
The Resting Pan splint is continued at night.
10-12 weeks:
Soft putty and other gentle resistive exercises may be initiated.
Writing is permitted
6 mo. - 1 yr:
The Resting Pan splint may be discontinued.