Midcarpal Fusion Rehabilitation Protocol

10‐14 Days Postoperative

  • The post-operative splint and sutures are removed
  • The wrist is placed into a removable splint that should be worn most of the time and removed for therapy and for hygiene
  • Continue anti‐edema management. This includes, but not limited to, self‐retrograde massage, cold therapy, and extremity elevation
  • Encourage full finger ROM. Patient should be able to form a fist. Goal is to achieve full finger ROM by 2-3 weeks post op
    • Passive and active-assisted ROM can be performed to encourage full finger ROM
  • Initiate active and gentle passive ROM to wrist (Composite wrist/digit extension/flexion should be avoided to prevent stretching of extrinsic muscles.)

6-8 Weeks Post Op

  • Weighted wrist stretches initiated to regain passive ROM to wrist
  • Begin isometric strengthening exercises
  • Forceful manipulation and joint mobilization are NOT appropriate
  • Neoprene wrist wrap may be worn for comfort
  • X-ray will be performed to assess midcarpal fusion
  • Do NOT force the range of motion. Forcing the range of motion or moving the wrist beyond the limitation could cause the hardware to become loose or break.

8-12 Weeks Post Op

  • Removable splint may be discontinued and worn only as needed
  • Gentle strengthening exercises initiated with putty, hand exerciser, or hand weights, followed by job simulations
  • X-rays at 12 weeks to confirm midcarpal fusion in order to release the patient to full strengthening and full activities with no restrictions
  • The patient may begin full active and passive range of motion exercises of the wrist

4-6 Months Post Op

  • Most patients should be back to work after 2-3 months
  • Heavy labor jobs may require up to 6 months.  Follow up with doctor on a PRN basis.
  • Considerations: Expect some weakness; grip and strength averages about 50-80% of the contra-lateral side. Usually it takes up to a year to regain best strength. Expect ~50% of wrist flexion and/or extension loss. Attempting to achieve full wrist ROM can create instability and ultimately increase risk of future wrist pathology
  • The healing process can take up to a full year. Therefore, it is advised to continue with the home exercise program until goals have been met. 

Note: These instructions are to serve as guidelines and are subject to Physician discretion.  Actual progress may be faster or slower depending on the individual