Metacarpophalangeal Joint (MCPJ) Replacement – Splint & Exercises

Splints

You will be provided with two forearm-based splints.  One will keep your fingers straight and the other will place them in a bent position. You will alternate these splints daily as guided by your physiotherapist on the day of your first appointment.

You should always wear your splints, removing only for exercise and hygiene purposes in the first 4 weeks following the operation. Your physiotherapist will inform you when you can start to wean from using your splints although you will need to wear them longer for going outdoors and when in bed.

It is important that your splint feels comfortable. If any of the following symptoms occur, please contact your physiotherapist.

Pain | increased swelling | changes in sensation | changes in hand colour or temperature | skin redness | any pressure areas or rubbing

Exercises

Following your surgery your hand will be stiff and swollen. It is important to exercise to improve the range of movement and function. You will be guided through an exercise programme by your physiotherapist.  Please continue to move other joints in the arm which are not affected by the surgery.

The following exercises should be completed every 1 to 2 hours throughout the day, 10 repetitions each.

Weeks 2 – 4

Start with straight fingers. 

Then bend at your knuckle joints while keeping your fingers straight.

Only move as pain allows.

Do not force the movement. 

Start with straight fingers. 

Keep your knuckle joints straight, bend at the joints of the fingers.

Try to make a hook with your fingers, then straighten. 

Rest your palm on a flat surface. 

Slide your thumb away from your palm.

Walk your fingers one at a time towards your thumb.

Do not walk your fingers towards your little finger. 

Bend and straighten your wrist.

Rest the hand over the edge of a table. 

Use your other hand to straighten one finger at a time to a comfortable position.

Try to hold your finger in this position, on their own for 3 – 5 secs. 

You can progress to doing all fingers together. 

Progression: 

Rest the hand over the edge of a table. 

Have your knuckles supported on a table.

Try to straighten your fingers on their own.

Weeks 4 – 6

You will be guided by your physiotherapist as to when you can start removing the splint during the day for light activities. This is usually around 4 – 6 weeks from surgery. Continue to wear the splint at night time and when going out in crowded places until advised.

Light activities include:

• Handling money and light clothing
• Reading a newspaper
• Writing for short periods
• Self-care i.e.: showering/brushing teeth
• Avoid using your hand for heavy activities like lifting shopping bags, household items.

Continue with the above exercises. Exercises can be progressed as below.

Passive flexion MCPJs 

You can start to do gentle passive flexion at the MCPJ (knuckle) joints. Hold for a few seconds and then repeat.  

Pure pinch 

Be guided by your physiotherapist with this exercise. You will need to start to learn to use your fingers in a correct precision grip.  Start with a tip-to-tip pinch between your fingers.  

Making a fist

You can start to make a fist from 6 weeks post-surgery. Be guided by your physiotherapist. 

Start with straight fingers. Bend into a fist and then straighten again.

Weeks 6 – 12

Your therapist will guide you when you can stop using your splints during the day. The night splint will be worn until 12 weeks post-surgery.

You will continue to improve your function, movement and strengthening exercises of the hand and fingers.  You should avoid any heavy lifting until at least 12 weeks after your operation.

Lateral pinch can be started from 12 weeks post-surgery.

Lateral pinch  

Be guided by your physiotherapist with this exercise.    

Only start this exercise FROM 12 weeks. This is so you do not stress the joint replacements into a position of deformity.

General Instructions

• Continue to keep your arm elevated to reduce swelling.
• Complete scar massage once your wound has fully healed. You can use non-perfumed moisturising cream such as E45, aqueous or Vaseline.
• You will not be able to use your hand for the first 4 weeks. After that when instructed by your therapist, you will be able to start using your hand for light activities.
• Do not pinch with your operated finger until 6 weeks.  No lateral pinch for 12 weeks.
• No heavy activity/contact sport for 12 weeks.

How can I look after my joint replacements?

• Be guided by your pain
• Distribute weight over as many joints as possible when using your hand for function.
• Avoid positions which may stress your joints. For instance, avoid
  • Pushing down on your knuckles
  • Activities which push the fingers towards the little finger side of the hand i.e.: picking up a mug using one or two fingers only
  • Lifting objects with your wrist bent forward
  • Avoid gripping objects tightly

Telephone number

Should you have any concerns or issues regarding this information or exercises, please contact the physiotherapy department on 0191 445 2320 during the hours of 08:00 – 16:30 and ask to speak to the upper limb physiotherapist or a member of the team.

Data Protection

Any personal information is kept confidential. There may be occasions where your information needs to be shared with other care professionals to ensure you receive the best care possible.

In order to assist us to improve the services available, your information may be used for clinical audit, research, teaching and anonymised for National NHS Reviews and Statistics.

Further information is available via Gateshead Health NHS Foundation Trust website or by contacting the Data Protection Officer by telephone on 0191 445 8418 or by email [email protected].