Phases of Rehabilitation:

Acute/Protection Phase (0-4/6 weeks):

• Immobilization: A thumb spica splint or cast is typically used to immobilize the thumb and wrist. This protects the healing ligament and reduces stress.
• RICE Protocol: Rest, Ice, Compression, and Elevation to reduce pain and swelling.
• Pain and Swelling Management: Modalities like ice, gentle compression, and elevation.
• Gentle Passive Range of Motion (PROM): For joints not immobilized (e.g., fingers not in the splint, wrist if possible) to prevent stiffness.
• Patient Education: Instructions on wearing the splint, activity modification, and protecting the thumb from further injury.

Early Motion/Mobilization Phase (around 4-8 weeks, depending on injury and surgery):

• Removal of immobilization (or reduction in wear time): Under therapist guidance.
• Gentle Active Range of Motion (AROM):
  • Thumb movements: Gentle flexion and extension of the thumb MCP and IP (interphalangeal) joints, adduction and abduction (moving thumb away from/towards palm), and opposition (touching thumb to fingertips).
  • Wrist and Finger Movements: Continue full range of motion for adjacent joints to prevent stiffness.
• Scar Management (Post-Surgery): Gentle massage, silicone gel sheets, or other techniques to prevent excessive scar tissue formation and improve tissue mobility.
• Manual Therapy:
  • Gentle Joint Mobilizations: To restore accessory motion and reduce stiffness at the MCP joint and surrounding carpal bones if restricted.
  • Soft Tissue Mobilization: Around the injury site to address swelling and improve tissue texture.
• Proprioceptive Exercises: Early, gentle activities to re-educate the thumb’s position sense, often without resistance initially.

Strengthening and Functional Integration Phase (starting around 8-12 weeks):

• Progressive Strengthening:
  • Thumb Pinch Strength: Using therapy putty, soft balls, or resistance bands for exercises like:
    • Pinch strength (key pinch, tip pinch, tripod pinch).
    • Opposition exercises (touching thumb to each finger).
  • Grip Strength: Squeezing a soft ball or grip strength dynamometer.
  • Thumb Adduction and Abduction: Using light resistance (e.g., rubber bands around the thumb and fingers).
  • Forearm and Wrist Strengthening: To support overall hand function.
• Advanced Proprioceptive and Stability Exercises:
  • Activities challenging fine motor control and stability.
  • Weight-bearing through the hand (e.g., on a flat surface initially, progressing to uneven surfaces or light pushing activities).
• Functional Activities: Gradually reintroducing daily tasks that require thumb use:
  • Opening jars, turning keys, using tools.
  • Returning to sport-specific drills, ensuring proper technique and gradual load progression.

Return to Activity/Sport Phase (around 12+ weeks, can be longer for severe injuries):

• Sport-Specific Training: Mimicking movements required for the patient’s sport or occupation, with increasing intensity and resistance.
• Bracing/Taping: Use of protective taping or custom splints during sports or heavy activity to provide additional support.
• Injury Prevention Education: Proper techniques for holding sports equipment (e.g., ski poles), fall prevention strategies, and recognizing signs of re-injury.

Advanced Physiotherapy Techniques

• Instrument-Assisted Soft Tissue Mobilization (IASTM): Can be used in later stages to address persistent scar tissue or fascial restrictions around the MCP joint, improving tendon gliding and overall tissue mobility.
• Dry Needling: While less commonly the primary intervention for a UCL tear, it could be considered to address myofascial trigger points in surrounding muscles (e.g., in the forearm or hand) that might be contributing to pain or altered movement patterns. Its use directly on a healing ligament needs careful consideration and would only be done by highly experienced practitioners.
• Kinesiology Taping: Can provide gentle support, reduce swelling, and facilitate muscle activation or inhibition depending on the application. Useful during the transition from immobilization to active movement or for added support during sports.
• Neuromuscular Re-education: Specific exercises and drills to re-establish the brain’s control over the thumb muscles, focusing on proper movement patterns and coordination. This can involve visual feedback or biofeedback.