What work restrictions should a patient follow after extensor pollicis longus (EPL) tendon repair?

Work Restrictions After EPL Tendon Repair

Patients should avoid all manual labor and repetitive gripping activities for the first 8 weeks after EPL repair, with gradual return to light-duty work at 8-12 weeks and unrestricted work activities only after demonstrating adequate strength restoration at 3-6 months postoperatively.

Immediate Postoperative Period (0-2 Weeks)

• Complete work restriction is mandatory for any job requiring hand use during the first 2 weeks while the surgical repair is most vulnerable 1
• Desk work with minimal keyboard use may be permitted if the operative hand can remain completely protected in a splint without any functional demands 1
• The thumb must be immobilized in a protective splint that controls metacarpophalangeal joint movements during this critical healing phase 1

Early Protection Phase (Weeks 2-8)

• No manual labor, lifting, gripping, or repetitive hand activities should be performed during this period as the tendon repair remains at significant risk for rupture 1
• Sedentary office work may be resumed if it does not require use of the operative hand for typing, writing, or object manipulation 1
• Jobs requiring bilateral hand coordination or any forceful thumb extension must be completely avoided 1, 2
• Dynamic splinting protocols allow controlled motion but do not permit functional work activities 1

Progressive Return Phase (Weeks 8-12)

• Light-duty work modifications can begin at 8 weeks if the patient demonstrates pain-free active thumb extension without lag 1, 2
• Activities should be limited to those requiring minimal grip strength (less than 5 pounds of force) and no repetitive thumb extension 2
• Jobs involving computer work, light assembly, or administrative tasks may be appropriate with continued splint protection during non-work hours 1
• Avoid any work requiring forceful pinch, power grip, or sustained thumb extension as these activities can overload the healing repair 1, 2

Return to Unrestricted Work (3-6 Months)

• Full return to manual labor and unrestricted work activities should not occur before 3 months postoperatively, even in patients with excellent early recovery 2, 3
• Objective criteria must be met before clearing for unrestricted work: total active motion achieving at least 85-90% of the contralateral thumb, absence of pain with resisted thumb extension, and no extensor lag at the interphalangeal or metacarpophalangeal joints 1, 2, 3
• Heavy manual labor, construction work, or jobs requiring repetitive forceful gripping typically require 4-6 months before safe return 2, 3
• The mean time to return to previous employment in one series was approximately 6.8 months, with 97% of patients ultimately able to resume their prior work 2

Occupation-Specific Considerations

• Surgeons, musicians, and workers requiring independent index finger extension may have different functional demands that affect work restrictions, particularly if extensor indicis proprius transfer was performed rather than direct repair 4
• Jobs requiring precision pinch (assembly work, dental hygienists, jewelers) need careful assessment of interphalangeal joint flexion recovery, as loss of this motion causes significant functional impairment 1
• Dominant hand injuries are associated with longer duration to return to work and may require extended light-duty modifications 5

Critical Monitoring Points

• Progression should be based on objective functional criteria rather than arbitrary timelines 5, 6
• Any increase in pain, swelling, warmth, or loss of previously achieved motion requires immediate work cessation and surgical consultation 5, 6
• Development of extensor lag during the return-to-work phase indicates the repair is being overloaded and work restrictions must be reimposed 1
• Scar tethering causing loss of thumb flexion is more functionally problematic than mild extension deficits and may require extended work modifications 1

Common Pitfalls to Avoid

• Premature return to work based on pain-free status alone is dangerous, as absence of pain does not indicate adequate tendon healing strength for occupational demands 5
• Allowing patients to "try" their regular job duties before meeting objective strength criteria risks repair rupture 1, 2
• Underestimating the functional demands of seemingly "light" jobs that involve repetitive thumb extension (computer mouse use, smartphone operation) 1
• Failing to provide specific written work restrictions to employers, leading to inadvertent overuse during the healing period 1, 2